Midwifery education and models of care—Moving forward mindfully

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A media release in April this year¹ by the Australian College of Midwives stated “With closures in rural services being reported weekly all over the country the main focus should be on enabling women to stay close to their families for birth and that towns continue to have local birthing facilities available”. That “Governments need to act and ensure that midwifery led services are rolled out across the country”.

According to figures available from the 2002–2012 Midwifery Workforce in Australia report, 19.1% or nearly 1 in 5 persons working with birthing women were found to lack midwifery qualifications.² The employment of people without qualifications in maternity care is said to be because of an inability to recruit midwives; most particularly in rural and remote areas.

The use of non-qualified staff in maternity units is alarming because it means that we as a profession are unable to meet the needs of birthing women. The longer this goes on the more widely entrenched the non-midwifery workforce to will become. The use of non-midwives only occurs in and strengthens models of maternity care that are task orientated and/or institutionalised. The use of non-qualified maternity staff prevents access and equity in relation to midwifery services, particularly in regional and rural Australia. Finally, the models of care available for student midwives to experience are limited to what is currently available thus making it more difficult to prepare graduate midwives to work within the ACM philosophy of midwifery and continuity models of care.

I believe the only way that rural services can be initiated or maintained long-term is to ensure persons living in the local environment can undertake the majority of their midwifery education where they live. Local students educated by competent local midwives working with birthing friends, family and women in that area. Graduate entry programs delivered on-line under the supervision of a local, competent midwife would ensure students gain common midwifery knowledge as well as specific and culturally appropriate midwifery knowledge for their local birthing women. We cannot assume the continuation of postgraduate diplomas because postgraduate student numbers are dwindling due the declining number of funded clinical placements offered to employed, registered nurse students.

Increasing financial pressures in health directly affects operational resources available to health services and therefore the potential number of paid clinical placements for students. There are currently two modes of clinical practice placements—salaried (known as the ‘employment model’) and the supernumerary model. The financial incentive to allocate student positions to unpaid or supernumerary placements is high as wages can be used for registered midwife positions. This seems like a logical solution to staff shortages, financial constraints and birthing women's needs with potentially a greater number of registered midwives available in the workforce. The strategy only works, however, if there are qualified midwives available to fill the midwifery student vacancies, which, sadly, is often not the case. My experience as a midwifery program convenor is that reducing the number of student positions results in a decrease in registered midwives and an increase in the employment of non-midwives in maternity services.

Will the push for a bachelor of midwifery be the death of graduate entry programs for registered nurses? According to consultations carried out by the Australian Health Workforce Advisory Committee,² access to and completion of programs are problematic for many registered nurses who are interested in pursuing midwifery education. This is primarily due to the fees involved, difficulties being released from paid work and the length and structure of some of the programs.

Graduate entry midwifery programs are obligated to meet the same national standards as bachelor programs. Ideally this is best for the profession and birthing women. In the real world however making this happen in a professionally meaningful way that is equitable for all persons wishing to enter midwifery is difficult. The difficulties include the introduction of “follow-through” experiences and the requirement for 12 months continuous clinical midwifery practice. The demand, that registered nurse students undertake supernumerary midwifery experiences as a way of being introduced to midwifery models of care has increased the workload and stress on potential midwives. The profession must be creative in maintaining standards whilst ensuring we are not generating a pressure cooker program for nurses wishing to enter midwifery as a graduate entry student.

I have argued that the changes impacting on graduate entry midwifery programs may very well lead to the extinction of graduate entry programs for registered nurses wishing to become midwives. I am not convinced that the consequences for students, regional and rural health services and birthing women's needs have been fully considered by the profession. I am arguing that the midwifery profession should enable and support all access modes to midwifery; including graduate entry for registered nurses. There may be others persons and bodies erecting barriers to birthing women in Australia having a known midwife across the childbearing year. The midwifery profession should not be one of them.

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References 

1. ACM. (2007). Media Release Wednesday, April 11, 2007. Rural Midwifery Model Has Great results. Retrieved 20th September, 2007, from http://www.acmi.org.au/News/CollegeMediaReleases/RuralMidwiferymodelhasgreatresults/tabid/405/Default.aspx.
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2. Australian Health Workforce Advisory Committee (2002), The Midwifery Workforce In Australia, AHWAC Report 2002.2, Sydney.
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