Midwifery Qualifications at Home and Abroad
Midwifery standards, quality, and educational routes vary astronomically across the globe. According to the International Confederacy of Midwives, "A midwife is a person who has successfully completed a midwifery education programme that is duly recognized in the country where it is located and that is based on the ICM 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’; and who demonstrates competency in the practice of midwifery". While this definition is concise, it leaves a huge portion of the midwifery educational routes on the sidelines, excluding hundreds if not thousands of well trained and highly skilled midwives across the globe, a contention held by many unrecognized midwives in South Africa. In this country, a nurse can be qualified as a bonafide nurse-midwife afer 3 years of general nursing and 4 months of midwifery education after attending only 10 births. It is this gross educational oversite that can be singly pinpointed as one of the leading causes in the rise of maternal and infant mortality in this country, and the inapproprate rise of unecessary cesareans and obstetric intervention as more and more obstetricians have to step into the place where well trained and experienced midwives once stood. It is this educational funnel in combination with the narrow minded view of the international community towards birth attendants that have created a catalyst for South African women to seek education that is more inclusive, more well-rounded, and better sourced to equip the midwives of the future with everything they need to know how to deliver babies in an out-of-hospital setting.
The North American Registry of Midwives is a registering body for women who have completed 1 of 2 educational approaches. Often taking aspiring midwives 3-5 years on average to complete their training before being authorized to sit the final 8 hour qualifying exam. This educational route is an intensive and immersive specialization into all things midwifery related, "Based on the MANA Core Competencies, the guiding principles of the practice of CPMs (Certified Professional Midwives) are to work with women to promote a healthy pregnancy, and provide education to help her make informed decisions about her own care. In partnership with their clients they carefully monitor the progress of the pregnancy, labor, birth, and postpartum period and recommend appropriate management if complications arise, collaborating with other healthcare providers when necessary. The key elements of this education, monitoring, and decision making process are based on Evidenced-Based Practice and Informed Consent." This qualification route can be attained either through an intensive apprenticeship training with midwives who have years of experience and excellent track records, or through a formal institution that blends apprenticeship with grade based education and structured classes.
Amanda Busson was the first South African to challenge the system and complete the NARM qualification process with over 4 years of training and study. Since her graduation, dozens of South Africans have made the pilgrimage to Tennesee in the United States to seek a higher quality of education in order to better serve the women of their community. No such intensive and well rounded maternity healthcare training or education exists in South Africa or the continent at large. CPMs have undergone thousands of hours of theoretical and hands on training as well as needing to participate in 50 out of hospital births and over 200 maternity care appointments. Trained in Neonatal Resuscitation, and requiring 50 hours of continuing education every 3 years in order to maintain their CPM status, it is a great understatement to say that CPMs are the most qualified care providers for low risk women seeking holistic care in an out-of-hospital setting.
No SANC Nurse-Midwife, Obstetrician, or GP is ever required to sit with a labouring woman through her entire birthing process from beginning to end, nor have they ever been required to attend a planned birth in an out-of-hospital setting. Most of them have never even seen a woman give birth in any other position than on her back or semi-reclining. Ask your care provider about their training. Don't be afraid to demand transparency. A professional training within such a narrow understanding and rigid framework cannot be considered the most well qualified to serve the vastly wide range of normal that appears in pregnancy and birth. The current education system regarding maternal health in South Africa is rigid and broken. We must demand more from our health care providers and education systems. The dogmatic and ego driven approach of the current healthcare system must be continually challenged to do better for its communities. CPMs take up that challenge gladly. They are undoubtedly the most dedicated group of professionals in South Africa to improving the maternal healthcare landscape, travelling far and workng tirelessly for years to become masters in supporting natural physiology and empowering women. No CPM has taken up this charge for money or glory, as it is a hard and messy job with mediocre pay, poor hours, and no vacation time. But it is of no consequence because midwifery is a calling to serve. And we endeavour to be the best we can be so that we may do the most good with the time we have.
We encourage all women to demand excellence from their care providers. To expect that their informed consent and informed refusal will be respected. To research and understand their rights as healthcare consumers. To demand transparency and access to up to date statistics. We implore you to educate yourself on how to create the best circumstances you can for birth success. Cultivate your own beliefs and standards surrounding your pregnancy and birth and unapologetically hold your careproviders to that standard.