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Core Competencies for Basic Midwifery Practice
The core competencies for basic midwifery practice describe the fundamental knowledge, skills, and behaviors expected of a new practitioner. Accordingly, they serve as guidelines for educators, students, health care professionals, consumers, employers, and policy-makers and constitute the basic requisites for graduates of all nurse-midwifery and midwifery education programs accredited/preaccredited by The American College of Nurse-Midwives (ACNM) Division of Accreditation (DOA)*. Midwifery practice is based on the Core Competencies for Basic Midwifery Practice, The Standards for the Practice of Midwifery and the Code of Ethics promulgated by the American College of Nurse-Midwives. Certified nurse-midwives (CNMs) and certified midwives (CMs) who have been certified by ACNM or the American Midwifery Certification Board, Inc. (AMCB), formerly the ACNM Certification Council, Inc. (ACC), assume responsibility and accountability for their practice as primary health care providers. The scope of midwifery practice may be expanded beyond the core competencies to incorporate additional skills and procedures that improve care for women and their families. Following basic midwifery education, midwives may choose to expand their practice following the guidelines outlined in Standard VIII of the Standards for the Practice of Midwifery. Midwifery education is based on an understanding of health sciences theory and clinical preparation that shapes knowledge, judgment, and skills deemed necessary to provide primary health care management to women and newborns. Midwives provide health care that incorporates appropriate medical consultation, collaborative management, or referral. Each education program is encouraged to develop its own method of addressing health care issues beyond the scope of the current core competencies, and each graduate is responsible for complying with the laws of the jurisdiction where midwifery is practiced and ACNM Standards for the Practice of Midwifery. ACNM defines the midwife's role in primary health care based on the Institute of Medicine's report (1996)*, the ACNM philosophy (2004), and ACNM Board of Directors' Position Statement on Certified Nurse-Midwives and Certified Midwives as Primary Health Care Providers/Case Managers (1997). Primary health care is the provision of integrated, accessible health care services by clinicians who are accountable for addressing the majority of health care needs, developing a sustained partnership with patients, and practicing within the context of family and community. As primary health care providers, CNMs and CMs assume responsibility for the provision of, and referral for, appropriate health care services that are within a defined scope of practice. The concepts, skills, and midwifery management process identified below comprise the foundation upon which practice guidelines and educational curricula are built. The core competencies are reviewed and revised regularly to incorporate changing trends in midwifery practice. This document must be adhered to in its entirety. I. Hallmarks of Midwifery The art and science of midwifery are characterized by these hallmarks: A. Recognition of pregnancy, birth, and menopause as normal physiologic and developmental processes
B. Advocacy of non-intervention in the absence of complications C. Incorporation of scientific evidence into clinical practice D. Promotion of family-centered care E. Empowerment of women as partners in health care F. Facilitation of healthy family and interpersonal relationships G. Promotion of continuity of care H. Health promotion, disease prevention, and health education I. Promotion of a public health care perspective J. Care to vulnerable populations K. Advocacy for informed choice, shared decision-making, and the right to self-determination L. Cultural competence M. Familiarity with common complementary and alternative therapies N. Skillful communication, guidance, and counseling O. Therapeutic value of human presence P. Collaboration with other members of the health care team II. Components of Midwifery Care: Professional Responsibilities of CNMs and CMs The professional responsibilities of CNMs and CMs include, but are not limited to, these components: A. Promotion of the hallmarks of midwifery
B. Knowledge of the history of midwifery C. Knowledge of the legal basis for practice D. Knowledge of national and international issues and trends in women's health and maternal/newborn care E. Support of legislation and initiatives which promote high quality health care services F. Knowledge of issues and trends in health care policy and systems G. Commitment to the ACNM's Philosophy, Standards, and Code of Ethics H. Ability to evaluate, apply, interpret, and collaborate in research I. Participation in self-evaluation, peer review, continuing education, and other activities that ensure and validate quality practice J. Development of leadership skills K. Familiarity with practice management and finances III. Components of Midwifery Care: Midwifery Management Process The midwifery management process includes: A. Systematically compiling and updating a complete and relevant database for the comprehensive assessment of each client's health, including a thorough health history and physical examination
B. Identifying problems and formulating diagnoses based upon interpretation of the database C. Identifying health care needs/problems in collaboration with the client D. Providing information and support to enable clients to make informed decisions and to assume primary responsibility for their own health E. Developing a comprehensive plan of care with the client F. Assuming primary responsibility for the implementation of individualized plans G. Obtaining consultation, planning, and implementing collaborative management; referral or transferring the care of the client as appropriate H. Initiating management of specific complications, emergencies, and deviations from normal I. Evaluating, with the client, the effectiveness of care and modifying the plan of care as appropriate. IV. Components of Midwifery Care: Fundamentals A. Anatomy and physiology, including fetal anatomy and physiology
B. Normal growth and development C. Clinical genetics D. Psychosocial, sexual and behavioral development E. Basic epidemiology F. Nutrition G. Pharmacokinetics and pharmacotherapeutics H. Principles of individual and group health education V. Components of Midwifery Care: The Primary Health Care of Women A. Health Promotion and Disease Prevention Independently manages primary health screening and health promotion of women from the perimenarcheal through the postmenopausal periods
MIDWIFERY PRACTICE 1. Applies knowledge of midwifery practice that includes, but is not limited to, the following:
