Subject benchmark statements
Health care programmes: Midwifery

Subject benchmark statements: Health care programmes

Subject benchmark statements provide a means of describing the nature and characteristics of programmes of study and training in health care. They also represent general expectations about standards for the award of qualifications at a given level and articulate the attributes and capabilities that those possessing such qualifications should be able to demonstrate.

Subject benchmark statements are used for a variety of purposes. Primarily, they are an important external source of reference when new programmes are being designed and developed. They provide general guidance for articulating the learning outcomes associated with the programme but are not a specification of a detailed curriculum. Benchmark statements provide for variety and flexibility in the design of programmes and encourage innovation within an agreed overall conceptual framework.

Subject benchmark statements also provide support in the pursuit of internal quality assurance. They enable the learning outcomes specified for a particular programme to be reviewed and evaluated against agreed general expectations about standards.

Finally, subject benchmark statements are one of a number of external sources of information that are drawn upon for the purposes of academic review* and for making judgements about threshold standards being met. Reviewers do not use subject benchmark statements as a crude checklist for these purposes however. Rather, they are used in conjunction with the relevant programme specifications, the associated documentation of the relevant professional and statutory regulatory bodies, the institution's own self evaluation documentation, together with primary data in order to enable reviewers to come to a rounded judgement based on a broad range of evidence.

The benchmarking of standards in health care subjects is undertaken by groups of appropriate specialists drawn from higher education institutions, service providers and the professional and statutory regulatory bodies. The statements represent the first attempt to make explicit in published form the general academic characteristics and standards of awards in these subjects in the UK. In due course, the statements will be revised to reflect developments in the subjects and the experiences of institutions, academic review and others that are working with it.

* academic review in this context refers to the Agency's arrangements for external assurance of quality and standards. Further information regarding these may be found in the Handbook for academic review, which can be found on the Agency's web site.

Foreword

This benchmark statement describes the nature and standards of programmes of study in midwifery, that leads to awards made by higher education institutions in the United Kingdom (UK) in the subject.

It has been developed in collaboration with a number of other health care professions and these are listed below. Although initial work was undertaken in subject specific groups, the analysis of these early drafts identified a number of features which all the subject groups shared. It was, therefore, agreed by each of the specialist benchmarking groups that their respective statements could be cast using a common structure. As work progressed it became increasingly apparent that there was considerable overlap within the details of the subject-specific statements and a common health professions framework was emerging. This emerging framework is, accordingly, displayed in each of the subject statements in order to illustrate on the one hand, the shared context upon which the education and training of health care professionals rests and, on the other, the uniquely profession-specific context within which programmes are organised. It is important to emphasise that benchmark statements are not cast in tablets of stone and will need to be revisited in the light of experience and further developments in health care. Moreover, we are confident that the emerging framework has the potential to embrace other health related professions such as social work, dentistry, medicine and other therapies. It is anticipated that further work in a second phase of the project could lead to an overarching health professions framework.

The initial section of this statement sets out the health professions framework under three main headings:

A Expectations of the health professional in providing patient/client services;

B The application of practice in securing, maintaining or improving health and well-being;

C The knowledge, understanding and skills that underpin the education and training of health care professionals.

The main section of this statement, in addition to describing the nature and extent of programmes leading to awards in midwifery, describes the profession-specific expectations and requirements under the same three categories.

The key feature in this statement, as in the associated statements, is the explicit articulation of the academic and practitioner standards associated with the award in midwifery. This duality reflects the significance of the academic award as the route to registration for professional practice and formal recognition by the professional and statutory regulatory bodies. The threshold standards set out the expectations of health professionals entering their first post immediately on qualification.

The section on standards accords with the relevant level descriptor for awards in the qualifications frameworks published by the Quality Assurance Agency for Higher Education.

The section on teaching, learning and assessment draws attention to the central role of practice in the design of learning opportunities for students and the importance of ensuring that professional competence developed through practice is adequately assessed and rewarded. It also notes how essential it is that the integration of theory and practice is a planned process within the overall arrangements made for teaching and learning.

The statement acknowledges the need to put the prospective client/patient at the centre of the student's learning experience and to promote within that experience the importance of team-working and cross-professional collaboration and communication. Implicit in the statement are the opportunities that exist for shared learning across professional boundaries, particularly in the latter stages of training when inter-professional matters can be addressed most productively. It is essential that the opportunities that exist for shared learning in practice are optimised, as well as best use being made of similar opportunities that prevail more obviously in classroom-based activities.

This statement and the associated statements will therefore allow higher education institutions, in partnership with service providers (where appropriate), to make informed curriculum choices about the construction of shared learning experiences. In this context shared learning is seen as one of a number of means of promoting improved collaborative practice and addressing a range of issues which span professional accountability and professional relationships.

Finally, the statement does not set a national curriculum for programmes leading to awards in midwifery. It acknowledges that the requirements of the professional and statutory regulatory bodies need to be incorporated into the design of programmes. It seeks to encourage higher education institutions and service providers to work collaboratively in the design and delivery of their curricula. Its essential feature is the specification of threshold standards, incorporating academic and practitioner elements, against which higher education institutions are expected, as a minimum, to set their standards for the award.

¹ Dietetics, Health Visiting, Midwifery, Nursing, Occupational Therapy, Orthoptics, Physiotherapy, Podiatry (Chiropody), Prosthetics and Orthotics, Radiography, and Speech & Language Therapy.

