National Review of Nursing Education

Midwifery Education

Literature Review and Additional Material (Revised Edition)

1. Introduction

The quality, nature or process of education of midwives has not been seriously studied in Australia for nearly two decades. During this period, programs have moved from hospital locations and teaching to universities. The hospital programs and their regulating framework of the 70s and 80s were recognised as highly problematic (Barclay 1985) but, despite this, recent shifts in education have not been managed, monitored or evaluated. These factors are particularly significant given that, in the last decade, new models of maternity care have been developed in Australia and overseas in response to changes in government policies and the identification of strategies to better meet the needs of childbearing women (Tracy et al 2000, NHMRC 1996).

‘Midwives practising… [across]…the world face the same challenges as those in the UK and Europe: the challenges of re-humanising maternity care; of restoring the possibility of continuous and sensitive relationships between mothers and midwives from highly fragmented systems; of reducing high intervention rates; of restoring pride in the profession of midwifery. The basis of these reforms for all of us is the provision of appropriate education and preparation for modern day midwifery practice’. (Page 1997:5)²

The introduction of innovative maternity services has contributed to changes in the way midwives are educated overseas. In New Zealand, Canada, the United Kingdom and other European countries, the dominant form of preparation for practice is now through three and four-year courses rather than the routes that required students to be nurses first. In many European countries these educational systems have varied little over hundreds of years, while in the other nations considerable shifts have mirrored developments of understanding in maternity care. Innovative systems of educating midwives, which are not embedded in nursing education, are beginning to be developed in Australia. These developments have been associated with consensus and shared standards developed by the profession (unlike the previous developments associated with the transfer of midwifery education to universities).

In 2002, over 150 students commenced study in a three-year Bachelor of Midwifery in four universities in South Australia and Victoria. At least four other universities in New South Wales, ACT and Victoria are planning to start a three-year Bachelor of Midwifery (BMid) in 2003. The new BMid programs have been developed to simultaneously address:

Standards, perceived to have become problematic since the ad hoc transfer of midwifery education to universities,
Recruitment and retention issues for midwifery where there is a serious labour shortage for reasons that are different from those faced in nursing; and
Innovative models of maternity care that are increasingly different from acute care nursing models of care.

These changes to maternity care and midwifery education have occurred in the last ten-years, a period that also covers the transition from hospital located, to university managed, education. A review of midwifery education to critically appraise unique midwifery education issues is therefore necessary. Education issues in midwifery differ from those facing nursing education because of differences in the relevant literature, the required outcomes for employers, policy directions, and the need to respond to changes in the delivery of maternity care. In addition, in Australia, as elsewhere, midwives are licensed so they must be prepared at a level that enables them to function as practitioners in their own right, without having to undertake further education or training. This means that graduates of midwifery education programs should be capable of taking responsibility for the total care of a woman (and her baby) throughout the woman’s pregnancy, labour and birth, and the early postnatal period, referring to other health professionals only when complications arise.

Researchers at the Centre for Family Health and Midwifery (CFHM), University of Technology, Sydney (UTS) have carried out this Review and combined this with interim analyses from the Australian Midwifery Action Project (AMAP), a research project undertaken from the Centre. They have drawn on their expertise in midwifery research, education and practice and their links with national and international midwifery networks.

This report has therefore been informed by:

A substantive review of the published literature;
A report of the findings of the Australian Midwifery Action Project (AMAP) survey of midwifery education
A recent AMAP analysis of the impact of State and Territory regulations on the education and practice of midwives in Australia (Brodie & Barclay 2001);
An analysis of the development of the Australian Bachelor of Midwifery and the development of national standards by the Australian College of Midwives Incorporated (ACMI) for the accreditation of these new programs;
An analysis of the continuing education needs of Australian midwives with particular reference to the new models of care that are being developed in order to address the identified needs of child bearing women in both rural and urban settings;
An overview of midwifery development and education in the UK, Canada, New Zealand, the Netherlands and the USA, written in consultation with midwifery experts in those countries.

This report draws on an extensive literature search and relies on consensus development derived from expert opinion synthesised with empirically derived data when this exists. This process has enabled an analysis of midwifery education according to the major themes identified by the National Review of Nursing Education in the terms of reference, that is:

Models of midwifery education and training that focus on essential issues of articulation, competency, professional expertise and re-entry to the workforce;
The type of skills and knowledge required to meet the changing needs of the midwifery labour workforce and the identified needs of childbearing women;
Strategies to address recruitment and retention issues in midwifery and to encourage the commitment to reflective practice and life-long learning;
Strategies to ensure responsiveness to international lessons and compatibility in Australian midwifery education.

The major findings of this review have been organised to relate to the National Review of Nursing Education terms of reference.

Foot Notes:

2. Reviewers' emphasis

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