Workshop on Harmonisation of the Education for Nurses and
Midwives, Serbia
21-22nd January 2013
Mervi Jokinen MSc (Dist), PGCert, BSc (Hons), RM, RN
Practice and Standards Development Advisor
Royal College of Midwives UK
President European Midwives Association
Directive 2005/36/EC
 Articles 40, 41
 Specifies access to and duration of training
 Recognition of evidence of qualifications e.g. years/hours of
training
 Articles 42, 43 and Annex V
 (i) The pursuit of the professional activities of a midwife
 (ii) Acquired rights specific to midwives
 (iii) Annex V sets the framework of


(a) theoretical and technical instruction
(b) practical and clinical training
Directive 2005/36/EC
The strength of the Directive rests in its existence and is seen
enabling:
 As it attempts to ensure agreed minimum standard
 Specifies access to and duration of training
 Clarifies the pursuit of activities
The weakness of the Directive is seen in
that though having been contemporary
and fit for purpose at the time, it has been questioned if it
is too low as minimum and some new criteria or updating
would be expected
Current issues: 2005/36/EC
 Level of education
 Certificate - Diploma - Degree - Masters


This influences practice
Transfer of knowledge and skills
 Many countries have moved beyond the minimum
requirements and content in their pre registration midwifery
education programmes
 Research and evidenced based care
 Knowledge and skills of critical thinking
 Autonomy
 Focus on competence, professional responsibility and
accountability and life long learning
Current issues: 2005/36/EC
The Member States shall ensure that institutions providing
midwife training are responsible for coordinating theory and
practice throughout the programme of study
 There has been minimal monitoring on national level
training; EU level accreditation and on-going professional
development harmonisation is absent
 Some countries appear to fulfill the EU Directive
requirements as a tick box exercise
 In many countries the persons responsible for delivery of
midwifery education are medical personnel
European Midwives (EMA) surveys
 Baseline surveys to inform EMA of current midwifery practice




linked to the activities as set in the Directive 2005/36/EC:
antenatal, intrapartum and postnatal care (2009, 2011, 2010)
Responding associations represent about 78,000 midwives in
the 25 countries
5,622,722 deliveries per annum
65% spontaneous vaginal delivery rate (varying 86% to 50%)
25% caesarean section rate (varying 14% to 50%)
Pursuit of the professional activities of
a midwife
 The Member States shall ensure that midwives are able
to gain access to and pursue at least the following
activities:
 b) diagnosis of pregnancies and monitoring normal
pregnancies: carrying out the examinations necessary for
the monitoring of the developments of normal pregnancies
 e) caring for and assisting mother during labour and
monitoring the condition of foetus in utero by the
appropriate clinical and technical means
 g) examining and caring for the new-born infant; taking all
initiatives which are necessary in case of need and carrying
out where necessary immediate resuscitation;
Findings
 Data accuracy
 Language
 Health systems
 Clinical data most congruent
 Less variation within intrapartum practice than ante- or postnatal practice
 Concurring themes:
 midwives in some countries are not able to practice within ante-, postnatal
care
 restricted practice environment and varied level of women’s choice
 cannot practice autonomously, more of add-on to the obstetric care;
obstetric nurses
 As midwives’ activities vary; it will impact on students’ ability to gain
experience, midwives’ on-going CPD and competence
 It will also impact on mobility and safety of mothers and babies
Health Systems
The organisation of health care varies considerably in
Europe
 A national health service model where services are
usually free at the point of delivery
 e.g. in UK, Sweden or Denmark,
 A health care services which are based on insurance
schemes and a fee for service model
 e.g. in France, Belgium or Germany
 Private practices
Healthy women can choose to have their AN care with
Midwives allowed to diagnose pregnancy
11
Pregnant women must be seen by a Dr
Which of the following choices are offered to women as a place to give birth?
Are there national guidelines or standards that are written for the
midwives in your country to help them manage labour safely?
Answer Options
Response Percent
Response Count
Yes
79.2%
19
No
20.8%
5
answered question
24
skipped question
0
Are there a separate set of guidelines for midwifery led care?
Answer Options
Response Percent
Response Count
Yes
41.7%
10
No
58.3%
14
answered question
24
skipped question
0
1. Do midwives in your country use a partogram or graph to record progress in
labour?
2. How often do women in labour routinely have a vaginal
examination in labour?
Answer Options
Response Percent
Response Count
Never
4.5%
1
Every 1-2 hours
50.0%
11
Every 3-4 hours
36.4%
8
Every 5-6 hours
0.0%
0
When the doctor orders it
9.1%
2
Other (please specify)
4
When a woman comes into hospital because she thinks she is in labour,
which health professional normally checks that she is really in labour?
Country
Albania
Austria
Belgium
Croatia
Cyprus
Denmark
Estonia
Finland
France
Germany
Greece
Ireland
Italy
Latvia
Lithuania
Malta
Netherlands
Norway
Portugal
Slovakia
Slovenia
Spain
Sweden
Switzerland
United Kingdom
Midwife
a
a
a
Doctor
Both
a
a
a
a
a
a
a
a
a
a
a
a
a
a
a
a
a
a
a
a
a
a
Legal definition of postnatal period
 10 days -
Luxembourg
 36 days - The Netherlands, Spain
 42 days - Cyprus, Estonia, Finland, France, Greece,
Ireland, Italy, Latvia, Norway, Portugal, Slovenia, Turkey,
UK
 56 days - Germany
 9 months - FYR Macedonia
 12 months - Belgium
 Different county councils - Sweden
Availability of PN care
Hospital and/or
home
Hospital only
Countries
Croatia, Cyprus, Estonia, France,
FYR Macedonia, Ireland, Norway
Home only
Latvia and The Netherlands
Hospital and home UK, Sweden
Spain, but very limited in hospital
Not usually
Portugal
available
Modernisation of professional qualifications
Directive 2005/36/EC
 Proposed change into the process - divide into 3 phases
 current amendments and IMCO proposals been through 2
stages and to be voted on by the EU parliament this 2013

Midwifery community (EMA and Network of Midwifery
Regulators) recommendations re general education, training
requirements, update of pursuit of professional activities a
midwife - autonomous practice
 next phase –training programme and competencies
 third phase European Qualifications Framework (EQF)/ECTS
Conclusion
 EU Directive 2005/36/EC is about mobilisation of workforce;
for sectoral professions it is about freedom of movement
across EU countries under automatic
recognition
 For women and their families (patients)
it is about safety and quality of care
(EU Directive on Cross Border Health care)
 On national level changing the education
curricula in higher education institutes is not
sufficient in fulfilling requirements
 Delivery of care models/systems have to be
involved in the dialogue
Хвала за слушање
Thank you for listening
Extra slides if required not for current
presentation
How do the majority of women in your country have to pay for labour
care and delivery?
By paying for private insurance
37.5%
9
By paying the doctor privately
25.0%
6
By paying the midwife privately
25.0%
6
Care by a midwife is free to all women
87.5%
21
Care by a doctor is free to all women
87.5%
21
Health professional involved in PN care