An emerging health professions framework

The subject specific statements for midwifery have been set within the emerging health professions framework outlined below. As indicated in the foreword, this framework developed as a result of the benchmarking work undertaken collaboratively by 11 different health professional groups. Further evolution of the framework is anticipated through a second phase of the project which will address its goodness of fit with a range of other health and social care professions benchmark statements.

A Expectations of the health professional in providing patient/client services

This section articulates the expectations of a registered professional within health and social care services. It describes what is regarded as a minimum range of expectations of a professional that will provide safe and competent practice for patients/clients in a variety of health and social care contexts.

A1 Professional autonomy and accountability

The award holder should be able to:

maintain the standards and requirements of professional and statutory regulatory bodies;
adhere to relevant codes of conduct;
understand the legal and ethical responsibilities of professional practice;
maintain the principles and practice of patient/client confidentiality;
practise in accordance with current legislation applicable to health care professionals;
exercise a professional duty of care to patients/clients/carers;
recognise the obligation to maintain fitness for practice and the need for continuing professional development;
contribute to the development and dissemination of evidence-based practice within professional contexts;
uphold the principles and practice of clinical governance.

A2 Professional relationships

The award holder should be able to:

participate effectively in inter-professional and multi-agency approaches to health and social care where appropriate;
recognise professional scope of practice and make referrals where appropriate;
work, where appropriate, with other health and social care professionals and support staff and patients/clients/carers to maximise health outcomes;
maintain relationships with patients/clients/carers that are culturally sensitive and respect their rights and special needs.

A3 Personal and professional skills

The award holder should be able to:

demonstrate the ability to deliver quality patient/client-centred care;
practise in an anti-discriminatory, anti-oppressive manner;
draw upon appropriate knowledge and skills in order to make professional judgements, recognising the limits of his/her practice;
communicate effectively with patients/clients/carers and other relevant parties when providing care;
assist other health care professionals, support staff and patients/clients/carers in maximising health outcomes;
prioritise workload and manage time effectively;
engage in self-directed learning that promotes professional development;
practise with an appropriate degree of self-protection;
contribute to the well-being and safety of all people in the work place.

A4 Profession and employer context

The award holder should be able to:

show an understanding of his/her role within health and social care services;
demonstrate an understanding of government policies for the provision of health and social care;
take responsibility for his/her own professional development;
recognise the value of research and other scholarly activity in relation to the development of the profession and of patient/client care.

B The application of practice in securing, maintaining or improving health and well-being

All health care professionals draw from the knowledge and understanding associated with their particular profession. This knowledge and understanding is acquired from theory and practice. It forms the basis for making professional decisions and judgements about the deployment in practice of a range of appropriate skills and behaviours, with the aim of meeting the health and social care needs both of individual clients/patients and of groups, communities and populations. These decisions and judgements are made in the context of considerable variation in the presentation, the setting and in the characteristics of the client/patient health and social care needs. They often take place against a backdrop of uncertainty and change in the structures and mechanisms of health and social care delivery.

Sound professional practice is essentially a process of problem solving. It is characterised by four
major phases:

the identification and analytical assessment of health and social care needs;
the formulation of plans and strategies for meeting health and social care needs;
the performance of appropriate, prioritised health promoting/health educating/caring/diagnostic/therapeutic activities;
the critical evaluation of the impact of, or response to, these activities.

B1 Identification and assessment of health and social care needs

The award holder should be able to:

gather relevant information from a wide range of sources including electronic data;
adopt systematic approaches to analysing and evaluating the information collected;
communicate effectively with the client/patient, (and his/her relatives/carers), group/community/population, about their health and social care needs;
use a range of assessment techniques appropriate to the situation and make provisional identification of relevant determinants of health and physical, psychological, social and cultural needs/problems;
recognise the place and contribution of his/her assessment within the total health care profile/package, through effective communication with other members of the health and social care team.

B2 Formulation of plans and strategies for meeting health and social care needs

The award holder should be able to:

work with the client/patient, (and his/her relatives/carers), group/community/population, to consider the range of activities that are appropriate/feasible/acceptable, including the possibility of referral to other members of the health and social care team and agencies;
plan care within the context of holistic health management and the contributions of others;
use reasoning and problem solving skills to make judgements/decisions in prioritising actions;
l formulate specific management plans for meeting needs/problems, setting these within a timescale and taking account of finite resources;
l record professional judgements and decisions taken;
l synthesise theory and practice.

B3 Practice

The award holder should be able to:

conduct appropriate activities skilfully and in accordance with best/evidence-based practice;
contribute to the promotion of social inclusion;
monitor and review the ongoing effectiveness of the planned activity;
involve client/patient/members of group/community/population appropriately in ongoing effectiveness of plan;
maintain records appropriately;
educate others to enable them to influence the health behaviour of individuals and groups;
motivate individuals or groups in order to improve awareness, learning and behaviour that contribute to healthy living;
recognise opportunities to influence health and social policy and practices.

B4 Evaluation

The award holder should be able to:

measure and evaluate critically the outcomes of professional activities;
reflect on and review practice;
participate in audit and other quality assurance procedures;
contribute to risk management activities.

