registered midwife sop

8/13/2019 Registered Midwife SOP

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Scope of Practice for Registered Midwife (RM)

Health Regulation Department

Dubai Health Authority (DHA)


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Introduction

Health Regulation Department in DHA is responsible for regulating midwifery practicein the Emirate of Dubai, United Arab Emirates. Scope of Practice (SOP) refers to the

activities that registered midwives are educated, authorized and competent to perform as

well as their decision making capacity. Such activities are established through the

legislated definition of licensed midwifery practice, complemented by standards, limits,conditions and education and influenced by setting, environment and health needs of the

population. The Eastern Mediterranean Region (EMRO) of the World HealthOrganization (WHO) in its Global Advisory Group Meeting in 2000 identified lack of

legislation as the most prevailing reason for nurses and midwives not working to their full

potential.

The primary purpose of this document is to guide and direct midwives practice within

this environment. Through this framework DHA health regulation meets its responsibility

to regulate midwifery practice in the public interest and address incompetent, impaired orunethical practice amongst midwives. DHA health regulation in recognising its further

responsibilities to ensurepublic safety and in line with its published expectations of theregistered nurse, equally expects that registered midwives must self assess theircompetence and make individual decisions about their practice within unique

circumstances and settings. Furthermore midwives retain accountability for their own

practice and are accountable to the woman and her newborn, the public, their employerand the regulatory authority.

To ensure consistency in midwifery standards throughout the UAE the following

Midwifery Competency Framework has drawn largely on the work undertaken in 2007 to

develop the Scope of Practice (SOP) for the Midwife, which was endorsed by the Health

Authority of Abu Dhabi (HAAD) Nursing and Midwifery Advisory Committee in

December 2007 and the Federal Department of Nursing (FDON) Midwifery Committeein January 2008. During the collaborative development of the SOP by midwifery

representatives throughout the UAE, the International Confederation of Midwives (ICM)Essential Competencies for Basic Midwifery Practice (2002) provided an international

guide and benchmark. In order to provide more detailed evidence guidelines for

midwifery practice in Dubai the Midwifery Competence Framework has been modifiedand expanded.

The Scope of Practice for the Licensed Midwife is endorsed by DHA health regulationand should be read in conjunction with DHA health regulation Code of Conduct and

Ethics for Nurses and Midwives.

DHA health regulation upholds that no midwife should be directed or compelled to

undertake any practice that falls short of DHA health regulation standards or code of

conduct requirements.


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International Definition of a Midwife

As accepted by the ICM Membership and Joint Study Group on Maternity Care, FIGO,

WH0

A midwife is a person who, having been regularly admitted to a midwifery educational

program, duly recognized in the country in which it is located, has successfullycompleted the prescribed course of studies in midwifery and has acquired the requisite

qualifications to be registered and/or legally licensed to practice midwifery.

The sphere of practice: She must be able to give the necessary supervision, care andadvice to women during pregnancy, labour and postpartum period, to conduct deliveries

on her own responsibility, and to care for the newborn and the infant. This care includes

preventive measures, the detection of abnormal condition in mother and child, theprocurement of medical assistance, and the execution of emergency measures in the

absence of medical help.

She has an important task in counseling and education, not only for the women, but also

within the family and community. The work should involve antenatal education andpreparation for parenthood and extends to certain areas of gynecology, family planning,

and child care.

She may practice in hospitals, clinics, health units, domiciliary conditions or any other

service.

Competency Standards

Four Domains of Practice have been identified. Core midwifery competency standards

and associated performance criteria are located within these domains of practice which

are guided by the ICM/WHO/FIGO (1992) and ICM (2005) Definitions of the Midwife

and the ICM essential competency standards for the Midwife (2002).

Domains of Practice

1. Midwifery Practice and Comprehensive Care2. Professional, Legal and Ethical Practice3. Professional Development4. Quality Improvement and Collaborative Healthcare


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Competency Statements

Each Domain of Practice has competency statements and associated performance criteriathat a midwife must demonstrate to fulfil regulatory requirements.

Evidence of safety to practice is demonstrated when the registered midwife meets the

competency criteria within the domains.

