Essential Competencies - International Confederation Of .

1.f Adhere to jurisdictional laws,regulatory requirements, and codesof conduct for midwifery practice1.g Facilitate women to makeindividual choices about care1.h Demonstrate effective interpersonal communicationwith women and families, health care teams, andcommunity groupsKNOWLEDGEKNOWLEDGEKNOWLEDGE Explain the laws and regulations ofthe jurisdiction regarding midwifery National/state/local communitystandards of midwifery practice Ethical principles ICM and other midwiferyphilosophies, values, codes of ethics Cultural norms and practicessurrounding sexuality, sexualpractices, marriage, the childbearingcontinuum, and parenting Principles of empowerment Methods of conveying healthinformation to individuals, groups,communities Role and responsibilities of midwives and other maternal –infant health providers Principles of effective communication Principles of effectively working in health care teams Cultural practices and beliefs related to childbearing andreproductive health Principles of communication in crisis situations, e.g. griefand loss, emergenciesSKILLS & BEHAVIOURSSKILLS & BEHAVIOURS Advocate for and support womento be the central decision makers intheir care Assist women to identify theirneeds, knowledge, skills, feelings,and preferences throughout thecourse of care Provide information and anticipatoryguidance about sexual andreproductive health to assistwomen’s decision making Collaborate with women indeveloping a comprehensive plan ofcare that respects her preferencesand decisions Listen to others in an unbiased and empathetic manner Respect one others’ point of view Promote the expression of diverse opinions andperspectives Use the preferred language of the woman or an interpreterto maximise communication Establish ethical and culturally-appropriate boundariesbetween professional and non-professional relationships Demonstrate cultural sensitivity to women, families, andcommunities Demonstrate sensitivity and empathy for bereaved womenand family members Facilitate teamwork and inter-professional care with othercare providers (including students) and community groups/agencies Establish and maintain collaborative relationships withindividuals, agencies, institutions that are part of referralnetworks Convey information accurately and clearly and respond tothe needs of individualsSKILLS & BEHAVIOURS Practise according to legalrequirements and ethical principles Meet requirements for maintenanceof midwifery registration Protect confidentiality of oralinformation and written recordsabout care of women and infants Maintain records of care in themanner required by the healthauthority Comply with all local reportingregulations for birth and deathregistration Recognize violations of laws,regulations, and ethical codes andtake appropriate action Report and document incidents andadverse outcomes as required whileproviding care10Category 1: General Competencies

1.i Facilitate normal birth processes ininstitutional and community settings,including women’s homes1.j Assess the health status, screen forhealth risks, and promote general healthand well-being of women and infants1.k Prevent and treat common healthproblems related to reproduction andearly lifeKNOWLEDGEKNOWLEDGEKNOWLEDGE Normal biologic, psychologic, social, andcultural aspects of reproduction and early life Practices that facilitate and those thatinterfere with normal processes Policies and protocols about care of womenin institutional and community settings Availability of resources in various settings Community views about and utilization ofhealth care facilities and place(s) of birth Health needs of women related toreproduction Health conditions that pose risks duringreproduction Health needs of infants and common risks Common health problems related tosexuality and reproduction Common health problems and deviationsfrom normal of newborn infants Treatment of common health problems Strategies to prevent and controlthe acquisition and transmission ofenvironmental and communicable diseasesSKILLS & BEHAVIOURS Promote policies and a work culture thatvalues normal birth processes Utilize human and clinical care resources toprovide personalized care for women andtheir infants Provide continuity of care by midwivesknown to womanSKILLS & BEHAVIOURS Conduct a comprehensive assessment ofsexual and reproductive health needs Assess risk factors and at-risk behaviour Order, perform, and interpret laboratory and/or imaging screening tests Exhibit critical thinking and clinicalreasoning informed by evidence whenpromoting health and well being Provide health information and advicetailored to individual circumstances ofwomen and their families Collaborate with women to develop andimplement a plan of care11SKILLS & BEHAVIOURS Maintain/promote safe and hygienicconditions for women and infants Use universal precautions consistently Provide options to women for coping withand treating common health problems Use technology and interventionsappropriately to promote health and preventsecondary complications Recognize when consultation or referralis indicated for managing identified healthproblems, including consultation with othermidwives Include woman in decision-making aboutreferral to other providers and servicesCategory 1: General Competencies

