Croatian Association of Midwives32nd Symposium

Strengthening MidwiferyDéirdre Daly

President European Midwives Association

Lecturer in Midwifery University of Dublin Trinity College

Practising Midwife

EUROPEAN ASSOCIATION DES MIDWIVES SAGES-FEMMESASSOCIATION EUROPEENNES

Coombe Women and Infant’s University Hospital

University of Dublin Trinity College

Rotunda Hospital

EUROPEAN ASSOCIATION DES MIDWIVES SAGES-FEMMES ASSOCIATION EUROPEENNES

Croatian Association of Midwives32nd Symposium

Strengthening Midwifery

Presentation: 3 parts

1 Midwifery and midwifery education in Europe

2

Midwifery and midwifery education in Ireland

3

Midwifery and midwifery education in Croatia

1

Midwifery and midwifery education in Europe

The European Midwives Association (EMA) is a non-profit and non-governmental organisation of midwives, representing midwifery organisations and associations from the member states of the European Union (EU) and the European Economic

Area (EEA) and EU applicant countries

What EMA can do and what EMA can do for you…Provide a forum for European midwives to meet and discuss issues

concerning midwifery and women’s health

Members say that networking and making contacts with midwives from other countries is vital and beneficial for them

Promote minimum standards of midwifery education within the EU

Maintain a presence at venues affecting health policy and midwifery

EMA Educational Conference in Berlin, December 7-8, 2007

• DAY 1• Belfrage_Sweden.ppt  

Brumter-Coret EU.ppt Gomes_Marques_Portugal.pptSutter_Switzerland.pptPolleit_Austria.pptJanicke_Germany.pptLarsson_Sweden.pptMivsek_Slovenia.pptWittgenstein_Pehlke-Milde_Germany.pptvan_Huis_Netherlands.pptEichenberger_Switzerland.pptStudents_voices_Netherlands.pptStromerova_Czech_Republic.pptStudents_voices_Denmark.ppt

• DAY 2• Arthur_NMC_UK.ppt

Fleming_GCU_UK.pptClement_Belgium.ppt

• There were midwives from 26 countries registered for the conference which

– Provided a genuine opportunity for sharing information and learning from each other

– Established networks

EMA Educational Conference in Berlin, December 7 and 8, 2007

• DAY 1• Belfrage_Sweden.ppt  

Brumter-Coret EU.ppt Gomes_Marques_Portugal.pptSutter_Switzerland.pptPolleit_Austria.pptJanicke_Germany.pptLarsson_Sweden.pptMivsek_Slovenia.pptWittgenstein_Pehlke-Milde_Germany.pptvan_Huis_Netherlands.pptEichenberger_Switzerland.pptStudents_voices_Netherlands.pptStromerova_Czech_Republic.pptStudents_voices_Denmark.ppt

• DAY 2• Arthur_NMC_UK.ppt

Fleming_GCU_UK.pptClement_Belgium.ppt

• What did we learn about midwifery education in Europe from each country?

• Some examples• Sweden:

– Post nursing education with strong midwifery philosophy

– Highly developed post registration programmes

• Germany:– Midwifery education not yet at

university level

• Netherlands:– Strong midwifery philosophy

– Emphasis on birth at home and normality

– Well developed referral patterns

EMA Educational Conference in Berlin, December 7 and 8, 2007

• DAY 1• Belfrage_Sweden.ppt  

Brumter-Coret EU.ppt Gomes_Marques_Portugal.pptSutter_Switzerland.pptPolleit_Austria.pptJanicke_Germany.pptLarsson_Sweden.pptMivsek_Slovenia.pptWittgenstein_Pehlke-Milde_Germany.pptvan_Huis_Netherlands.pptEichenberger_Switzerland.pptStudents_voices_Netherlands.pptStromerova_Czech_Republic.pptStudents_voices_Denmark.ppt

• DAY 2• Arthur_NMC_UK.ppt

Fleming_GCU_UK.pptClement_Belgium.ppt

• What did we learn about midwifery education in Europe from each country?

• Belgium: – University level education

– Well developed international placements

• The Czech Republic:– A desire for change

Key issue:

Each country developed their education programme to suit their country-specific system.