The indicators and evidence guides are neither comprehensive nor exhaustive but ratherprovide examples of evidence of competence.

NB: For the purpose of this document she may mean he in specific circumstances


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Domain 1Midwifery Practice and Comprehensive Care

Competency 1.1 Promotes health and provides education to the woman and her family

Indicator Sub Indicator

.1.1 Midwives provide high

quality, culturally sensitive

health education and services to

he woman and her family in

order to promote healthy family

ife, planned pregnancies and

birth spacing and positive

parenting.

1.1.1.1Identifies, participates in and contributes to the development ofhealth education programs in the community

1.1.1.2Provides the woman and her family with accurate information1.1.1.3Supports the woman and her family to promote health and well-

being

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Competency 1.3 Provides safe and effective antenatal care


1.3.1 Promotes the health and

well-being of the pregnant

woman and the fetus

1.3.1.1 Plan, implement and evaluate holistic antenatal care incollaboration with the woman and her family

1.3.1.2 Educates the woman and families about normal physiologicalchanges of pregnancy and advise on strategies to relievecommon discomforts

1.3.1.3 Assesses the growth and well-being of the fetus1.3.1.4 Provides nutritional advice for pregnancy and lactation1.3.1.5 Interprets and acts upon information from antenatal

assessments

1.3.1.6 Interprets and analyses basic screening laboratory/ultrasoundstudies

1.3.1.7 Identifies health risk factors and refers care as necessary

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Competency 1.3 Provides safe and effective antenatal care

Sub Indicator Evidence Guide Examples

.3.2Prepares the woman forabour, birth and parenting

1.3.2.1Educates the woman about the onset and process of labour1.3.2.2Provides information about pain relief, birth positions and delivery

options to facilitate informed choices

1.3.2.3Protects, promotes and supports breastfeeding in alignment withcurrent WHO/UNICEF guidelines

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Competency 1.4 Provides safe and effective intrapartum care


.4.1 Demonstrates an

nderstanding of the physiology

f labour

1.4.1.1Recognizes the relevant critical diameters and landmarks of thematernal reproductive anatomy

1.4.1.2Identifies the signs which indicate onset and progress of labour1.4.1.3Identifies the measures to assess fetal and maternal well-being in

labour

1.4.1.4Identifies the signs and indicators of deviations fromnormal/complications

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Competency 1.4 Provides safe and effective intrapartum care


.4.2 Demonstrates competency

n the skills needed to support

he woman during childbirth

1.4.2.1Promotes normal physiological childbirth1.4.2.2Identifies complications or deviations from normal1.4.2.3Implements midwifery care which reduces risk and harm to the

woman and fetus

1.4.2.4Encourages and respects the womans preferencesthroughout labour and delivery, within safe parameters of practiceor safe delivery in an environment conducive to well being of

mother and newborn as requested

1.4.2.5Recognizes emergency situations and intervenes in an appropriateand timely manner.

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ompetency 1.6: Provides safe and effective care of the newborn


6.1 Demonstrates aknowledge of the physiology

and needs of the newborn

1.6.1.1Recognizes signs of newborn adaptation to extra-uterine life1.6.1.2Identifies factors relevant to growth and development1.6.1.3Identifies variations in the normal newborn and acts accordingly

appropriately

1.6.1.4Implements health promotion and disease prevention strategies

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ompetency 1.6: Provides safe and effective care of the newborn


6.2 Demonstrates competency

n the skills needed to safely care

or the newborn

1.6.2.1Immediately assesses the newborns condition1.6.2.2Performs a detailed physical examination of the newborn1.6.2.3Promotes early breastfeeding1.6.2.4Performs interventions to facilitate adaptation to extra-uterine life1.6.2.5Recognizes deviations from normal and acts accordingly1.6.2.6Initiates emergency measures when necessary

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ompetency 1.7 Performs safe and effective pharmacological interventions


7.1 Demonstrates evidence

ased practice in use of

harmacological preparations

elevant to midwifery practice

1.7.1.1Educates the woman about the potential effects of medicationduring pregnancy, birth and lactation

1.7.1.2Educates the woman about any medications required by thenewborn

1.7.1.3Accurately calculates medication doses for administration1.7.1.4

Safely administers medications during pregnancy, birth andlactation

1.7.1.5Recognizes contra-indications and side effects and acts accordingly1.7.1.6Documents medication administration accurately

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Domain 2: Professional, legal and ethical practice

Competency 2.1 Functions in accordance with legislative and policy guidelines relevant to midwifery practice


.1.1 To practice within acope of competency and an

bility to work independently

nd in collaboration with others.

