Core Competencies are Essential for High Quality Midwifery Care
The Midwives Alliance Core Competencies establish the essential knowledge, clinical skills and critical thinking necessary for entry-level practice for direct-entry midwifery in the United States. The Certified Professional Midwife (CPM) is based on the MANA Core Competencies.
The MANA Core Competencies were written and adopted by the MANA Board of Directors on October 3,1994, and revised and adopted on August 4, 2011.
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Midwives Alliance Core Competencies
The Midwives Alliance of North America Core Competencies establish the essential knowledge, clinical skills and critical thinking necessary for entry-level midwifery practice. An entry-level midwife is qualified to practice midwifery autonomously.
The Competencies inform practicing midwives, student midwives, midwifery education programs, consumers, accreditation and certification agencies, state and federal legislators, licensing authorities, health policy makers and other health care professionals concerning the practice of midwifery. Individual midwives are responsible to the licensing authority and regulations of the jurisdiction within which they practice.
Midwives provide care to parturient women and their newborn babies in a variety of settings in accordance with the Midwives Model of Care™, which is based on the principle that pregnancy and birth are normal life processes.
The Midwives Model of Care™ includes:
- monitoring the physical, psychological and social well-being of the mother throughout the childbearing cycle;
- providing the mother with individualized education, counseling and prenatal care; continuous hands-on assistance during labor and delivery; and postpartum support;
- minimizing technological interventions;
- identifying and referring women who require obstetrical attention.
[http://cfmidwifery.org/mmoc/define.aspx; Copyright © 1996–2008, Midwifery Task Force, Inc., All Rights Reserved.]
The application of this woman-centered model of care has been proven to reduce the incidence of birth injury, trauma and cesarean section.
The scope of midwifery practice may be expanded beyond the Core Competencies outlined in this document to incorporate additional skills and procedures that improve care for women and their families.
The midwife provides care according to the following guiding principles of practice:
- Pregnancy and childbearing are natural physiologic life processes.
- Women have within themselves the innate biological wisdom to give birth.
- Physical, emotional, psychosocial and spiritual factors synergistically shape the health of individuals and affect the childbearing process.
- The childbearing experience and birth of a baby are personal, family and community events.
- The woman is the only direct care provider for herself and her unborn baby; thus the most important determinant of a healthy pregnancy is the mother herself.
- The parameters of “normal” vary widely, and each pregnancy, birth and baby is unique.
In consideration thereof:
- Midwives work in partnership with women and their chosen support community throughout the caregiving relationship.
- Midwives respect and support the dignity, rights and responsibilities of the women they serve.
- Midwives are committed to addressing disparities in maternal and child health care status and outcomes.
- Midwives work as autonomous practitioners, although they collaborate with other health care and social service providers when necessary.
- Midwives work to optimize the well-being of mothers and their developing babies as the foundation of caregiving.
- Midwives recognize the empowerment inherent in the childbearing experience and strive to support women to make informed decisions and take responsibility for their own and their baby’s well-being.
- Midwives integrate clinical or hands-on evaluation, theoretical knowledge, intuitive assessment, spiritual awareness and informed consent and refusal as essential components of effective decision making.
- Midwives strive to ensure optimal birth for each woman and baby and provide guidance, education and support to facilitate the spontaneous processes of pregnancy, labor and birth, lactation and mother–baby attachment, using appropriate intervention as needed.
- Midwives value continuity of care throughout the childbearing cycle and strive to maintain such continuity.
- Midwives are committed to sharing their knowledge and experience through such avenues as peer review, preceptorship, mentoring and participation in MANA’s statistics collection program.
MANA Core Competencies
Academic knowledge provides the theoretical foundation for understanding the scope of health during the childbearing year in order to distinguish deviations from healthy functioning.
Clinical skills refer to the hands-on assessment of the woman’s physical health, observation of her psychosocial well-being and skilled listening. The midwife views health holistically, uses critical thinking to evaluate clinical findings, applies intuition as authoritative knowledge, maintains an integrated understanding of the whole picture and, with the woman, identifies and creates a plan of care based on conscious analysis of challenges and goals.
I. General Knowledge and Skills
The midwife’s knowledge and skills include but are not limited to:
A. communication, counseling and education before pregnancy and during the childbearing year;
B. human anatomy and physiology, especially as relevant to childbearing;
C. human sexuality;
D. various therapeutic health care modalities for treating body, mind and spirit;
E. community health care, wellness and social service resources;
F. nutritional needs of the mother and baby during the childbearing year;
G. diversity awareness and competency as it relates to childbearing.
The midwife maintains professional standards of practice including but not limited to:
A. principles of informed consent and refusal and shared decision making;
B. critical evaluation of evidence-based research findings and application to best practices;
C. documentation of care throughout the childbearing cycle;
D. ethical considerations relevant to reproductive health;
E. cultural sensitivity and competency;
F. use of common medical terms;
G. implementation of individualized plans for woman-centered midwifery care that support the relationship between the mother, the baby and their larger support community;