C Knowledge, understanding and skills that underpin the education and training of health care professionals

The education and training of health care professionals draws from a range of well-established scientific disciplines that provide the underpinning knowledge and understanding for sound practice. Each health care profession will draw from these disciplines differently and to varying extents to meet the requirements of their specialty. It is this contextualisation of knowledge, understanding and skills that is characteristic of the learning in specific health care programmes. Consequently, in this introductory section, the attributes and capabilities expected of the student are expressed at a generalised level.

C1 Knowledge and understanding

The award holder should be able to demonstrate:

understanding of the key concepts of the disciplines that underpin the education and training of all health care professionals, and detailed knowledge of some of these. The latter would include a broad understanding of:
the structure and function of the human body, together with a knowledge of dysfunction and
pathology;
health and social care philosophy and policy, and its translation into ethical and evidenced based
practice;
the relevance of the social and psychological sciences to health and healthcare;
the role of health care practitioners in the promotion of health and health education;
the legislation and professional and statutory codes of conduct that affect health and social care
practice.

C2 Skills

Information gathering

The award holder should be able to demonstrate:

an ability to gather and evaluate evidence and information from a wide range of sources;
an ability to use methods of enquiry to collect and interpret data in order to provide information that would inform or benefit practice.

Problem solving

The award holder should be able to demonstrate:

logical and systematic thinking;
an ability to draw reasoned conclusions and sustainable judgements.

Communication

The award holder should be able to demonstrate:

effective skills in communicating information, advice, instruction and professional opinion to colleagues, patients, clients, their relatives and carers; and, when necessary, to groups of colleagues or clients.

Numeracy

The award holder should be able to demonstrate:

ability in understanding, manipulating, interpreting and presenting numerical data.

Information technology

The award holder should be able to demonstrate:

an ability to engage with technology, particularly the effective and efficient use of information and communication technology.

Benchmark statement for midwifery

Introduction

Midwives work with women and their families to assess their needs and to determine and provide programmes of care and support prior to conception and throughout the antenatal, intranatal and postnatal periods. They focus on providing holistic care which respects individual needs, choices and cultures in a variety of contexts. Legislation enables midwives to carry out their role autonomously, while expecting them to work in partnership with others and across professional boundaries when this is in the best interests of women and their families. Midwives work in and across a wide range of settings, from women's homes to acute hospitals. They also make a significant contribution to the wider public health agenda.

The UKCC has specified: "The minimum academic standard of pre-registration midwifery programmes remains that of a diploma of higher education." (UKCC, 2000). All midwifery programmes are evolving and while meeting this UKCC minimum standard, there is a diversity of routes and awards evident in all four countries of the UK. The profession is moving towards graduate entry, which properly recognises the increasing complexity of the subject and the responsibility and autonomy of midwives. This benchmark statement articulates what midwives are able to do at the point of registration. It is recognised that registration on part 10 of the UKCC Professional register may be obtained by those who exit with a diploma in higher education, a Scottish ordinary degree as well as an honours degree.

Nature and extent of programmes in midwifery

This section describes midwifery as an applied academic discipline recognising that while the profession is moving towards all graduate status some students may exit the programme with the minimum UKCC requirement of diploma in higher education. Irrespective of the academic award individuals undertaking programmes that lead to registration on Part 10 of the UKCC Professional Register must achieve the UKCC Midwifery Competencies.

Midwifery programmes involve integrated study of the following:

the subject knowledge, understanding and associate skills that are required;
the essential learning and assessment arrangements for programmes in the subject;
the academic and practitioner standards that need to be demonstrated.

This benchmark statement, embraces the learning outcomes and competencies required for professional practice as defined by the UKCC in Midwives Rule 33 and the Registrar's Letter 35/2000 respectively. It also encompasses the requirements of the European Union Midwives Directive (80/155/EEC Article 4). The standards described in this statement relate, consequently, to both academic and practitioner attributes and capabilities.

The International Confederation of Midwives (ICM), the International Federation of Gynaecologists and Obstetricians (FIGO), and the World Health Organisations (WHO) have adopted the following definition of a midwife:

'A midwife is a person who, having been regularly admitted to a midwifery educational programme, duly recognised in the country in which it is located, has successfully completed the prescribed course of studies in midwifery and has acquired the requisite qualifications to be registered and/or legally licensed to practise midwifery.

'She must be able to give the necessary supervision, care and advice to women during pregnancy, labour and the postpartum period, to conduct deliveries on her own responsibility and to care for the new-born and the infant. This care includes preventative measures, the detection of abnormal conditions in mother and child, the procurement of medical assistance and the execution of emergency measures in the absence of medical help. She has an important task in health counselling and education, not only for the women, but also within the family and the community. The work should involve antenatal education and preparation for parenthood and extend to certain areas of gynaecology, family planning and child care. She may practise in hospitals, clinics, health units, domiciliary conditions or in any other service.'

The above definition places a sharp focus on the nature of midwifery as an applied academic subject, underpinned by the human biological sciences and the social sciences, in particular psychology and sociology. However, it is not driven by such propositional knowledge alone, because its mastery requires proficiency in a range of cognitive, affective and psychomotor skills. It is the integration of these underpinning elements through the coherent planning of programmes which establishes the basis for midwives to provide care which is woman centred and focused on the premise that childbirth is (normally) a natural, physiological and important event in women's lives.

The midwife's role also centres on the woman in the family context. The care of the family during childbearing is central to the definition of the discipline and as such the boundaries of the discipline/profession articulate with other health and social care professions.