2.1.1.1Maintains current license to practice as an outcome of self-regulation

2.1.1.2Identifies unsafe practice and intervenes accordingly2.1.1.3Functions within a set midwifery scope of practice as delineated

by this document

2.1.1.4Practices only to the level for which s/he is adequately prepared,supervised and supported to perform

2.1.1.5Utilizes relevant codes of conduct as a guide to midwifery practice2.1.1.6Contributes to policy development impacting on midwifery

practice

2.1.1.7Interacts with policy makers and legislators to influence legislationand regulation pertaining to midwifery practice

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ompetency 2.2 Assumes responsibility and accountability for own actions and clinical decision making


2.2.1.1Performs ongoing self-evaluation to determine strengths andlimitations in knowledge and skills

2.2.1.2Consults and performs referrals as necessary2.2.1.3Assumes responsibility for delegation and supervision of

midwifery care (direct and indirect), which is relevant to thecontext and the competence of the person to whom care is

delegated

2.2.1.4Accepts responsibility for delegated activities relevant to thecontext and own level of competence

2.2.1.5Works collaboratively with other health care professionals toimprove the delivery of services to the woman and her family

2.2.1.6Advocates for the woman and families to ensure promotion of ahealthy and safe birth

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ompetency 2.3 Delivers care and practices midwifery within an ethical framework and social context


2.3.1.1Implements midwifery care in a culturally respectful andnon-judgmental manner

2.3.1.2Bases midwifery practice on ethical decision making2.3.1.3Works in partnership with the woman to support them in

making informed choices about their health

2.3.1.4Acts to strengthen the woman in promoting health of selfand others

2.3.1.5Communicates effectively with the woman, significantothers and health care professionals to optimize care

2.3.1.6Advocates to protect rights of the woman and families inrelation to midwifery care

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omain 3: Professional development

ompetency 3.1 Demonstrates a commitment to development of self


3.1.1 The midwife isaccountable for establishing,

maintaining and evaluating her

own life long learning needs to

nsure continuing competence

o practice.

3.1.1.1Maintains knowledge and skills through activelyparticipating in continuing professional development

programs

3.1.1.2Uses valid research to inform midwifery practice3.1.1.3

Actively engages in continuous self-assessment toevaluate and enhance own practice

3.1.1.4Maintains record of all learning and professionaldevelopment activities attended

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ompetency 3.2 Demonstrates a commitment to development of others and the profession


2.1 Contributes to the support,

irection and teaching of

olleagues to enhance

rofessional development

3.2.1.1Collaborates and shares professional knowledge withothers

3.2.1.2Supports others less experienced or new to the professionthrough formal and informal preceptor and mentor

programs

3.2.1.3Participates in facilitating and co-coordinating learningopportunities for others

3.2.1.4Contributes to health care policy as relevant to midwiferypractice

3.2.1.5Identifies opportunities and contributes to nursing research3.2.1.6Refers to and disseminates current research to guide

midwifery practice

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omain 4: Quality Improvement and Collaborative Healthcare: This domain contains competencies to dem

ealthcare team, the midwife evaluates the effectiveness of care and promotes a midwifery perspective within the am

ompetency 4.1 Recognizes and values quality improvement activities to monitor and improve standards of midwif


1.1 Participates in quality

mprovement activities.

