Relating to: Standards for pre-registration midwifery programmes
Midwifery is regulated as a distinct profession. The title of midwife is protected in law and there is a protected legal function associated with this title1.
Only the following people may attend a woman in childbirth:
- A midwife
- A registered medical practitioner
- A student undergoing training with a view to becoming a midwife or a medical practitioner as part of approved course of practical instruction.
Overview
Our pre-2023 Standards for pre-registration midwifery programmes are underpinned by the EU Directive 2005/36/EC[2]. During our review of the programme standards, we found no evidence[3] to affect a change to the absolute numbers of clinical skills student midwives need to achieve at the point of registration. Several other countries have also adopted the EU Directive in terms of the number of births that need to be achieved and some exceed the requirement.
Therefore, a decision was taken that our updated Standards for pre-registration midwifery programmes will continue to state the number of times a skill has to be undertaken. This means that there is also no available evidence to support the number of personally facilitated births student midwives need to gain to be proficient at the point of registration.
The standard in relation to the number of births to be achieved by a student midwife is stated as follows in the EU Directive:
“Conduct by the student of at least 40 deliveries, where the number cannot be reached owing to the lack of available women in labour, it may be reduced to a minimum of 30, provided that the student assists with 20 further deliveries.”
As we have removed reference to the EU Directive from our updated pre-registration midwifery standards, we have added and amended the birth standard as follows:
“Support and care for no less than 40 women in labour and facilitate the birth. Where 40 births cannot be reached owing to the lack of available women giving birth, it may be reduced to a minimum of 30, provided that the student is given the opportunity to assist with caring for an additional 20 women giving birth.”
Risk
How the birth standard is met can vary and inconsistency in meeting the standard could increase the likelihood of risk to women, infants, and midwives, namely:
- There is a potential risk to women and newborn infants that the newly qualified midwife, who cares for them autonomously at the point of registration, has not had sufficient experience of facilitating spontaneous vaginal births during their pre-registration programme.
- There may also be a risk to the individual midwife as inconsistency of meeting the standard could increase the possibility of a concern being raised with their employer or the NMC.
In recent years there has been a change to UK maternity services shift patterns and many midwives work 12-hour shifts, over fewer days per month, and student midwives tend to follow this pattern. Anecdotally, it appears that student midwives who follow a shift pattern approach where this means working 12-hour shifts, could have less opportunity each week to facilitate births and therefore, meet the birth standard.
N.B. Approved Education Institutions (AEIs) determine how many hours per week a student midwife works but it is not uncommon for them to be restricted to 12 hours in any one shift.
Principles
The aim of the birth standard is for all student midwives to facilitate 40 spontaneous vaginal births. Facilitated spontaneous vaginal births enhance the confidence in student midwives for registration and prepare them to practice autonomously, and in some instances, on their own in the birth environment. The principles that drive this standard are as follows:
- Student midwives need to care for the woman in labour prior to facilitating the birth.
- Student midwives need to gain as much experience as possible of spontaneous vaginal births to learn about optimising physiological processes to avoid unnecessary intervention in women.
- The experience that student midwives gain in spontaneous vaginal births should reflect what a midwife on our register must know and do as a registered midwife.
- There needs to be equity of opportunity for students within a cohort and across midwifery programmes to experience spontaneous vaginal births.
- Student midwives are supervised according to their individual learning needs, proficiency, and confidence[4]. Some students may need additional experience to achieve proficiency.
- Any decision made in relation to experience needs should be in conjunction with the student midwife and in partnership with the AEI and placement providers.
- Students who have lost time during the programme for whatever reason, including sickness, may need to have their programmes extended. The extension period will vary from student to student and an individual learning plan can be developed to ensure a student can meet their proficiencies.
- It is good practice for the number of births gained by a student midwife to be monitored throughout the whole midwifery programme. The latter part of their midwifery programme can provide a student midwife the opportunity to consolidate their proficiencies and be able to adopt a holistic approach to caring for the woman and the newborn infant.
- Before applying the birth standard caveat, the Lead Midwife for Education (LME) will review the proficiency and confidence of the student midwife. Some students may need to be given the opportunity of further time in placement to achieve the 40 births.
Conduct by the student of at least 40 births:
- Care should be provided throughout the continuum of labour.
- There should be a flexible approach to student midwives achieving their required number of births. For example, enabling students to follow women to meet their proficiencies and birth numbers when a spontaneous vaginal birth is anticipated.
- For cases of retained placenta and/or membranes, the birth may be counted towards the 40 births if the student cared for the woman throughout all stages of labour.
- In the case of a twin birth, the births are counted as two when both babies are spontaneous vaginal births.
- A student may facilitate a pre-term birth or a stillbirth as appropriate under the direct supervision of a midwife.
Where 40 births cannot be reached owing to the lack of available women in labour, it may be reduced to a minimum of 30, provided that the student assists with 20 further births:
- The decision about the use of the birth standard caveat should be made at the end of the programme by the LME in discussion with the student midwife and the Practice Supervisor/Assessor.
- It is expected that a range of experience would make up the 20 further births.
- When a student needs to achieve 20 further births, the following can be considered:
- A spontaneous vaginal birth where there is a retained placenta and/or membranes, and the student midwife has not given care during the third stage.
- Assisting a midwife with a spontaneous vaginal birth to observe particular areas of practice.
- Providing midwifery care during a vaginal instrumental birth.
[1] NMC pre-2023 Standards for pre-registration midwifery programmes. London. Available at: https://www.nmc.org.uk/standards-for-education-and-training/pre-2023-standards-for-education-and-training/
[2] DIRECTIVE 2005/36/EC OF THE EUROPEAN PARLIAMENT AND OF THE COUNCIL https://eur-lex.europa.eu/LexUriServ/LexUriServ.do?uri=OJ:L:2005:255:0022:0142:en:PDF
[3] NMC programme standards review, Harlow and Traverse reports. London. Available at: www.nmc.org.uk/education/programme-of-change-for-education/how-we-reviewed-our-pre-education-programme-standards/how-we-reviewed--our-education-programme-standards/
[4] Standard 3.7 from the Standards framework for nursing and midwifery education. London. Available: www.nmc.org.uk/standards-for-education-and-training/standards-framework-for-nursing-and-midwifery-education/
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