The pre registration midwifery programmes of education and training are built around university and practice-based learning. The sound organisation of these two elements, enables students to develop autonomy and confidence and to emerge as competent practitioners with the capacity to work effectively in women's homes, hospital, community clinics, or other settings as part of a broadly based health and social care team.

The following principles inform the design and delivery of the programme leading to registration on Part 10 of the UKCC Professional Register:

a midwife is an independent, autonomous practitioner and provides holistic, woman-centred midwifery care prior to conception and throughout the antenatal, intranatal and postnatal periods;
a midwife plays a key role in health promotion and within the public health agenda.
partnership and effective communication with women is central to a unique relationship;
a midwife works in collaboration with other health care professionals to provide seamless care and appropriate interventions that enhance outcomes;
a midwife achieves quality care through using best available evidence, research, and audit of practice;
midwifery knowledge and practice are dynamic and responsive to the changing needs of society;
midwifery practice is moral and ethical with the rights, beliefs and values of others acknowledged and respected in a multi-dimensional society.

A Expectations of the midwife as a professional

This section of the benchmark statement articulates the requirements of a registered midwife at the point of qualification. The core expectations that are common to all health care professionals can be found in section A of the emerging health professions framework. Listed below are the attributes required of a midwife.

A1 Professional autonomy and accountability

The award holder should be able to:

maintain the standards of practice required by the statutory regulatory body;
recognise the political and ideological influences on midwifery practice;
adhere to the Midwives Rules and Code of Conduct;
recognise the contribution of different approaches to management and leadership in midwifery settings;
understand the relationship between professional codes defining ethical practice in the maternity services, the regulation of professional conduct and management of potential conflicts and dilemmas;
understand and apply ethical theories to midwifery practice in the management of dilemmas and conflicts in both interpersonal and professional contexts;
understand the contribution of statutory supervision of midwives to clinical governance;
have an understanding of the art and culture of midwifery and its effect on childbirth outcomes and modern day practice;
demonstrate application of knowledge and skills derived from the profession and practice of midwifery, both historical and contemporary, including global perspectives, which involves listening to childbirth stories from women and midwives;
have an understanding of the legal and statutory framework that governs midwifery practice, including supervision of midwives and the role of the midwife in public protection;
challenge the philosophies and beliefs about the nature of knowledge which lead to particular approaches and priorities for research;
accept responsibility and accountability, at the same time acknowledging the boundaries of professional competence.

A2 Professional relationships

The award holder should be able to:

participate effectively in multiprofessional approaches to health care, in a range of different settings, within and outside the NHS;
demonstrate the capability to act co-operatively with others, liaising and negotiating across organisational and professional boundaries and differences of identity or language;
handle inter-personal and intra-personal conflict constructively;
understand and manage changing situations and respond in a flexible manner;
consult actively with others, including users of the maternity services, who hold relevant information
or expertise;
contribute to initiatives and developments to improve the health and well-being of women, babies
and families;
develop effective skills in team building, group activities and organisation of others;
identify risk factors and be able to justify practice in the light of risk management frameworks and clinical governance.

A3 Personal and professional skills

The award holder should be able to:

take action on own responsibility including the initiation of the action of other disciplines and know when to refer;
recognise own learning needs and independently advance learning and understanding;
reflect on and modify behaviour in light of experience, and take action where necessary;
identify and keep under review own personal and professional boundaries;
challenge unacceptable practices in a responsible manner based on the critical review and dissemination of research and audit findings;
be aware of effective strategies for coping with personal stress;
apply the principles of health promotion and education to midwifery practice;

A4 Profession and employer context

The award holder should be able to:

demonstrate an understanding of the midwives role when supporting the woman's choice;
demonstrate an ability to use resources effectively and adapt where necessary to meet changes in demand on midwifery services;
create and maintain environments which promote the health, safety and well- being of women, babies and others;
show understanding of strategies for managing personal safety particularly within the domiciliary setting;
display skills in management of self in relation to time management, uncertainty, change and stress in work situations;
demonstrate ability to maximise the use of available resources;
show understanding of the way in which midwives can have a positive influence on political agendas;
demonstrate an understanding of government policies for the provision of maternity care;

B The application of practice in midwifery

B1 Assessment and identification of care needs

The award holder should be able to:

diagnose pregnancy and in partnership with women undertake a systematic assessment of their individual needs, where applicable, prior to conception and throughout the antenatal, intranatal and postnatal stages;
help women to reflect on their own, and their family's health to make informed choices to improve health;
help women to make a choice, by providing essential information to inform the decision;

B2 Formulation of plans and strategies

The award holder should be able to:

formulate and negotiate with women, programmes of care and support within available resources;
use skills derived from problem solving techniques to prioritise needs of individuals within a variety of environments;
within the overall care programme, refer women, when necessary, to others with appropriate skills and expertise;
identify actual and potential risks to women, babies and self and establish a safe environment for care;
make contemporaneous records of professional judgements, decisions and action taken.