EMA Educational Conference in Berlin, December 7 and 8, 2007

• DAY 1• Belfrage_Sweden.ppt  

Brumter-Coret EU.ppt Gomes_Marques_Portugal.pptSutter_Switzerland.pptPolleit_Austria.pptJanicke_Germany.pptLarsson_Sweden.pptMivsek_Slovenia.pptWittgenstein_Pehlke-Milde_Germany.ppt

van_Huis_Netherlands.pptEichenberger_Switzerland.pptStudents_voices_Netherlands.pptStromerova_Czech_Republic.pptStudents_voices_Denmark.ppt

• DAY 2• Arthur_NMC_UK.ppt

Fleming_GCU_UK.pptClement_Belgium.ppt

• What did we learn about midwifery education in Europe from each country?

• Duration of education differed: 3 vs 4 years– Structure of programmes differed– Assessment of theory and practice differed– Focus on competence– Re establishing practices– Variations in practices– Variations in legislative and regulatory

processes• Levels of education differed

– Certificate – Diploma (descriptive)– Degree (critical)– Masters (analytical)

• Opportunities varied greatly for ongoing education• Opportunities for international partnerships exist

at various levels (including practice placements)

Definition of the Midwife

“A midwife is a person who, having been regularly admitted to a midwifery educationalprogramme, duly recognised in the country in which it is located, has successfully

completed the prescribed course of studies in midwifery and has acquired the requisitequalifications to be registered and/or legally licensed to practise midwifery.

The midwife is recognised as a responsible and accountable professional who works inpartnership with women to give the necessary support, care and advice during pregnancy,

labour and the postpartum period, to conduct births on the midwife’s own responsibility andto provide care for the newborn and the infant. This care includes preventative measures,

the promotion of normal birth, the detection of complications in mother and child, theaccessing of medical care or other appropriate assistance and the carrying out of

emergency measures.The midwife has an important task in health counselling and education, not only for the

woman, but also within the family and the community. This work should involve antenataleducation and preparation for parenthood and may extend to women’s health, sexual or

reproductive health and child care.A midwife may practise in any setting including the home, community, hospitals, clinics or

health units.”

Adopted by the International Confederation of Midwives Council meeting, 19th July, 2005,Brisbane, Australia

Supersedes the ICM “Definition of the Midwife” 1972 and its amendments of 1990International Confederation of Midwives

EUROPEAN ASSOCIATION DES MIDWIVES SAGES-FEMMES ASSOCIATION EUROPEENNES

Croatian Association of Midwives32nd Symposium

Strengthening Midwifery

Presentation: part 2

1 Midwifery and midwifery education in Europe

Midwifery and

midwifery education

in Ireland

Midwifery education in Ireland:

Notable points in time

1973 1983 1996/1997 1998 2000 2006 2007

Ireland joined EEC

2 year midwifery educationBased in schools of midwifery (linked to hospitals)Students employees: salaried ‘care’ givers13 weeks theoryCertificate award

Affiliation to universitiesPostgraduate /Higher Diploma in Midwifery13 weeks theory

Theory increased

to 26 weeks

Diploma in Midwifery (Pilot programme)3 yearStudents; supernumerary status

BSc (Hons) Midwifery4 year programme

1 year programmeSeveral intakes per annumEmployee statusAd hoc lectures

Declining birth rateHospital closuresEmigration

Rising birth rateImmigration

2002: BSc (Hons) Nursing Degree

Higher Diploma in Midwifery18 month programme26 weeks theory

Awaiting implementation ofNurses and Midwives Act Recommended in 1998Expected 2009

Some statistics: birth numbers for the Republic of Ireland

• 1979 72,539• 1980 74,064• 1981 72158• 1989 52,018• 1994 48,255• 1996 50,655• 1997 52,775• 1998 53,969• 1999 53,354• 2000 54,239• 2001 57, 854• 2002 60, 503• 2003 61, 529• 2004 61, 972• 2005 61, 042• 2006 64, 262• 2007 69,000 (approximate)

» Source Central Statistics Agency (CSO)

Birth rate in Ireland

This affects issues nationally:

