The Provision of Midwifery Care by Non Midwives

It is the right of all women to receive continuous pregnancy, labour, birth and postnatal care from a midwife. The routine or otherwise use of nursing or other health professionals to provide direct midwifery care for women and their babies is not evidence based or appropriate.

Rationale:
It is the responsibility of regulators, policy makers and service managers to ensure that all women have access to midwifery care. Likewise it is their responsibility to ensure that women’s care is not compromised by economic and/or workforce problems. Appropriate planning is always necessary to ensure sufficient recruitment and retention of midwives in all locations, including rural and remote areas.

Compromising women’s midwifery care in pregnancy, labour, birth and pregnancy care with non-midwifery personnel is not an appropriate strategy for addressing shortages of midwives. There is no evidence to support the safety of routine use of health professionals without a midwifery qualification to provide midwifery care. Such workforce strategies compromise the safety and quality of care women receive as well as the accountability and responsibility of health professionals involved.

Research has confirmed that optimal outcomes for women and their babies are achieved when women have readily available access to continuity and primary care by a midwife throughout the childbearing period, in collaboration with other relevant health professionals as needed. (Homer et al 2001, Sandal et al 2001, Enkin et al 2000, Hodnett 2000, Rowley et al 1995, Flint 1989)

The World Health Organisation’s specifies that:
“The midwife is the most appropriate and cost effective type of health care provider to be assigned the care of normal pregnancy and normal birth, including risk assessment and the recognition of complications” (WHO 1996).

Midwifery is a distinct profession with the scope of midwifery practice defined at both the international (ICM 2005) and national levels (ANMC 2006). There is both national and international recognition that the scope of midwifery practice is to provide the necessary professional support, care and advice for the woman and her family throughout pregnancy, labour and birth, and early parenting, with referral to other health professionals as the needs of the mother or baby dictate.

The ACM respects the complementary role that can be played by nurses and other health professionals, in particular that of Aboriginal and Torres Strait Islander health workers, in ensuring women and their babies achieve optimal health outcomes. Midwives are committed to effective and timely collaboration with other health professionals to ensure that the needs of individual mothers and babies are met. In such cases midwives refer women and/or their babies to the care of a medical or nursing professional, and continue to provide midwifery care to the woman and her baby in collaboration with these other health professionals.

The ACM recognises that situations can arise when it is difficult for maternity service managers to fill midwifery vacancies. This is a workforce issue that needs to be addressed by appropriate planning to ensure sufficient recruitment and retention of midwives in all locations, including rural and remote areas. Where additional staff are needed senior midwifery students may be taken into employment models during the final year of their undergraduate midwifery program or final semesters of their graduate programs. This would enhance their midwifery learning and practice opportunities under the supervision of registered midwives and the students would encompass the philosophy of midwifery/ maternity care. Workforce shortages are not an acceptable reason for relying on non-midwives to provide midwifery care to women and their families.

Delegation of midwifery care to non-midwives is not acceptable. Midwives in Australia are educated through accredited midwifery programs at universities in all States and Territories. Upon obtaining their qualification they are registered or endorsed to practice midwifery and must be able to demonstrate ongoing competence. Enrolled and Registered Nurses are neither educated nor qualified to provide midwifery care unless they undertake an accredited midwifery program and gain registration or endorsement to practise midwifery. Without a midwifery qualification, nurses lack the necessary knowledge, attitudes and skills to provide safe, evidence based midwifery care to women and their families, except when responding to an emergency situation in the absence of a midwife.

The introduction of other staff, such as Health Care Assistants, to support midwives in providing appropriate care for women must be defined within a clear framework of role, accountability and responsibility. In most circumstances, these assistants should be employed to undertake hotel and clerical duties that support the work of midwives but do not replace, conflict with, or obstruct the role of the midwife (RCM, 1999). These support workers should receive appropriate training and work only under the direct supervision of a midwife.