1.l Recognize conditions outsidemidwifery scope of practice and referappropriately1.m Care for women who experiencephysical and sexual violence and abuseKNOWLEDGEKNOWLEDGE Complications/pathologic conditions relatedto health status Limits of midwifery scope of practice andown experience Available referral systems to accessmedical and other personnel to managecomplications Community/facility plans and protocols foraccessing resources in timely manner Socio-cultural, behavioural, and economicconditions that often accompany violenceand abuse Resources in community to assist womenand children Risks of disclosureSKILLS & BEHAVIOURS Maintain up-to-date knowledge, skills, andequipment for responding to emergencysituations Recognize situations requiring expertisebeyond midwifery care Maintain communication with women aboutnature of problem, actions taken, andreferral if indicated Determine the need for immediateintervention and respond appropriately Implement timely and appropriateintervention, inter-professional consultationand/or timely referral taking account of localcircumstances Provide accurate oral and writteninformation to other care providers whenreferral is made. Collaborate with decision-making if possibleand appropriate12SKILLS & BEHAVIOURS Protect privacy and confidentiality Provide information to all women aboutsources of help regardless of whether thereis disclosure about violence Inquire routinely about safety at home, atwork Recognize potential signs of abuse fromphysical appearance, emotional affect,related risk behaviours such as substanceabuse Provide special support for adolescents andvictims of gender-based violence includingrape Refer to community resources, assist inlocating safe setting as neededCategory 1: General Competencies

CATEGORY 2PRE-PREGNANCYAND ANTENATALCompetencies in this category areabout health assessment of the womanand fetus, promotion of health andwell-being, detection of complicationsduring pregnancy, and care of womenwith an unexpected pregnancy.2.a Provide pre-pregnancy care2.b Determine health status of womanKNOWLEDGEKNOWLEDGE Anatomy and physiology of female andmale related to reproduction and sexualdevelopment Socio-cultural aspects of human sexuality Evidence based screening for cancerof reproductive organs and other healthproblems such as diabetes, hypertension,thyroid conditions, and chronic infectionsthat impact pregnancy Physiology of menstrual and ovulatory cycle Components of a comprehensive healthhistory including psycho-social responses topregnancy and safety at home Components of complete physical exam Health conditions including infections andgenetic conditions detected by screeningblood and biologic samplesSKILLS & BEHAVIOURSSKILLS & BEHAVIOURS Identify and assist in reducing barriersrelated to accessing and using sexual andreproductive health services Assess nutritional status, currentimmunization status, health behaviours suchas smoking, existing medical conditions,and exposure to known teratogens Carry out screening procedures for sexuallytransmitted and other infections, HIV,cervical cancer Provide counseling about nutritionalsupplements such as folic acid, dietaryintake, exercise, updating immunizationsas needed, modifying risk behaviours, andprevention of sexually transmitted infections13 Confirm pregnancy and estimate gestationalage from history, physical exam, laboratorytest and/or ultrasound Obtain comprehensive health history Perform a complete physical examination Obtain biologic samples for laboratory tests(e.g. venipuncture, finger puncture, urinesamples, and vaginal swabs) Provide information about conditions thatmay be detected by screening Assess status of immunizations, and updateas indicated Discuss findings and potential implicationswith woman and mutually determineplan of careCategory 2: Pre-pregnancy and Antenatal