• Available human resources: (midwives)

• Recruitment and retention of midwives

• Staffing levels and ratios

1 Letterkenny Hospital2 Sligo General Hospital3 Mayo General Hospital4 Cavan General Hospital5 Our Lady of Lourdes Hospital Drogheda6 Mullingar General Hospital7 The Coombe Women’s Hospital8 The National Maternity Hospital9 The Rotunda Hospital10 Mount Carmel Maternity Hospital11 Ballinasloe Hospital12 University College Hospital Galway13 Portlaoise Hospital14 St Munchin’s Hospital Limerick15 St Luke’s Hospital Kilkenny16 Tralee General Hospital17 Clonmel Hospital18 Waterford Regional Hospital19 Wexford General Hospital20 St Finbarr’s Hospital21 Erinville Maternity Hospital22 Bon Secours Hospital

(20-22 ) Amalgamated in 2007 to form Cork Unified Maternity Hospital)

The organization of the maternity services in Ireland

Location of Self-employed Midwives

X

X

XX

X XX

X

X

X

X

X

X

X

X

Midwifery education in Ireland:

Higher education providers

University of Dublin Trinity College

University College Dublin

University of Limerick

University College Cork

University College Galway

Dundalk Institute of Technology

Women and Infant’s University Hospital

Rotunda Hospital

University of Dublin Trinity College

Midwifery education in Ireland 2008

– Two means of entry to midwifery

• Higher Diploma in Midwifery (post RGN)

• BSc (Hons) Midwifery

Women and Infant’s University Hospital

Rotunda Hospital

University of Dublin Trinity College

Higher Diploma in Midwifery

– 18 month programme (since September 2007) (40 students) (150 approx. per annum in Ireland)

– 26 weeks theory, 52 weeks practice– Theoretical content organized in modules– Practice content organized as placements of minimum of

4 weeks duration:– Antenatal– Intranatal – Postnatal

» Preceptorship process in place– Specialist placements (neonatal, high dependency unit, gynae)

– Students are paid employees (‘care’ givers and part of each hospital’s funded establishment)

Women and Infant’s University Hospital

Rotunda Hospital

University of Dublin Trinity College

Assessment strategy for H. Dip. in Midwifery (1)

– Theoretical assessment • Variety of assessments: • Progression point from part 1 to part 2• Presentation• Parent education presentation in practice• Written examinations (year 1 and 2)• Literature review• Essay

Women and Infant’s University Hospital

Rotunda Hospital

University of Dublin Trinity College

Assessment strategy for H. Dip. in Midwifery (2)

– Practice • (incorporates theoretical knowledge in the form of learning

objectives and the acquisition of evidence as part of assessment process)

– Preceptorship process (each student has a named midwife preceptor for the duration of each placement)

– Continuous assessment of practice• Tripartite arrangement in place (Student, Midwife and Lecturer)• Initial, midpoint and endpoint review

– Emergency skills assessment at end of programme

Women and Infant’s University Hospital

Rotunda Hospital

University of Dublin Trinity College

BSc (Hons) midwifery• 4 year programme• Commenced in 2006

– Previous pilot programme was 3 years duration at diploma level

– Much background work achieved at this point

– Site visits to UK

– Obtained several curricula from UK, NZ,

– Ongoing discussions at national level amongst midwife teachers = shared vision and philosophy

• Organized in modules• Students have supernumerary status• Entry requirements: leaving certificate students and a

percentage of mature students

Women and Infant’s University Hospital

Rotunda Hospital

University of Dublin Trinity College

BSc (Hons) midwifery

– (40 students per annum: 140 in Ireland per annum)Module overview• Core midwifery practice• Adaptation to pregnancy• Midwifery practice: unexpected outcomes 1, 2• Sociology• Lactation and Infant feeding• Health and health promotion• Pre existing pathophysiologies• Biology, psychology shared with nursing programme)• Research methods• Pre existing medical condition• Legal and Ethical issues• Pharmacology: principles 1; for midwifery practice 2.• Birth, motherhood and midwifery• Promoting and protecting normal birth• Delivery of a quality maternity service

– Organized over four years (theoretical content mainly delivered in 3 years)

Women and Infant’s University Hospital

Rotunda Hospital

University of Dublin Trinity College

BSc (Hons) midwifery– Year 1:

• Focus on physiology and normality and skill development

• In practice from week 3 of programme (1 day per week) with Lecturers in midwifery

• 12 weeks practice placements of 4 weeks duration in antenatal, labour and postnatal areas

Women and Infant’s University Hospital

Rotunda Hospital

University of Dublin Trinity College

BSc (Hons) Midwifery– Year 2:

• Modules begin to focus on pathophysiology, pharmacology, pre existing medical disorders etc.