H. judicious use of technology;
I. self-assessment and acknowledgement of personal and professional limitations.
II. Care During Pregnancy
The midwife provides care, support and information to women throughout pregnancy and determines the need for consultation, referral or transfer of care as appropriate. The midwife has knowledge and skills to provide care that include but are not limited to:
A. identification, evaluation and support of mother and baby well-being throughout the process of pregnancy;
B. education and counseling during the childbearing cycle;
C. identification of pre-existing conditions and preventive or supportive measures to enhance client well-being during pregnancy;
D. nutritional requirements of pregnant women and methods of nutritional assessment and counseling;
E. emotional, psychosocial and sexual variations that may occur during pregnancy;
F. environmental and occupational hazards for pregnant women;
G. methods of diagnosing pregnancy;
H. the growth and development of the unborn baby;
I. genetic factors that may indicate the need for counseling, testing or referral;
J. indications for and risks and benefits of biotechnical screening methods and diagnostic tests used during pregnancy;
K. anatomy, physiology and evaluation of the soft and bony structures of the pelvis;
L. palpation skills for evaluation of the baby and the uterus;
M. the causes, assessment and treatment of the common discomforts of pregnancy;
N. identification, implications and appropriate treatment of various infections, disease conditions and other problems that may affect pregnancy;
O. management and care of the Rh-negative woman;
P. counseling to the woman and her family to plan for a safe, appropriate place for birth.
III. Care During Labor, Birth and Immediately Thereafter
The midwife provides care, support and information to women throughout labor, birth and the hours immediately thereafter. The midwife determines the need for consultation, referral or transfer of care as appropriate. The midwife has knowledge and skills to provide care that include but are not limited to:
A. the processes of labor and birth;
B. parameters and methods, including relevant health history, for evaluating the well-being of mother and baby during labor, birth and immediately thereafter;
C. assessment of the birthing environment to assure that it is clean, safe and supportive and that appropriate equipment and supplies are on hand;
D. maternal emotional responses and their impact during labor, birth and immediately thereafter;
E. comfort and support measures during labor, birth and immediately thereafter;
F. fetal and maternal anatomy and their interrelationship as relevant to assessing the baby’s position and the progress of labor;
G. techniques to assist and support the spontaneous vaginal birth of the baby and placenta;
H. fluid and nutritional requirements during labor, birth and immediately thereafter;
I. maternal rest and sleep as appropriate during the process of labor, birth and immediately thereafter;
J. treatment for variations that can occur during the course of labor, birth and immediately thereafter, including prevention and treatment of maternal hemorrhage;
K. emergency measures and transport for critical problems arising during labor, birth or immediately thereafter;
L. appropriate support for the newborn’s natural physiologic transition during the first minutes and hours following birth, including practices to enhance mother–baby attachment and family bonding;
M. current biotechnical interventions and technologies that may be commonly used in a medical setting;
N. care and repair of the perineum and surrounding tissues;
O. third-stage management, including assessment of the placenta, membranes and umbilical cord;
P. breastfeeding and lactation;
Q. identification of pre-existing conditions and implementation of preventive or supportive measures to enhance client well-being during labor, birth, the immediate postpartum and breastfeeding.
IV. Postpartum Care
The midwife provides care, support and information to women throughout the postpartum period and determines the need for consultation, referral or transfer of care as appropriate. The midwife has knowledge and skills to provide care that include but are not limited to:
A. anatomy and physiology of the mother;
B. lactation support and appropriate breast care including treatments for problems with nursing;
C. support of maternal well-being and mother–baby attachment;
D. treatment for maternal discomforts;
E. emotional, psychosocial, mental and sexual variations;
F. maternal nutritional needs during the postpartum period and lactation;
G. current treatments for problems such as postpartum depression and mental illness;
H. grief counseling and support when necessary;
I. family-planning methods, as the individual woman desires.
V. Newborn Care
The midwife provides care to the newborn during the postpartum period, as well as support and information to parents regarding newborn care and informed decision making, and determines the need for consultation, referral or transfer of care as appropriate. The midwife’s assessment, care and shared information include but are not limited to:
A. anatomy, physiology and support of the newborn’s adjustment during the first days and weeks of life;
B. newborn wellness, including relevant historical data and gestational age;
C. nutritional needs of the newborn;
D. benefits of breastfeeding and lactation support;
E. laws and regulations regarding prophylactic biotechnical treatments and screening tests commonly used during the neonatal period;
F. neonatal problems and abnormalities, including referral as appropriate;
G. newborn growth, development, behavior, nutrition, feeding and care;
H. immunizations, circumcision and safety needs of the newborn.
VI. Women’s Health Care and Family Planning
The midwife provides care, support and information to women regarding their reproductive health and determines the need for consultation or referral by using a foundation of knowledge and skills that include but are not limited to:
A. reproductive health care across the lifespan;
B. evaluation of the woman’s well-being, including relevant health history;
C. anatomy and physiology of the female reproductive system and breasts;
D. family planning and methods of contraception;
E. decision making regarding timing of pregnancies and resources for counseling and referral;
F. preconception and interconceptual care;
G. well-woman gynecology as authorized by jurisdictional regulations.
VII. Professional, Legal and Other Aspects of Midwifery Care
The midwife assumes responsibility for practicing in accordance with the principles and competencies outlined in this document. The midwife uses a foundation of theoretical knowledge, clinical assessment, critical-thinking skills and shared decision making that are based on:
A. MANA’s Essential Documents concerning the art and practice of midwifery,
B. the purpose and goals of MANA and local (state or provincial) midwifery associations,
C. principles and practice of data collection as relevant to midwifery practice,
D. ongoing education,
E. critical review of evidence-based research findings in midwifery practice and application as appropriate,
F. jurisdictional laws and regulations governing the practice of midwifery,
G. basic knowledge of community maternal and child health care delivery systems,
H. skills in entrepreneurship and midwifery business management.