2.c Assess fetal well-being2.d Monitor the progression of pregnancy2.e Promote and support healthbehaviours that improve well beingKNOWLEDGEKNOWLEDGEKNOWLEDGE Placental physiology, embryology, fetalgrowth and development, and indicators offetal well-being Evidence-based guidelines for use ofultrasoundSKILLS & BEHAVIOURS Assess fetal size, amniotic fluid volume,fetal position, activity, and heart rate fromexamination of maternal abdomen Determine whether there are indicationsfor additional assessment/examination andrefer accordingly Assess fetal movements and ask womanabout fetal activity Usual physiological and physical changeswith advancing pregnancy Nutritional requirements of pregnancy Common psychological responses topregnancy and symptoms of psychologicaldistress Evidence informed antenatal care policiesand guidelines, including frequency ofantenatal visitsSKILLS & BEHAVIOURS Conduct assessments throughout pregnancyof woman’s physical and psychologicalwell-being, family relationships, and healtheducation needs Provide information regarding normalpregnancy to woman, her partner, familymembers, or other support persons Suggest measures to cope with commondiscomforts of pregnancy Provide information (including written and/or pictorial) about danger signs, (e.g. vaginalbleeding, signs of preterm labour, prelabour,rupture of membranes) emergency preparedness, and when and where to seek help Review findings and revise plan of care withwoman as pregnancy progresses14 Impact of adverse social, environmental, andeconomic conditions on maternal -fetal health Effects of inadequate nutrition and heavyphysical work Effects of tobacco use and exposure tosecond-hand smoke, use of alcohol andaddictive drugs Effects of prescribed medications on fetus Community resources for income support,food access, and programs to minimize risksof substance abuse Strategies to prevent or reduce risks ofmother-to-child disease transmission includinginfant feeding options for HIV infection Effects of gender-based violence, emotionalabuse, and physical neglectSKILLS & BEHAVIOURS Provide emotional support to women toencourage change in health behaviour Provide information to woman and familyabout impact on mother and fetus of riskconditions. Counsel women about and offer referral toappropriate persons or agencies for assistance and treatment Respect women’s decisions about participating in treatments and programs Make recommendations and identify resources for smoking reduction/cessation inpregnancyCategory 2: Pre-pregnancy and Antenatal

2.f Provide anticipatory guidance relatedto pregnancy, birth, breastfeeding,parenthood, and change in the family2.g Detect, manage, and refer womenwith complicated pregnancies2.h Assist the woman and her family toplan for an appropriate place of birthKNOWLEDGEKNOWLEDGEKNOWLEDGE Needs of Individuals and families fordifferent information at different times intheir respective life cycles Methods of providing information toindividuals and groups Methods of eliciting maternal feelings andexpectations for self, infant, and family Complications of early pregnancy suchas threatened or actual miscarriage, andectopic pregnancy Fetal compromise, growth restriction,malposition, preterm labour Signs and symptoms of maternal pathologicconditions such as pre-eclampsia,gestational diabetes, and other systemicillnesses Signs of acute emergencies such ashemorrhage, seizures, and sepsis Evidence about birth outcomes in differentbirthplace settings Availability of options in specific location;limitations of climate, geography, meansof transport, and resources available infacilities Local policies and guidelinesSKILLS & BEHAVIOURS Participate in--and refer women and supportpersons to--childbirth education programs Convey information accurately and clearlyand respond to needs of individuals Prepare the woman, partner, and family torecognize labour onset, when to seek care,and progress of labour Provide information about postpartumneeds including contraception, care ofnewborn infants, and the importance ofexclusive breast feeding for infant health Identify needs or problems requiring furtherexpertise or referral such as excessive fear,and dysfunctional relationshipsSKILLS & BEHAVIOURS Collaborate in care of or refer for treatmentof complications Implement critical care activities to supportvital body functions (e.g. intravenous (IV)fluids) Mobilize blood donors if necessary Transfer to higher level facility if needed15SKILLS & BEHAVIOURS Discuss options, preferences andcontingency plans with woman and supportpersons and respect their decision Provide information about preparingbirth site if in community, e.g. travel andadmission to facility Promote the availability of a full range ofbirth settingsCategory 2: Pre-pregnancy and Antenatal