B3 Focused activity

The award holder should be able to provide care throughout the childbearing continuum and in particular:
in partnership with women, provide care during the antenatal period;
monitor and support women during labour and assess the condition of the fetus;
assist women to give birth safely in a variety of environments;
examine and care for babies immediately following birth;
in partnership with women, provide and/or arrange care for mother and baby during the postnatal period;
demonstrate the safe application of a range of essential psychomotor skills to meet individuals' needs and undertake appropriate interventions and emergency procedures when necessary;
monitor and review the effectiveness of programmes of care in partnership with the woman;
apply evidence based knowledge to inform decision making;
provide effective programmes of preparation for pregnancy, birth, parenting, family spacing and sexual health for women and their significant others;
use appropriate interpersonal skills to communicate effectively;
maintain records in accordance with agreed procedures and professional standards.

B4 Evaluation

The award holder should be able to:

evaluate changes in health care and respond appropriately;
monitor and evaluate programmes of care and support, in partnership with women;
modify programmes in light of experience, audit and other evidence-based judgements;
use skills of reflection to evaluate continually and optimise the care of women, babies and families;
through the frameworks of quality assurance and risk management evaluate the safety of the care environment and recognise situations in which quality of care might be compromised.

C Subject knowledge, understanding and associated skills that underpin the education and training of midwives

This section demonstrates the knowledge , understanding and associated skills that are essential to underpin informed, safe and effective midwifery practice.

C1 Knowledge and understanding

The award holder should be able to demonstrate understanding of:

Midwifery

holistic, woman-centred midwifery care
medical disorders and mental ill health and disabilities which may have significance to childbirth and parenting
organisational and professional systems
common factors, which contribute to, and those, which adversly affect the physical, emotional and social well being of the mother and baby
the birth process to assist women to give birth safely in a variety of settings
the physical and behavioural characteristics of a normal baby
the needs, treatment and management of a pre term and ill neonates
capacity to act on own responsibility
the multi disciplinary multi agency approach to the management of substance use and misuse during pregnancy, labour and postnatal periods
medical devices and equipment in common use in maternity services
skills derived from professional midwifery practice, of historical and contemporary, local and global perspectives, in order that the experiences of women and midwives inform and improve practice
screening and prevention programme
how patterns of care are determined
the role of the midwife in child protection, domestic violence, adoption, fostering and surrogacy

Life sciences

the anatomy , physiology and patho physiology necessary to underpin reproductive health and midwifery practice
genetics , inheritance and the effect on fertility
assisted reproduction
growth ,and development of the embryo, fetus and neonate
nutrition in relation to the needs of women before conception, during pregnancy, in the puerperium including infant feeding and healthy eating for the family
fetal development and adaptation to extra uterine life
pharmacology and administration of pharmacological preparations and complementary therapies and the effect on pregnant, labouring and lactating women, the fetus and neonate
the short and long term actions and effects of substance use and misuse on the woman fetus and infant
microbiology in relation to reproductive health

Social, health and behavioural sciences

the cultural, social, psychological and educational factors which influence pregnancy, childbirth, parenting and midwifery practice
the nature of midwifery in a diverse society and the impact of prejudice; inter personal, institutional and structural discrimination, empowerment and anti discriminatory practice
psychosocial influences which determine human behaviour in relation to the childbearing process, including the social processes which lead to marginalisation, isolation and exclusion and the impact on the provision of maternity care
the impact of health and social policy, political and ideological influences on contemporary midwifery practice and organisation of maternity care
contribution of demographic and epidemiological evidence to the outcomes of maternity services and use of the knowledge to improve public health
communicating with women and their partners according to context
interpersonal skills to develop caring, therapeutic and empowering relationships with women, their partners and families
effective communication with individuals and organisations
inequality and differential needs faced by users of maternity services

Ethics law and humanities

moral, legal and ethical framework in relation to conception, pregnancy, pregnancy loss, birth, parenting and family relationships
the importance of legislation relating to human rights, equal opportunities, record keeping and access to medical records
legislative, legal and statutory framework that govern midwifery practice
the responsibilities of the midwife and the relationship to statutory supervision
the midwive's role in relation to statutory requirements for notification and registration of births and deaths
participation in the risk management process and the clinical governance framework in maternity services and the health care environment
the relevant legislation which underpins the administration of a range of drugs and complementary therapies

Management of self and others

ability to be able to prioritise and plan care appropriately
the principles of reflection in and on practice
the principles of management within organisations
clinical governance and maintaining and monitoring standards

C2 Skills

Communication and interpersonal skills

communicate effectively across all potential barriers resulting from differences (for example in culture, language and age) using both verbal and non verbal cues
demonstrate sensitivity and empathy for women and partners experiencing loss and bereavement
demonstrating advocacy and negotiation skills to support women in their childbirth choices
provide information in a way which facilitates the woman making an informed choice
observing and listening actively to others engaging appropriately with life experiences of child bearing women
appreciating the viewpoints of others and overcoming personal prejudices to respond appropriately to a range of complex personal and interpersonal situations
ability to write contemporaneous, accurate and clear reports setting out the purpose and context of communication, and to communicate verbally , in writing or electronically
demonstrate effective presentation skills

Information gathering and analysis

audit and evaluate practice and use research to improve practice
ability to use research studies, confidential enquiries and epidemiological data related to pregnancy, childbirth and the neonate
using the best available evidence to challenge midwifery practice
ability to use knowledge to identify and take appropriate action
ability to appraise systems of care and contribute to the development of policy guidelines
ability to access a range of databases to find the evidence for practice

Care delivery

demonstrate competence, dexterity and sensitivity in the full range of skills and procedures as detailed in the EC Directives and set out by the statutory regulatory body

