Judith Fullerton | October 2015
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Presentation at the Global Maternal Newborn Health Conference, October 21, 2015

Background: The aggregate of countries and territories in the Caribbean region are noted to have maternal and child mortality statistics that are favorable in comparison to the other developing country regions. However the region still ranks fourth highest for maternal mortality and eighth for under-5 mortality in an MDG progress comparison. Midwives are recognized members of the health workforce in almost all Caribbean countries; however their education, regulation and scope of practice vary. It is acknowledged that a common curriculum of studies, licensure examinations, and standards of clinical practice would advantage health workforce mobility and quality of maternal/child health care. Members of the Caribbean Regional Midwives Association (CRMA) undertook the process of reflection about the fit-for-purpose for the region of the International Confederation of Midwives (ICM) essential competencies and education standards – a reverse task analysis.

Method: CRMA members assumed the roles of educator, preceptor, or policy maker. They reviewed the ICM documents, making a judgment about the applicability of the education standards, and the need for regional midwives to be competent in each of the tasks on the ICM skills list. They also identified tasks for which midwives were not presently authorized, and additional region-specific tasks that did not appear on the ICM 2013 document.

Results: There was general agreement among the three groups about the need for midwives to attain and sustain competence across the majority of skills noted on the ICM document. “Policy makers” suggested addition of skills in breech version, first assist at C-section, and ultrasonography, but deletion of abortion-related tasks. “Educators” affirmed substantial congruence of curriculum content across countries.

Conclusions: Education and practice policy changes that will need to be negotiated with nursing and government representatives across the many countries were identified, that, if enacted, would accommodate cross-country recognition of the midwifery title and credential.