2.i Provide care to women with unintended or mistimed pregnancyKNOWLEDGE Complexity of decision-making about unintended or mistimedpregnancies Emergency contraception Legal options for induced abortion; eligibility and availability of medicaland surgical abortion services Medications used to induce abortion; properties, effects, and sideeffects Risks of unsafe abortion Family planning methods appropriate for the post-abortion period. Care and support (physical and psychological) needed during and afterabortionSKILLS & BEHAVIOURS Confirm pregnancy and determine gestational age; refer for ultrasoundif unknown gestation and/or symptoms of ectopic pregnancy Counsel woman about options to maintain or end the pregnancy andrespect the ultimate decision. Provide supportive antenatal care if pregnancy continued; refer toagencies, and social services for support and assistance when needed Identify from obstetric, medical and social history, contraindications tomedication or aspiration methods Provide information about legal regulations, eligibility, and access toabortion services Provide information about abortion procedures, potential complications,management of pain, and when to seek help Refer to provider of abortion services upon request Provide post-abortion care̶̶ Confirm expulsion of products of conception from history, ultrasound, orlevels of HCG̶̶ Review options for contraception and initiate immediate use of method̶̶ Explore psychological response to abortion16Category 2: Pre-pregnancy and Antenatal

CATEGORY 3CARE DURINGLABOUR AND BIRTHCompetencies in this category areabout assessment and care ofwomen during labour that facilitatesphysiological processes and a safebirth, the immediate care of thenewborn infant, and detection ofcomplications in mother or infant.3.a Promote physiologic labour and birthKNOWLEDGE Anatomy of maternal pelvis and fetus; mechanisms of labour for different fetal presentationsPhysiologic onset and progression of labourEvidence about interventions in normal labour and birthCultural and social beliefs and traditions about birthSigns and behaviours of labour progress; factors that impede labour progressMethods of assessing fetus during labourSKILLS & BEHAVIOURS Provide care for a woman in the birth setting of her choice, following policies and protocolsObtain relevant obstetric and medical historyPerform and interpret focused physical examination of the woman and fetusOrder and interpret laboratory tests if neededAssess woman’s physical and behavioural responses to labourProvide information, support, and encouragement to woman and support persons throughoutlabour and birthProvide respectful one-to-one careEncourage freedom of movement and upright positionsProvide nourishment and fluidsOffer and support woman to use strategies for coping with labour pain, e.g. controlled breathing,water immersion, relaxation, massage, and pharmacologic modalities when neededAssess regularly parameters of maternal-fetal status, and e.g. vital signs, contractions, cervicalchanges, and fetal descentUse labour progress graphic display to record findings and assist in detecting labour delay or othercomplicationsAugment uterine contractility judiciously using non-pharmacological or pharmacological agents toprevent non-progressive labourPrevent unnecessary routine interventions, e.g. amniotomy, electronic fetal monitoring, directedclosed glottis pushing17Category 3: Care during Labour and Birth

3.b Manage a safe spontaneous vaginal birth and preventcomplications3.c Provide care of the newborn immediately after birthKNOWLEDGEKNOWLEDGE Methods of conducting birth to protect perineal integrity Evidence about conduct of third stage, including use of uterotonics Potential complications and their immediate treatment e.g. shoulderdystocia, and excessive bleeding Signs of placental separation; appearance of normal placenta,membranes, and umbilical cord Types of perineal and vaginal trauma requiring repair and suturingtechniques Normal transition to extra-uterine environmentScoring systems to assess newborn statusSigns indicating need for immediate actions to assist transitionAppearance and behaviour of healthy newborn infantMethod of assessing gestational age of newborn infantNeeds of small for gestational age and low birth weight infantsSKILLS & BEHAVIOURS Use standardized method to assess newborn condition in the firstminutes of life (Apgar or other); refer if needed Institute actions to support breathing and oxygenation Provide a safe warm environment for initiating breastfeedi

competencies by multiple audiences. Two consultants, a learning designer8 and a midwife educational expert9, revised the format of the framework and the competencies and a team from Laerdal Global Health designed the visual representation of the competencies. 8 Carolyn Levy, Blank Design and Project Management, Vancouver, Canada