• 2 practice placements in antenatal, labour or postnatal area and 1 medical/surgical placement in a general hospital

• Gynae and theatre placements (in maternity hospital)

Women and Infant’s University Hospital

Rotunda Hospital

University of Dublin Trinity College

BSc (Hons) Midwifery– Year 3:

• Modules include physiology, pathophysiology, pharmacology; research; legal and ethical issues; Birth, motherhood and midwifery; delivering a quality maternity service

• 12 weeks practice placements in antenatal, labour and postnatal areas

• Placement in community midwifery practice• Other placements include• High dependency unit, gynaecology, theatre,

Women and Infant’s University Hospital

Rotunda Hospital

University of Dublin Trinity College

BSc (Hons) Midwifery

– Year 4 is less theoretical than 1-3:• Student status changes • 34 weeks in practice ‘internship’: paid• Protected reflective time (4 hours per week)

Women and Infant’s University Hospital

Rotunda Hospital

University of Dublin Trinity College

BSc (Hons) Midwifery• Assessment strategy: theoretical component

– Each module is assessed and a variety of assessments are used

– Written examinations– Practice skills (In year 1 particularly)– Communication skills: (Simulated practice scenario given

and recorded on DVD with reflective essay by student)– MCQ examination (research, pharmacology)– Essays– Parent education presentation (in practice)– Participation in online discussion (legal and ethical issues)– Emergency skills assessment

Women and Infant’s University Hospital

Rotunda Hospital

University of Dublin Trinity College

BSc (Hons) midwifery

Assessment of practice: continuous• Each student has a named midwife preceptor for

each practice placement of 4 weeks duration» (incorporates theoretical knowledge in the

form of learning objectives and the compilation of evidence as part of assessment process)

• Tripartite arrangement (Student, Midwife, Lecturer)• Initial, midpoint and endpoint review

Women and Infant’s University Hospital

Rotunda Hospital

University of Dublin Trinity College

• Support structures for the programme• All Lecturers educated to master level• Clinical placement coordinators (for BSc (Hons) Midwifery programme. Ration 1: 15• Preceptorship programme (16 hours) for all midwives• Allocations officer (in College and in hospital)• Post registration clinical placement coordinators (for Higher diploma in midwifery

programme) (Hospital appointment)• Clinical tutors (for Higher Diploma programme) (University appointment) (3 year

contract)

• Various joint University and institution committees (curriculum and course) to oversee ongoing programme development

– Essential for the development of a partnership approach and shared ownership of programme delivery

• All programmes have external examiner verification• All programmes are scrutinized and approved by (i) regulatory authority

and (ii) university• External 5 year review process in place

Women and Infant’s University Hospital

Rotunda Hospital

University of Dublin Trinity College

Post registration education opportunities

– BMS (Bachelor in Midwifery Studies)• For midwives who have been educated at certificate level

– Master in Midwifery• Started 1996/1997

– Part shared with MSc Nursing – Includes and opportunity to take education pathway leading to registration as a

midwife teacher• Midwifery specific modules:

– Advancing the theoretical foundations of midwifery– Women centered maternity care– Situating midwifery in Ireland – Research– Dissertation– Legal and ethical issues

– PhD

– Ireland has no mandatory continuing education for midwives or nurses but many professional development issues are in place with 2 yearly updating expected

EUROPEAN ASSOCIATION DES MIDWIVES SAGES-FEMMES ASSOCIATION EUROPEENNES

Croatian Association of Midwives32nd Symposium

Strengthening Midwifery

Presentation: part 3

Midwifery and midwifery

education in Croatia

Strengthening Midwifery in Croatia• What aspects should be addressed?

