Midwifery Education: The View of 3 Midwives' Professional Organizations

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1 Midwifery Education: The View of 3 Midwives' Professional Organizations We three organizations dedicated to professionalism in midwifery (the Japan Association for Midwifery Education, the Japanese Midwives Association and the Japan Academy of Midwifery) affirm our support for the present midwifery system of education, but also for a new initiative to establish graduate schools of midwifery with a mission of bettering the midwifery profession. Following are the reasons for this position. 1 Midwives today face a more diversified and wider range of tasks, involving a higher degree of responsibility than ever before. In order to be able to meet these demands, advanced levels of knowledge are required. Graduate schools capable of teaching advanced midwifery have therefore become necessary. 2 Midwifery is an independent and highly specialized profession and there is a limit to the adequacy of midwifery education taught as a part of basic nursing education. 3 The licensed midwife is entitled to practice independently and exclusively, performing medical acts concerned with normal pregnancies and deliveries in accordance with the Medical Service Law. Thus, midwifery qualifies as a distinct and specialized profession. 4 High quality care administered to women, their children and their families by professionals having advanced skills is a necessity in a society that places high value on the quality of life. In view of the demands of the society and the requirements for advanced training of professional caregivers, the time has come to rethink midwifery education. 5 In a society having a low birth rate, the training of highly qualified caregivers will meet the needs of women, children and families and provide a good foundation for ongoing development of the society. 1

2 Reasons for this View on Midwifery Education of the 3 Midwives' Professional Organizations 1 Midwives today face a more diversified and wider range of tasks, involving a higher degree of responsibility than ever before. In order to be able to meet these demands, advanced levels of knowledge are required. Graduate schools capable of teaching advanced midwifery have therefore become necessary. The past half century has seen sweeping changes in the midwife's working environment as the result of progress in obstetrics and perinatology, diversification of issues involving sex and reproduction and greater awareness of human rights and bioethics. Midwifery is expanding as it incorporates new studies that keep pace with the latest developments, but the minimum required length of study for graduation remains unchanged, at six months. This makes it impossible to provide an adequate curriculum and stands in the way of meaningful development of midwifery education. The Japan Association for Midwifery Education, the Japanese Midwives Association and the Japan Academy of Midwifery, all organizations concerned with midwifery education, have been identifying problems in this area since 1989, and have since then submitted a number of petitions to the Ministry of Education, Culture, Sports, Science and Technology and the Ministry of Health, Labor and Welfare. Today lifelong education is universally endorsed, and the development of career specialities in nursing are the subject of long range planning. Graduate school education is likewise diversifying, its programs notably oriented to meeting the society's need for highly specialized professionals. Those who seek to become midwives should have the option of selecting an attractively challenging course of studies at a graduate school. 2 Midwifery is an independent and highly specialized profession and there is a limit to the adequacy of midwifery education taught as a part of basic nursing education. Nursing education must provide the basic skills needed in nursing practice. Midwifery education must equip the practitioner with the capability of assuming responsibility for conducting examinations independently as a midwife in the areas of reproductive health and midwifery and providing care that maximizes the chances for pregnancies to come to term normally. The specified requirement for completion of a midwifery course is a minimum of 22 credits, but some 4-year universities permit midwifery students to take less than the minimum for qualification to take the national midwifery exam by counting credits earned in other 2

3 education courses as credits in midwifery. This raises the possibility of there being midwifery graduates who have taken too few courses in their specialty to have acquired an understanding of the field or the practical skills it requires. This kind of midwifery education has the potential for lowering the standards of licensed professionals as well as increasing the possibility that women and their families will not receive appropriate care. Insuring the quality of childbirth protects the people's safety and is the first step in providing for the welfare of future generations. This cannot be done without improving the quality of midwives. Japan licenses midwives according to an educational system based on nursing education. There is a limit to how far the midwifery education currently provided by 4-year university curricula can go toward producing midwives capable of independently overseeing safe, good quality childbirth. The proposal contained herein that students who have finished a course in basic nursing be given the option of a course in midwifery at a graduate school looks forward to a desirable future state of childbirth in Japan. 3 The licensed midwife is entitled to practice independently and exclusively, performing medical acts concerned with normal pregnancies and deliveries in accordance with the Medical Service Law. Thus, midwifery qualifies as a distinct and specialized profession. The midwife can, under the Medical Service Law, open a maternity home and engage in midwifery, in accordance with the Public Health Nurses', Midwives' and Nurses' Law, thereby assuming full responsibility for the ongoing health care of women, neonates and infants throughout normal pregnancy, delivery and the postnatal period, providing care to the respective parties according to their needs. The midwife's license to practice requires the capability of providing emergency care to mothers or their children under life-threatening situations. Thus, the licensed midwife is a professional who plays an important role and bears major responsibilities. It is desirable to provide a number of educational paths to becoming a midwife who establishes roots in the community and provides support to many women, children and families in order to bring about quality childbirth. In addition, graduate school education is a resource that will encourage research toward such goals as preventing medical accidents or holding down medical costs and inspire new proposals for better ways of doing things or introducing changes in health care. 3

4 4 High quality care administered to women, their children and their families by professionals having advanced skills is a necessity in a society that places high value on the quality of life. In view of the demands of the society and the requirements for advanced training of professional caregivers, the time has come to rethink midwifery education. The heart of the midwife=s job is being at the side of a woman during pregnancy and birth, helping her to utilize her own procreative power and providing the entire family with a safe, satisfying birth. Specifically, this involves diagnosing the pregnancy, observing its natural day-to-day course, conducting explorations and assisting the woman and her family develop their abilities to deal with birth and child care. The midwife is also expected to be able to make appropriate decisions and take the necessary steps for swift conveyance of the woman to a competent medical facility when the pregnancy deviates from normal. Thus, the midwife is a highly qualified professional, who must be able to make the right decisions for care recipients and draw upon a wide range of skills to provide appropriate care, counseling or take necessary measures. The periods of pregnancy, birth and child care are very important in the lives of the woman and her family; the midwife who accompanies them during this special time is expected to be well cultivated as a human being in addition to having professional skills. Graduate midwifery education can raise to a level of excellence the skills of the licensed midwife who has completed a course of basic nursing. In order to realize this potential it must provide a curriculum that exceeds the requirements of the national midwifery qualification examination, which conforms to legal requirements for schools training public health nurses, midwives and nurses. Establishing midwifery studies at the graduate level will compete with but complement graduate nursing programs. 5 In a society having a low birth rate, the training of highly qualified caregivers will meet the needs of women, children and families and provide a good foundation for ongoing development of the society. Industrially advanced societies are providing for research based support for safe childbirth and promoting utilization of midwives, who do their work without running up unnecessary medical costs. To this end, advanced societies make a clear distinction between the respective domains and roles of nursing and midwifery, and they provide for a robust system of midwifery education. Surveys by the health, labor and welfare ministry have shown that women give their highest approval to care received at maternity homes run and attended 4

5 by midwives. In order to provide women, children and families with birth-related care to their full satisfaction, there has to be a system of training that produces midwives well qualified to go into communities and establish practices that can fulfill these needs. Accordingly, we believe that the appropriate system of education for the midwife profession should include, in addition to the present options of speciality schools and courses in junior colleges and universities, a new set of master degree programs offered by speciality graduate schools and graduate departments of universities. 5

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