Midwifery and the Nurse Practitioner

2005

The ACM acknowledges and respects that midwifery and nursing are distinct professions with different career pathways. Midwives are practitioners in their own right who are licensed to practise midwifery at entry point of qualification and registration, according to the role and sphere of practice of a midwife. This is recognised in the International Definition of a Midwife which states that the midwife practises ‘… on her own responsibility…’

In comparison, following initial qualification, nurses may undertake further education to function in a variety of advanced/expanded specialist nursing roles. In Australia this has led to the development of the Nurse Practitioner (NP) role as defined in respective state/territory legislation. NP responsibilities are specified within scopes of specialised nursing practice.

Midwifery in Australia is in a transitional phase and in each state and territory there are moves towards midwives working according to the internationally defined role and scope of practice of a midwife in partnership with women providing continuity of care throughout pregnancy, birth and the early weeks following childbirth. This role is not 'advanced' or 'extended' midwifery practice - it is fundamental to fulfilling the comprehensive role of a midwife

In Australia NPs have been accorded certain rights to prescribe order and interpret certain diagnostic tests and investigations. The NHMRC (1998) recognises that these rights are already an integral part of the practice and services offered by midwives. Currently there is no federal or state & territory legislative framework to support midwives in this aspect of their role.

Legislative reform needs to address this as a matter of urgency in the interests of providing quality midwifery care to all women and their families. Therefore the ACM believes it inappropriate to categorise, authorise or endorse this fundamental role with the title of Nurse Practitioner (or Midwife Practitioner), as is currently being suggested or defined in some state and territory nursing regulations.

It is acknowledged that some midwives may wish to apply for Nurse Practitioner or Midwife Practitioner status, especially where such authorisation is accompanied by financial and /or industrial reward and incentive. However, it is also acknowledged that selection of a few practitioners to have this authorisation through NP status is ambiguous and fails to achieve the broader, evidence based, public health objective of developing midwifery continuity of care models where all midwives have these privileges.

A more robust approach is the implementation and recognition of adequate educational and legislative frameworks to support the internationally defined role and scope of practice for all midwives.