Advanced Diploma in Midwifery

Purpose

The purpose of the Advanced Diploma in Midwifery is to produce competent, independent, and critical-thinking midwives who will provide scientific, safe, comprehensive, holistic, community-oriented and quality midwifery care to individuals, families, and communities within the legal and ethical framework.

This qualification strives to produce competent, service-driven Midwives, who understand and value the practice of culturally competent care and can effect positive changes in healthcare practices for clients.

This qualification will provide theoretical engagement, sound clinical judgement, intellectual independence, and competence in midwifery care.

It will enable midwives to have the capacity to assess and implement midwifery practice and policies in a range of contexts to render professional, evidence-based and competent midwifery practice in all health care settings taking into consideration priority health needs and issues of women.

This qualification provides midwives with a wide range of skills, knowledge and attitudes that will enable them to make a meaningful and sustained contribution to midwifery services.

On successful completion of the learning outcomes, the learner will be awarded an Advanced Diploma in Midwifery and will be responsible for providing and evaluating midwifery care in all settings for the promotion of health, prevention of complications, care of unhealthy women and neonates, and functions as a member of a health team. The Midwife will be registered with the South African Nursing Council (SANC) to practice as a Midwife in accordance with R1497.

A qualified learner will be able to

• Apply specific knowledge of Bio-Natural, and Social Sciences including Pharmacology in Midwifery using an integrated approach.
• Provide safe and quality midwifery and neonatal care in a scientific, integrated and evidence-based approach in all care settings.
• Demonstrate an ability to practice independently and professionally within an appropriate ethical-legal framework.
• Improve the quality of midwifery and neonatal care through an analytic, reflective, and problem-solving approach.
• Effectively manage a midwifery unit through clinical governance strategy.

Rationale

The Advanced Diploma in Midwifery qualification will enable the learner to function as a clinically focused, service-orientated, independent midwife, who can render comprehensive midwifery care from the pre-natal stage to the postnatal stage.

According to the World Health Organisation (2006) report, there was slow progress towards the achievement of the reduction of maternal mortality rate (MMR) due to shortages of professional midwives in many countries in Africa.

In sustainable development goal number 3, the reduction of the global maternal mortality ratio to less than 70 per 100,000 live births by the year 2030 is proposed, including ending preventable deaths of new-borns and children under 5 years of age, with all countries aiming to reduce neonatal mortality to at least as low as 12 per 1,000 live births and under-5 mortality to at least as low as 25 per 1,000 live births.

The National Development Plan (NDP) 2030 goal number ten aims at reducing maternal, infant and child mortality, reducing under-five child mortality from 56 to below 30 per 1 000 live births. It further projects that approximately 97% of pregnant women attend at least one antenatal clinic and 89% of children are fully immunised at one year old. The rate of hospital births is also high, indicating a high rate of interaction of pregnant women and young children with the health system. Improving the quality of antenatal and postnatal care and using health information to follow up on patients can contribute to reducing unnecessary deaths.

In South Africa, Pick et al (2001) found that 80% of midwifery and neonatal services in the country are delivered by midwives and given the high peri-natal and maternal mortality and morbidity rates, it is essential to have a properly trained midwifery practitioner who can provide quality midwifery and neonatal nursing.

South Africa is struggling to improve maternal and perinatal outcomes despite substantial investment in health compared to most countries in Africa and the world.

The Advanced Diploma in Midwifery programme will contribute to the production of Midwives who are who will be

• Able to function as clinically focused, service-oriented independent registered Midwives.
• Equipped with critical thinking and decision-making skills and capable of functioning beyond the defined scope.

This qualification is primary care oriented therefore, responding to primary health care re-engineering, ensuring that midwives attend to mothers and babies at the lowest level of care within their socio-cultural context taking into consideration the ethical and legal framework of midwifery practice.

This qualification consists of the following compulsory modules at National Qualifications Level 7 totalling 120 Credits.

Compulsory Modules, Level 7, 120 Credits.