a. Nationally defined goals and objectives for health promotion and disease prevention
b. Parameters for assessment of physical and mental health, including domestic violence, sexually transmitted infections, and substance, alcohol, and tobacco use c. Nationally defined screening recommendations to promote health and detect/prevent disease d. Management strategies and therapeutics to facilitate health and promote healthy behaviors 2. Applies knowledge of midwifery practice in the preconception period that includes, but is not limited to, the following: a. Assessment of individual and family readiness for pregnancy, including emotional, psychosocial, and sexual factors
b. Impact of health, family and genetic history on pregnancy outcomes c. Influence of environmental and occupational factors, health habits, and behavior on pregnancy planning d. Health and laboratory screening to evaluate the potential for a healthy pregnancy 3. Applies knowledge of midwifery practice of gynecologic care that includes, but is not limited to, the following: a. Human sexuality
b. Common screening and diagnostic tests c. Parameters for differential diagnosis of common gynecologic problems, including sexually transmitted infections d. Essentials of barrier, hormonal, mechanical, chemical, physiologic, and surgical conception control methods e. Management strategies and therapeutics for common gynecologic problems and family planning needs f. Management strategies and therapeutics for sexually transmitted infections that includes indicated partner evaluation, treatment, or referral g. Counseling principles for sexual behaviors that promote health and prevent disease h. Counseling, clinical interventions and/or referral for unplanned or undesired pregnancies, sexual concerns, infertility, and common gynecologic problems. 4. Applies knowledge of midwifery practice in the perimenopausal, postmenopausal and aging periods that includes, but is not limited to, the following: a. Effects of menopause on physical and mental health
b. Identification of deviations from normal c. Counseling and education for health maintenance and health promotion in the aging woman d. Management strategies and therapeutics for alleviating the common discomforts that may accompany the perimenopausal period B. Management of Common Health Problems Independently manages, within the CNM's/CM's defined scope of practice, common health problems of women, utilizing consultation, collaboration, and/or referral to appropriate levels of health care services as indicated 1. Applies the knowledge of midwifery practice that includes, but is not limited to, the following:
a. Identification of deviations in the following areas:
b. Management strategies and therapeutics for the treatment of common health problems/deviations of essentially healthy women
VI Components of Midwifery Care: The Childbearing Family A. Care of the Childbearing Woman: Independently manages the care of women during pregnancy, childbirth, and the postpartum period 1. Applies knowledge of midwifery practice in the antepartum period that includes, but is not limited to, the following:
a. Diagnosis of pregnancy
b. Genetics, placental physiology, embryology, and fetal development c. Epidemiology of maternal and perinatal morbidity and mortality d. Influence of environmental and occupational factors, health habits, and maternal behaviors on pregnancy outcomes e. Emotional and psychosexual changes during pregnancy f. Health risks, including but not limited to, domestic violence, sexually transmitted infections, substance, alcohol, and tobacco use g. Promotion of breastfeeding h. Indicators of normal pregnancy and deviations from normal i. Assessment of the progress of pregnancy and fetal well-being j. Etiology and management of common discomforts of pregnancy k. Management strategies and therapeutics that facilitate healthy pregnancy and Outcome l. Anticipatory guidance related to birth, breastfeeding, parenthood, and change in the family constellation 2. Applies knowledge of midwifery practice in the intrapartum period that includes, but is not limited to, the following:
a. Diagnosis and assessment of labor and its progress
b. Assessment of maternal and fetal status during labor c. Indicators of deviations from normal, including complications and emergencies d. Measures to support psychosocial needs during labor and delivery e. Management strategies and therapeutics to facilitate normal labor progress f. Techniques for (i) administration of local anesthesia, (ii) spontaneous vaginal delivery, (iii) third stage management, and (iv) performance and repair of episiotomy and repair of lacerations. g. Techniques for management of emergency complications and abnormal intrapartum events 3. Applies knowledge of midwifery practice in the postpartum period that includes, but is not limited to, the following: a. Postpartum self-care, newborn care and feeding, contraception, and family relationships
b. Management strategies and therapeutic to facilitate a healthy puerperium c. Facilitation of the initiation and establishment of lactation d. Deviations from normal and appropriate interventions including management of complications and emergencies e. Management of discomforts of the puerperium B. Newborn Care: Independently manages the care of the newborn during the first 28 days of life. 1. Applies knowledge of midwifery practice that includes, but is not limited to, the following:
a. Effect of maternal fetal risk factors on the newborn
b. Bonding and attachment theory c. Evaluation of the newborn: physical and behavioral assessment and gestational age assessment d. Primary health screening and health promotion up to 28 days of life e. Methods to facilitate adaptation to extrauterine life: (i) stabilization at birth, (ii) resuscitation, and (iii) emergency management f. Facilitation of continuation of breastfeeding g. Indications of deviation from normal and appropriate interventions h. Management strategies to facilitate integration of the newborn into the family *Committee on the Future of Primary Care, Institute of Medicine, National Research Council. "Primary Care: America's Health Care in a New Era". Washington, D.C: National Academy Press, 1996. Source: Education Section, Division of Education Approved by the ACNM Board of Directors: May 31, 2002 (Supersedes ACNM Core Competencies for Basic Midwifery Practice, May 1997) Language in the introduction only was revised and approved by the ACNM Board of Directors in June 2004. This language reflects the retiring of the Guidelines for the Incorporation of New Procedures into Nurse-Midwifery Practice in 2003, concurrent with the revision of the ACNM Standards for Midwifery Practice. |
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