4.1.1.1Recognizes that quality improvement involves ongoingconsideration, use and review of practice in relation to practice

outcomes, standards and guidelines and new developments

4.1.1.2Participates in case review activities

4.1.1.3Participates in clinical audits4.1.1.4Uses appropriate risk assessment tools to identify actual and

potential risks

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ompetency 4.2Demonstrates accountability for communication, consulting and collaborating with other health pro

egarding activities of care planning, implementation and evaluation of care


2.1 Recognizes that the

membership and roles of

ealthcare teams and service

roviders will vary depending

n an individuals/groups needs

nd healthcare setting

4.2.1.1 Recognizes when to negotiate with, or refer to other healthcareor service providers

4.2.1.2 Establish positive and productive working relationships withcolleagues

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2.2 Recognizes that the

membership and roles of

ealthcare teams and service

roviders will vary depending

n an individuals/groups needs

nd healthcare setting

4.2.2.1 Recognizes when to negotiate with, or refer to other healthcareor service providers

4.2.2.2 Establish positive and productive working relationships withcolleagues

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2.3 Demonstrates knowledgef effective inter-professional

ork practices which respectnd utilize the contributions of

members of the health team

4.2.3.1 Participates with members of the healthcare team in decision-making

4.2.3.2 Reviews and evaluates care with members of the healthcareteam

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SCOPE OF PRACTICE DECISION MAKING

Decision makingin midwifery practice is complex and relies on a number of factors. TheMidwife should use the following stepsto assist in making appropriate and accountable

decisions.

Step

1. Is the function within the scope of practice of the registered midwife?Midwifery practice in Dubai is guided by contemporary standards and policy

endorsed by DHA HEALTH REGULATION and benchmarked against standardsand procedures endorsed by national and international associations.

IDENTIFY

Is the activity within the scope of practice of the registered midwife?

Does the practice comply with midwifery standards, is it supported bypolicy and is it supported by research/evidence based practice for this

situation?

Are there other standards or regulatory policy that I must consider andwill the practice comply with these?

Do I require regulatory authorization to perform this activity?

Step

2. Is the function within the individuals scope of practice?It is the responsibility of every midwife to understand and apply the relevant

standards of professional practice within their own scope of practice. In making

decisions in relation to their scope of practice midwives must actively engage in

continuous self assessment and self regulation to ensure continuing competence topractice.

IDENTIFY

Do I possess the current knowledge, training, skill and experience toperform the function?

Are these skills and abilities documented in my employment file?

Do I have required authorization to perform this activity?

Do I require the expert assistance of other health professionals?

Have I met the requirements for delegation?

Have I met the requirements for supervision?


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Step

3. Is there an identified client/patient need or benefit?Midwifery care should occur in consultation with the woman and her family.

IDENTIFY

Is there a legitimate need by the woman for this service?

Will the woman benefit from my performing this service?

Has the woman been consulted in the decision process?

Step

4. Does the employing facility support this function?

Midwives have the responsibility to practice within professional standards and

guidelines which are supported by appropriate policies and procedures providedby employers.

Is this function identified within my role/job description?

Do I have the support of my supervisor to perform this function?

Is there organizational policy or procedure in place?

Step

5. Am I willing to accept accountability and responsibility for my decision?


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EVALUATE

SCOPE OF PRACTICE DECISION MAKING STEPS

Question: How do I know what my current Scope of Midwifery Practice is?

ASK

No

YES

No

YES

No

YES

No

Yes

No

YES

Step 1

Is the function within

licensed midwifery

practice?

Step 2

Is the function within

the individual's scope

of practice?

Step 3

Is there an identified

need by the woman or

identified benefit?

Is the activity within the licensed midwifery practice?

Does the practice complies with midwifery standardsand supported by policy and is it supported by

research/evidence based practice for this situation?

Do I possess the current knowledge, training, skilland experience to perform the function?

Are these skills and abilities documented in myemployment file?

Do I have required authorized to perform thisactivity?

Do I require the expert assistance of other healthprofessionals?

Have I met the requirements for delegation?

Have I met the requirements for supervision?

Is there a legitimate need by the woman for thisservice?

Will the woman benefit from my performing this

service? Has the woman been consulted in the decision

process?

Is this function identified within my role/jobdescription?

Do I have the support of my supervisor to performthis function?

Do I accept responsibility for the performance andoutcome of this function in this context and mindful

of an com etence?

DO NOT PROCE

Review & conresources &

PROCEED

Step 4

Does the employing

facility support this

function?

