Throughout this course, you will hear the words midwife and midwifery many times. But what exactly do we mean when we say these terms? What is your working definition, and perception about midwives? Take a moment to consider the following questions. How would you define a midwife? Do you consider a midwife more or less educated or trained then a nurse? What's the difference between a midwife and a doula? There are many misconceptions surrounding what a midwife is and what a midwife does. At least that is the case in the United States, public perception or understanding is likely different around the globe. In this lesson, you will learn the definition of a midwife according to the International Confederation of Midwives and the Lancet series, and identify different characteristics of this health care profession. You will also learn about the full scope of care that can be provided by midwives given the parameters of the setting. The International Confederation of Midwives defines, "A midwife is a person who has successfully completed a midwifery education program that is duly recognized in the country where it is located. That is based on the International Confederation of midwives, essential competencies for basic midwifery practice, and the framework of the ICM, global standards for midwifery education. Who has acquired the requisite qualifications to be registered and/or legally licensed to practice midwifery, and use the title midwife. Who demonstrates competency in the practice of midwifery." The key aspects of this definition that you should pay attention to are educated, standardized care, licensed, and competent. Now, let's dig in a bit deeper to discuss the term midwifery as developed in the 2014 Lancet series, which reads quote, skilled, knowledgeable, and compassionate care. These are the components of care for childbearing women, new born infants, and families. These groups represent the focus of care across the continuum throughout pre-pregnancy, pregnancy, birth, post-partum, and the early weeks of life. This is the timeframe of care. Core characteristics include optimizing normal biological, psychological, social, and cultural processes of reproduction and early life, timely prevention and management of complications. These core characteristics are the clinical focus. Consultation with, and referral to other services. This is the clinical place, respect for women's individual circumstances, and views and working in partnership with women to strengthen women's own capabilities to care for themselves and their families. This last portion of the definition highlights the position of support in relation to the individuals we serve. We believe these are accurate and comprehensive definitions, but you still might be wondering, what does a midwife do, what is their scope of practice? According to ICM, the midwife is recognized as a responsible, and accountable professional who works in partnership with women to give the necessary support, care, and advice during pregnancy, labor and the postpartum period to conduct births on the midwife's own responsibility, and to provide care for the new born, and the infant. This care includes preventative measures that promotion of normal birth, the detection of complications in mother and child, the accessing of medical care or other appropriate assistance, and the carrying out of emergency measures. The midwife has an important task in health counseling and education, not only for the woman, but also within the family and the community. This work should involve antinatal education and preparation for parenthood, and may extend a women's health, sexual and reproductive health, and childcare. A midwife may practice in any setting including the home, community, hospitals, clinics, or health units. The full scope of care that midwives could provide is often limited by health care systems along with cultural barriers and legal barriers. For example, in the US, not all states recognized certified nurse midwives or certified midwives as independent practitioners with full prescriptive authority. While we may practice in those states, we are constrained to do so under the supervision of a physician or to have a physician sign off on these prescriptions. These constraints do not allow midwives to practice to their full capacity and skill. Midwifery care does not necessarily mean delivered by a midwife. Many aspects of midwifery care provided by other providers including obstetricians, family physicians, nurses, auxiliary midwives, traditional midwives, and community health workers. Renfrew et al. 2014 in the Lancet series states that, "midwifery care can be thought of as a package of care." The view of maternal health, and the midwifery approach to care is expanding. For example, the scope can go beyond just women, and beyond just during pregnancy to serve individuals seeking care that supports normal physiologic processes. It may include primary care and the care of chronic conditions such as diabetes, and hypertension. For example, in the United States a certified nurse midwife is considered a primary care provider. Midwives care for women throughout their lifespan, and can add on additional skills, such as first assist for caesarian sections, performing vacuum assisted births, abortion care, and advanced gynecologic carriers such as colposcopy and endometrial biopsies. Again, the exact scope and skills will vary from setting to setting based on laws and regulations. But what is clear is that the knowledge, skills, and competence must be at the highest level. In this lesson, we reviewed the definition of a midwife, and the general scope of midwifery practice. You may want to take the time now to research your own area, which organizations certify and regulate midwives, and what the scope of midwifery practice is, if you're not already familiar or better yet, find a midwife in your local area or in our learner discussion forums and ask them these questions.