Problem solving and data collection and interpretation

ability to plan care in light of relevant research and best evidence

Information technology

ability to use relevant electronic patient information systems
integrate skills using information technology systems to contribute to the management and development of midwifery care

Numeracy

demonstrating numeracy in relation to prescription and administration of drugs to pregnant and postpartum women and the neonate

Teaching, learning and assessment

Decisions about the strategies and methods for teaching, learning and assessment are for institutions to determine, but should complement the learning outcomes associated with health profession programmes. It is not for benchmark statements to promulgate any one, or combination of, approaches over others. However, this benchmark statement promotes an integrative approach to the application of theory and practice. It underlines the significance attached to the design of learning opportunities that facilitate the acquisition of professional capabilities and to assessment regimes that ensure these are being both delivered and rewarded to an appropriate standard. Fundamental to the basis upon which students are prepared for their professional career, is the provision of programmes of academic study and practice-based learning which lay the foundation for career-long professional development and lifelong learning to support best professional practice and the maintenance of professional standards.

Teaching, learning and assessment in midwifery

The pre-registration midwifery programmes are structured to reflect the complexity of independent midwifery practice alongside the midwife's multi-faceted role as a member of different health and social care teams. The integration of university and practice based learning is explicit across a wide variety of learning environments., Students' prior learning and experiences will be capitalised upon and developed alongside the acquisition of essential new knowledge and skills which will be adapted according to maternity care contexts. The overall aims and final outcomes of the award together with the available learning environments and specific topic requirements should inform the progression staging points and the learning and teaching strategies and assessment methods.

Effective learning requires appropriate and supportive learning environments. From the outset of the programme students need to be assisted in the effective use of theory in practice and the use of practice to inform theory, as well as the development of essential observational, communication and psychomotor skills. Early targeted visits to midwifery practice areas with university teachers/lecturers, as well as specific placements with midwife practitioners, will enable students to understand the breadth and depth of knowledge and understanding that are needed to underpin competent midwifery practice. Placements in appropriate non-midwifery settings and with other health professionals will provide opportunities to develop broader clinical skills and multi-professional teamwork. Consideration needs to be given to the length, continuity and variety of practice settings, midwife mentors, and practice educators that will enable students to experience the full scope of midwifery practice. Opportunities for multiprofessional learning to enhance a team approach to the care of women should be capitalised upon. The final two to three months of the programme should be designated as a period of consolidation to assist students gain confidence in their capabilities to be autonomous midwife practitioners.

The learning is facilitated by appropriately qualified and experienced lecturers in the university and mentors in practice who are academically and clinically credible. The learning process can be expressed in terms of three inter-related themes:

Multiple ways of knowing:

the woman's perspective, research and other relevant evidence from a broad subject field, the multi-professional reflexivity perspective and awareness and motivation to engage in new ways of thinking and acting.

Student centred learning:

to include approaches which are manipulated by wide ranging prior knowledge and experiences, the various contexts and environments experienced by women with very different needs together with peer, teacher/lecturer and practice based mentor/assessor feedback on performance. These approaches will enable students to be self-critical and make adjustments to their attitudes and goals. They will also be facilitated to understand the need for self-directed and lifelong learning.

Holistic and specific skills learning:

which encompass key midwifery skills and the ability to integrate skills and knowledge with relevant contextual understanding to target midwifery care according to individualised holistic needs and health priorities.

The pre-registration midwifery programme acknowledge the wide entry gate for students and the expectation that they will learn at different rates and in diverse ways. Students need, therefore, to develop their preferred learning style, and also to learn new learning styles to equip them for the breadth, depth and differing speed of responses needed to cope with complexity and change in midwifery practice. A variety of learning and teaching strategies is required to enable this process.

Learning approaches may include:

enquiry based learning/problem based learning which enables students to participate actively in setting the learning agenda, to frame/reframe and solve problems and to learn from each other;
small group inter-professional learning (in the learning about each other context when objectives are shared, rather than learning about subjects together) to enhance multi-professional/multi-agency teamwork;
use of real life scenarios, lectures, role play, simulation of practice situations that are infrequently encountered, individual and group experiences and reflection on the practice of others, seminars, skills learning in laboratory and practice environments, computer assisted learning , learning journals/diaries and reflection on the development of learning, individual and group tutorials;
use of a variety of communication strategies and information technology systems and understanding of different research methodologies to enhance informed choice and relationships with women and their families as well as providing evidence for improving practice.

Assessment strategies should recognise the inter-dependent nature of theory and practice and hence incorporate a tripartite partnership between student, university midwife teacher/lecturer and practice-based mentors/assessors. Assessors must be both academically and clinically credible and assessment should take place in the contexts which are most appropriate for making valid assessment judgements. This can only be achieved if practice based mentors are given appropriate preparation and time to undertake this role. Midwife lecturers need to support the mentors by being visible on a regular basis in the midwifery practice placements.

Pre-registration midwifery programmes assess competence in practice on a continuous basis so that a repertoire of skills are assessed, as well as the capability to integrate knowledge and skills with relevant contextual understanding and empathy to provide holistic midwifery care.

Methods of assessment should include: student's portfolio of learning which draws upon evidence from practice, research and scholarship; essays, examinations, case studies, seminar papers, poster presentations, critical incidents, health promotion packages etc. Academic assessment is designed to be diagnostic, developmental and to test cognitive skills, drawing on the contexts of midwifery practice and reflecting the learning and teaching methods employed.