– You have started the process• EU Directive 2005/36/EC (the framework)• Reports:

– Mutual recognition of qualifications for nurses and midwives Zagreb January 31st 2007

– Report midwifery seminar 26-27 April 2007

– How are the maternity services currently organized? • Organization of maternity services: culture of service and

philosophy of service

– All of this influences what you can achieve in the immediate future

EUROPEAN ASSOCIATION DES MIDWIVES SAGES-FEMMESASSOCIATION EUROPEENNES

Strengthening Midwifery in Croatia• What aspects should be addressed

– Legislation• What is currently in place?• What does it permit• What does it restrict?

• Establish relationships with key persons• Preparation of other health care professionals: who

are you allies?• Preparation (and involvement) of women

EUROPEAN ASSOCIATION DES MIDWIVES SAGES-FEMMESASSOCIATION EUROPEENNES

Strengthening Midwifery in Croatia• What aspects should be addressed

– Maternity services and midwifery management within these services

• What is the culture?• Who are the leaders?• Who influences and shapes service development?

– Management: » National » Local» Expectations from service» Current “Norms’

• Identify exemplary practice areas

– Develop a vision and philosophy for midwifery

EUROPEAN ASSOCIATION DES MIDWIVES SAGES-FEMMESASSOCIATION EUROPEENNES

Strengthening Midwifery in Croatia• Where are midwives educated and who

educated midwives? – Who controls midwifery education?– Midwife educators

• Where are they?• Level of education? Degree? Masters?• What opportunities are available to you to have midwife

educators ready to take control of midwifery education?

– How is education organized in practice?• What education do midwives need to be prepared for a new

model of midwifery education?

EUROPEAN ASSOCIATION DES MIDWIVES SAGES-FEMMESASSOCIATION EUROPEENNES

Strengthening Midwifery in Croatia• Midwifery curriculum• Basis in Directive 2005/36/EC

– Duration and basic content• Level of education

– What do you need? What type of education do you want?• Diploma? Degree?

• Plenty of examples from other countries– Access these and decide what best suits Croatia – what you can

achieve– Essential:

• Involvement of regulatory authority; who approves the curriculum?• Preparation of midwives in practice• Links and relationships with universities• Establishment of committees• Process of assuring quality and integrity of programme• Involvement of other stakeholders• Involvement of women

EUROPEAN ASSOCIATION DES MIDWIVES SAGES-FEMMESASSOCIATION EUROPEENNES

Strengthening Midwifery in Croatia– What aspects should be addressed?

• Maternity services and midwives– What services are available for practice?

» Hospital» Community

• Where can midwifery students gain experiences in order to meet directives?

– This will influence programme development

EUROPEAN ASSOCIATION DES MIDWIVES SAGES-FEMMESASSOCIATION EUROPEENNES

Midwifery in Croatia• Where to from here?

– Network and develop links with midwives and educators in other countries

– Use the resources already developed and adapt them to suit Croatia

– Establish relationships with key people– Establish relationships with other professionals– Involve women and women’s groups– Identify allies

– Change will happen…slowly – be patient

EUROPEAN ASSOCIATION DES MIDWIVES SAGES-FEMMESASSOCIATION EUROPEENNES

Croatian Association of Midwives32nd Symposium

Strengthening Midwifery

Thank you

EUROPEAN ASSOCIATION DES MIDWIVES SAGES-FEMMESASSOCIATION EUROPEENNES

Coombe Women and Infant’s University Hospital

University of Dublin Trinity College

Rotunda Hospital

The European Midwives Association (EMA) is a non-profit and non-governmental organisation of midwives, representing midwifery organisations and associations from the member states of the European Union (EU) and the European Economic

Area (EEA) and EU applicant countries

What EMA can do and what EMA can do for you…Provide a forum for European midwives to meet and discuss

issues concerning midwifery and women’s healthMembers say that networking and making contacts with midwives from other

countries is vital and beneficial for them

Promote minimum standards of midwifery education within the EU

Maintain a presence at venues affecting health policy and midwifery

www.europeanmidwives.org ema@knov.nl