Step 5Am I willing toacceptaccountability formy decision?


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DELEGATION WITHIN THE SCOPE OF PRACTICE OF THE

REGISTERED MIDWIFE

DELEGATION BY REGISTERED MIDWIVES

For the purpose of this document delegation is the conferring of authority to performspecific functions or tasks/activities in a specific situation, to a person whose role/job

description and training allows them to perform such functions but does not have the

authority to perform such functions without supervision.

Only REGISTERED MIDWIVES are able to delegate.

It is not permitted for Registered Nurses or Assistant Nurses to delegate tasks that are the

domain of the qualified midwife.

Registered Midwives who delegate health care tasks retain accountability for the decisionto delegate and the subsequent performance of the delegated task. The decision to

delegate is based on the midwifes professional judgment and determination that the

person to whom the delegation is to be given is competent to perform the function.

DELEGATION must not be given in circumstances which involve a compromise to

the woman or new born safety or a breach of legislation or professional standards.

SUPERVISION

Supervision is defined as the activities of oversight, direction, advice, guidance, support,

monitoring or evaluating.

Supervision can be of the individual or a group of persons and is usually for a definedtime as determined by the licensed nurse depending on the situation and activity.

Supervision can be direct where the Registered Midwife works with the RegisteredNurse, Assistant Nurse or Health Care Assistant or Student Midwife and can provide

observation and intervention where necessary.

Supervision can be indirect where the Registered Midwife is not present and

supervision is provided other than by direct observation. Processes which are the shared

responsibility of the licensed midwife as well as the employer must be in place to supportthe Registered Nurse, Assistant Nurse or Health Care Assistant or Student Midwifeinthis situation.


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GLOSSARY OF TERMS

ACCOUNTABILITY

A Registered Midwife is answerable to the woman and her newborn, the employer, the

regulator and the public for her decisions, actions and behaviours and for the

consequences of those decisions, actions and behaviours.

ASSISTANT NURSE

A Person registered under the registered assistant nurse scope of practice

COMPETENT

Having the required abilities or qualities

COMPETENCE

The combination of skills, knowledge, attitudes, values and abilities that underpin

effective performance as a nurse

DUTY OF CARE

A duty to use care toward others that would be exercised by an ordinarily reasonable andprudent person in order to protect them from unnecessary risk of harm

PUBLIC

The community of the Emirate of Dubai, United Arab Emirates

REGISTERED NURSE

A person registered under the registered nurse scope of practice

SELF ASSESSMENT

Self assessment of competence is a continuous process of examination against

professional standards and guidelines. The midwife has the responsibility to maintain and

further develop the competence necessary for their area of practice. The focus should beon improvement.

SELF REGULATION

Self regulation is a dynamic process for the health professional which involves

accountable practice and sound decision making. Critical continuous self assessment of

competence to practice and actions to maintain and enhance competence is its foundation.


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References

1. Australian Nursing & Midwifery Council (2006) National Competency Standardsfor the Registered Midwife, www.anmc.org.au

2. ACMI (2001) Australian College of Midwives Incorporated CompetencyStandards for Midwives http://www.acmi.org.au

3. Australian Nursing and Midwifery Council (2006) National Competencystandards for the Midwife

4. Department of Health & Medical Services (2008); Job Description/ Performance5. Appraisal Midwife

6. Buscher, A., Wagner, L. (2004) Munich Declaration: nurses and midwives: Aforce for health. An Analysis of implementation of the Munich Declaration 2004

(WHO publication) http://www.euro.who.int/document/e86640.pdf

7. Federal Department of Nursing, Ministry of Health United Arab Emirates (2007);Scope of practice for the Midwife

8. Health Authority Abu Dhabi (2007); Scope of Practice for the Midwife,www.haad.ae

9. ICM/WHO/FIGO International Definition of the Midwife, ICM, The HagueInternational Confederation of Midwives (2002) Essential Competencies for Basic

Midwifery Practicehttp://www.internationalmidwives.org/modules.php?op=modload&name=News&

file=article&sid=27

10.Nurses Board South Australia (2006); A Scope of Practice Decision MakingTool