Academic and practitioner standards

As midwifery is both an academic and a professional discipline, these standards represent an integration of both academic and practice capabilities. The professional requirements are incorporated into the award, which means that students achieving all standards assessed through academic and practice modes will also have met the standards set by the statutory regulatory body for entry to part 10 of the Professional Register (UKCC 2000)

All students successfully completing the midwifery programme will have achieved a diploma in higher education award, minimum standard, or an honours degree.

The following statements are commensurate with the Honours Degree academic award and are in addition to the diploma for entry to the Professional Register.

Diploma

The following statements are commensurate with the diploma in higher education academic award and are the threshold standard for entry to Part 10 of the UKCC Professional Register.

A The midwife as a professional will:

The award holder should be able to:

demonstrate the ability to make autonomous decisions as the lead professional in individual midwifery cases, recognising the limits of her own personal and professional skills;
work as a collaborative member of multi-professional team in a range of settings;
recognise the importance of research and scholarly activity in informing midwifery practice;
demonstrate skills in health promotion which facilitate enhanced well-being for women and their families;
understand own responsibility in relation to statutory supervision of midwives, clinical governance and risk management;
demonstrate a commitment and capacity to update knowledge and skills in response to changing circumstances and scope of practice;
demonstrate ability to guide and supervise the work of others;
demonstrate the capability to take necessary emergency measures within the limitations of professional knowledge and expertise;
demonstrate professional and interpersonal skills and attitudes to enable communication with women according to context;
develop an insight into the process of reflection to enhance and update own practice;
practise in accordance with codes and rules governing professional conduct in the practice of midwifery and health and safety in the workplace;

Honours Degree

critically analyse the evidence to support decisions made as a lead professional in midwifery care, recognising the limits of professional knowledge and expertise.
demonstrate an in-depth understanding of the roles of the multi professional team, to use their expertise appropriately and work collaboratively as a member of the team in a variety of settings.
critically appraise research in order to improve care delivery
demonstrate skills in health promotion and evaluate the effect on women and their families;
understand and evaluate statutory supervision of midwives and its relationship to clinical governance and risk management;
analyse the knowledge and skills required for contemporary practice and the commitment to update in response to changing circumstances and scope of practice;
confidently apply knowledge base to provide appropriate levels of guidance and supervision of others;
critically examine and demonstrate the skills required to take necessary emergency measures within the scope of practice;
analyse use of own and other personal and professional communication skills
work effectively as a reflective practitioner to enhance and update own practice
practice in accordance with, whilst evaluating the codes and rules governing professional conduct in midwifery practice;

B Application of midwifery:

Diploma

diagnose pregnancy and, in partnership with women, assess their individual needs and monitor progress prior to conception and throughout the, antenatal, intranatal, and postnatal periods;
demonstrate respect for the rights, beliefs and preferences of others and confidentiality of privileged information;
demonstrate interpersonal skills and psychomotor dexterity in supporting both women and their partners during pregnancy, labour and the postnatal period;
demonstrate competence in carrying out the tests and examinations necessary to monitor and promote the health and well-being of childbearing women the fetus and new-born;
calculate drug dosages and administer drugs and, where appropriate, complementary therapies within agreed protocols and in accordance with the women's wishes;
negotiate and formulate with individuals and groups of women, programmes of preparation for pregnancy, childbirth and parenthood;
demonstrate capability to advise women and their families on healthy living and in particular to support women with infant feeding;
assess needs and preferences in relation to sexual health and family planning;
advise women on the examinations that might be necessary to diagnose pregnancies and labours at risk and refer appropriately;
demonstrate capability to undertake emergency procedures and call on appropriate others to meet the needs of women and babies;
provide, in seamless partnership with others, the necessary care of women and babies when the social context of care or of childbearing is complicated;
evaluate programmes of care and modify in the light of experience, research and women's decisions, to enhance outcomes;
keep contemporaneous and accurate records of practice;
initiate and respond to changes in midwifery practice in the light of evidence and research.

Honours Degree

demonstrate the ability to assess and implement the appropriate care management to meet womens' needs and monitor progress prior to conception and throughout the antenatal, intranatal and postnatal periods, drawing upon a range of evidence to inform the decisions made.
demonstrate an in-depth understanding of the rights of individuals taking into account social, cultural and spiritual needs and the effect this has on the child bearing process;
demonstrate psychomotor skills and critically reflect on the interpersonal skills required to meet individual needs of mothers in different situations throughout pregnancy, labour and postnatal period;
demonstrate critical understanding of and competence in carrying out tests and examinations necessary to monitor and promote the health and well-being of childbearing women the fetus and new-born;
critically examine the use of pharmacological methods and complementary therapies within midwifery practice;
negotiate and formulate and critically evaluate with individuals and groups of women, programmes of preparation for pregnancy, childbirth and parenthood, develop programmes to meet the needs of women/parents;
analyse own and others advice to women and their families on health living and in particular on infant feeding;
undertake and critically analyse the public health role of the midwife, with reference to sexual health and family planning;
critically reflect and evaluate the examinations necessary to diagnose pregnancies and labours at risk and refer appropriately;
confidently apply knowledge base to undertake emergency procedures and refer to appropriate professional when required;
investigate the partnership in order to provide a seamless approach to care of mothers and babies when the social context of care or of childbearing is complicated
challenge care management, where appropriate, in light of research, experience and mothers wishes;
critically reflect on and review mothers / baby records.
critically evaluate research findings and instigate changes to practice as appropriate;

C Midwifery subject knowledge and understanding.

