Monday, December 17, 2007

What makes a competent midwife?

It appears that there is some disquiet about the ongoing competency requirements for registered midwives in New Zealand (Guilliland, 2007). Apparently, some midwives have complained that the statutory requirements, as laid down by the Midwifery Council of New Zealand are too stringent and onerous.

These requirements include:
an annual declaration to say you are competent in all areas of the midwifery scope of practice and have fulfilled the requirements of the recertification program
an annual standards review - audit and reflection process
maintaining a portfolio
attending annual compulsory maternal and infant resuscitation update
attending compulsory technical skills workshop, once every three years
attending compulsory breastfeeding update every three years
gaining 40 education points and 30 professional development points.

There is no requirement for working a set number of hours or having a specific number of midwifery cases.

Once these requirements have been fulfilled, then one is entitled to an annual practicing certificate.

I can understand why midwives feel this is an added pressure to their already full lives, but in the grand scheme of things, being able to say that you have fulfilled all the requirements for competency to practice is a 'protective' measure if nothing else.

For myself, as a midwifery lecturer who works on clinical papers I am required to have an annual practicing certificate. This is right and proper for a number of reasons, not least that is maintains credibility with students and feeds into the teaching - clinical - research cycle. The issue for me is what amount of clinical work keeps me competent? There are a number of options for clinical work such as working at my local hospital or carrying out locum placements but I am not too keen on doing extra work on top of my lecturing job, study and research, especially if it means doing it in my time off.

So this is what I have to figure out: what clinical work should I do and in what areas, that will help me maintain competency yet do not add an additional stress and workload to my already chaotic life? Or, is the question not so much about what keeps me competent - I consider that I am very competent following many years in a variety of practice contexts and working with students keeps me updated - but more about maintaining confidence?

However one looks at things, there is no doubt that if midwifery teachers, academics and researchers are required to maintain their clinical competency, they must be supported in a way that does not cause additional stress or encourage burnout.

I'd love to hear your views about how you maintain your competence, if you are a midwife. If you are a lecturer, how do you keep current? If you are a student, what are your views about midwifery lecturers carrying out clinical work - should it be a requirement? If you are a non-midwife, how would you gauge if a midwife is competent or not?

Guilliland, K. (2007). Supporting and sustaining each other. Midwifery News. No 47, December, 6-7.

Image: 'Our Midwife' Stephen Rothlisberger "Kylene, our midwife, is impressively competent and thoroughly professional, and she's the friendliest person I've ever met. It has been our privilege to be in her care."

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