• Safe Motherhood 1, 24 Credits.
• Neonatal Care 1, 8 Credits.
• Community Oriented Midwifery, 16 Credits.
• Applied Fundamentals of Midwifery Practice, 8 Credits.
• Unit Management & Professional Practice, 16 Credits.
• Safe Motherhood 2, 28 Credits.
• Neonatal Care 2, 12 Credits.
• Contemporary Midwifery issues, 8 Credits.

Exit Level Outcomes

1. Apply specific knowledge of Bio-Natural and Social Sciences including Pharmacology in Midwifery using an integrated approach.
2. Provide safe and quality midwifery and neonatal care in a scientific, integrated and evidence-based approach in all care settings.
3. Practice independently and professionally within an appropriate ethical-legal framework.
4. Examine and improve the quality of midwifery and neonatal care through an analytic, reflective, and problem-solving approach.
5. Effectively manage a midwifery unit through clinical governance strategy.

Associated Assessment Criteria

Associated Assessment Criteria for Exit Level Outcome 1.

• Apply knowledge of Bio-Natural Sciences and Pharmacology during the assessment and care of the mother and neonate.
• Apply knowledge of Social Sciences in counselling and advocating for a mother and baby through the preconception, antenatal, intrapartum, and post-natal stages.

Associated Assessment Criteria for Exit Level Outcome 2

• Apply care and prepare woman and family for pregnancy, childbirth, and family changes appropriately, takes into consideration the woman's context/background and is facilitated by means of ante-natal classes and appropriate health promotion through education.
• Apply critical knowledge and conduct comprehensive obstetric history taking and physical examination of the mother, using a variety of available technology.
• Apply knowledge of anatomical and physiological changes related to conception, pregnancy, and labour in the practice of midwifery.
• Evaluate and interpret observations of significant changes and laboratory results accurately and appropriately refer to where a potential risk to mother and /or foetus exists.
• Apply an understanding and monitor the well-being of the foetus by monitoring foetal movement, heart rates and growth using a variety of available technology.
• Monitor and manage the mother during labour and delivery comprehensively, demonstrating an understanding of the physiology of labour, the technology used to monitor the mother and the wellbeing of the foetus.
• Manage the new-born, demonstrating an understanding of the changes taking place in the newborn baby.
• Identify, manage, and appropriately refer potential and actual emergencies of the mother and or foetus timeously.
• Comply with generally accepted regional, national, and provincial treatment guidelines, and promote the safety of both, for example, CARMMA, BANC protocol, ESMOE, saving mothers, etc. in intra-partum care delivered to the mother and baby.
• Provide integrated post-natal care, that provides for the long-term wellbeing of the mother and the child, in line with the accepted scope of practice for midwives.
• Document, manage and communicate midwifery data to support decision-making.

Associated Assessment Criteria for Exit Level Outcome 3

• Apply knowledge of relevant ethics, professional practice, and legal aspects during ethical decision-making in midwifery practice.
• Advocate for the rights of women, children, and their families in midwifery practice.
• Apply knowledge to show appreciation of accountability and responsibility for own professional acts and omissions within the relevant legal and ethical parameters.
• Respect human rights as enshrined in the Constitution and translated into the patient's rights in the practice of midwifery.

Associated Assessment Criteria for Exit Level Outcome 4

• Apply knowledge and implement quality improvement of midwifery practice that illustrates the use of analytic, reflective, and problem-solving skills.
• Apply an understanding and initiate, maintain, and utilise methods of inquiry to monitor the quality of care.
• Develop a quality improvement plan in accordance with own roles and responsibilities, scope of practice and standards of midwifery practice.
• Utilise evidence-based practice to inform and improve the standards of midwifery practice.

Associated Assessment Criteria for Exit Level Outcome 5

• Engage in communities of practice and clinical leadership and employ management principles in midwifery practice.
• Utilise indicators for quality midwifery care in the practice of midwifery.
• Promote cost-effectiveness in midwifery practice through the utilisation of quality indicators.
• Apply existing unit philosophy, vision, mission, goals, policies, procedures, and protocols to direct midwifery care.
• Collaborate with inter-professional teams and reflect respect for diversity within the midwifery context.
• Manage the midwifery unit, reflecting the ability to assess and develop self and others to maintain midwifery standards of practice and continuous professional development.