Diploma

show understanding and acknowledgement of the rights, beliefs and preferences of others;
provide individual women with the information to make informed choices;
draw on knowledge and show awareness of the factors which affect and are affected by pregnancy, childbirth and parenthood, in order to plan strategies and solve problems with childbearing women;
discriminate between the use and misuse of technology and drugs in providing safe and ethical maternity services;
draw on knowledge of systematic enquiry to critique and evaluate published materials of relevance to the maternity services and health of childbearing women;
communicate with midwives and others involved in the maternity service through listening, sharing information, research findings, ideas, problems and solutions;
understand the difference between statutory requirements and professional codes of practice and conduct;
exercise judgement and responsibility based on available evidence to work with women in achieving the best possible birth outcomes;
demonstrate key transferable skills including: IT, numeracy, verbal, written communication and ability to reflect on learning and experience and to use this reflection to inform future practice and learning;

Honours degree

show understanding and acknowledgement of the rights, beliefs and preferences of others and critically review structures which mitigate against these.
synthesise and evaluate the evidence from a range of sources to provide individual women with the information to make informed choices;
critically analyse the factors which are affected by pregnancy, childbirth and parenthood and the potential influence these have on the individual family and community;
critically examine the use and misuse of technology and drugs in providing safe and ethical maternity services;
critically reflect on the knowledge underpinned by research with regard to the maternity service and the health of the childbearing woman;
communicate with midwives and others involved in the maternity service through listening, sharing information, research findings, ideas, problems and solutions and analyse the communication systems within the maternity services;
articulate the difference between the statutory requirements and the professional code of conduct;
critically reflect on the effectiveness of personal and professional judgement to achieve the best possible birth outcome;
demonstrate confidence in key transferable skills; IT, numeracy, verbal, written communication and ability to reflect on learning and experience and to use this reflection to inform future practice and learning;

Appendix 1

Midwifery benchmark group membership

Mrs Elizabeth Bannon Royal Hospitals Trust, Belfast

Mrs Valerie Beale Somerset Health Authority

Dr Diane Fraser University of Nottingham

Ms Valerie Hall (facilitator) University of Brighton

Miss Joan Milne Grampian University Hospitals Trust

Professor Tricia Murphy-Black University of Stirling

Ms Robyn Phillips Welsh National Board for Nursing, Midwifery and Health Visiting

Mrs Judith Porch University of Teesside

Mrs Myfanwy Povey University of Wales Bangor

Appendix 2 Benchmark steering group membership

Mrs Margaret Andrews North East Wales Institute of Higher Education

Mr David Ashcroft Society of Chiropodists & Podiatrists

Mrs Linda Auty Leeds Metropolitan University

Miss Lesley Barrowman National Board for Nursing, Midwifery &
Health Visiting for Northern Ireland

Mrs Valerie Beale Somerset Health Authority

Ms Mary Boyle National Board for Nursing, Midwifery & Health Visiting for Scotland

Mrs Ann Clarke Bedford Hospital NHS Trust

Ms Helen Davis Royal Hallamshire Hospital, Sheffield

Professor Anne de Looy Queen Margaret University College, Edinburgh

Miss Faye Doris University of Plymouth

Mr Martin Duckworth College of St Mark & St John, Plymouth

Mr Brian Ellis Queen Margaret University College, Edinburgh

Miss Anne Fagan (deceased) Hospital of St John & St Elizabeth, London

Mrs Janice Gosby UK Central Council for Nursing, Midwifery & Health Visiting

Ms Valerie Hall University of Brighton

Mrs Julia Henderson University of Hertfordshire

Ms Anne Hopkins University of Wales Swansea

Mr Stephen Hutchins University of Salford

Mr Tom Langlands English National Board for Nursing, Midwifery and Health Visiting

Ms June Leishman University of Abertay, Dundee

Professor Jeffrey Lucas University of Bradford

Professor Dame University of Southampton
Jill Macleod-Clark (co-chair)

Ms Diane Marks-Maran Thames Valley University

Mrs Susan Montague University of Hertfordshire

Mrs Christine Mullen South Manchester University Hospital NHS Trust

Mr Luke O'Byrne East Berkshire NHS Trust

Mrs Audrey Paterson Canterbury Christ Church University College

Ms Robyn Phillips Welsh National Board for Nursing, Midwifery & Health Visiting

Professor Mike Pittilo (co-chair) Kingston University & St George's Medical Hospital

Ms Lorna Povey Wolverhampton Health Care NHS Trust

Mrs Jarina Rashid-Porter Coventry Healthcare NHS Trust

Mr Gwilym Roberts College of Occupational Therapists

Ms Jenny Routledge University of East Anglia

Mr Ian Rutherford University of Nottingham

Mrs Sandra Sexton University of Strathclyde

Ms Gail Stephenson University of Liverpool

Professor Averil Stewart Queen Margaret University College, Edinburgh

Professor Mary Watkins University of Plymouth

Subject benchmark statements Health care programmes: Midwifery

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