Postgraduate Diploma in Midwifery

Purpose

The purpose of the Postgraduate Diploma in Midwifery is to develop a learner who will ensure that the needs of the client are met through a holistic approach through the delivery of comprehensive midwifery and neonatal care by addressing the physical, psychological, and social dimensions of the health care user within the public and private health care domain to promote healthy outcomes.

This qualification will offer a wide range of transferable skills for application in other professions, disciplines, and general life, which include the capacity to assess and implement, evaluate, and develop health and other policies. Furthermore, the learner will be able to perform specialised skills, thus contributing to reducing maternal, foetal, and neonatal morbidity and mortality, and assessing, identifying, and managing complications associated with pregnancy and birth.

Ultimately, this qualification strives to produce competent, service-driven specialist midwives, who understand and value the practice of culturally competent care and can effect positive changes in midwifery care practices for clients.

The midwife/accoucheur will develop an ability to plan, commission and manage projects of a varied nature and work independently and as part of an interprofessional team.

The midwife/accoucheur will address the population`s healthcare needs within the parameters of the Health Care Plan 2030 and the sustainable development goals.

A qualified learner will be able to

• Practice as a competent, independent, critical thinker to provide scientific, safe comprehensive quality midwifery care.
• Promote healing, prevent complications and alleviate suffering based on acquired knowledge, skills, and competencies in midwifery care.
• Deliver holistic midwifery and neonatal care by addressing the physical, psychological, and social dimensions of the healthcare user within the public and private healthcare domain to promote health outcomes.
• Apply the principles of evidence-based (specialist) midwifery nursing practice.
• Practice within the ethical-legal framework of the midwifery and nursing profession and be able to resolve professional-ethical dilemmas by using decision-making and moral reasoning.
• Develop quality specialists who can be competent postgraduate diploma (specialist) midwifery practitioners.
• Manage midwifery and neonatal services and work within the interprofessional team as a midwife/accoucheur (specialist).
• Establish a research culture that will lead to evidence-based and reflective practice as well as lead and manage self and others within the interprofessional team.

In addition, this midwife/accoucheur will be able to progress in the marketplace with advanced knowledge, skills, and specific competencies. This midwife/accoucheur will enhance competencies in midwifery specialisation which will improve and advance the quality of care, knowledge and skills to address health needs.

Rationale

The rationale behind the qualification is to develop a midwife practitioner with a Postgraduate Diploma in Midwifery with advanced knowledge and expert clinical skills in line with the National and Provincial Healthcare Plans and Sustainable Development Goals as guided by the World Health Organisation (WHO). This will promote the health status of the South African population and alleviate the lack of skills and practitioners to address the quadruple burden of disease in the health care system.

The midwife/accoucheur with a Postgraduate Diploma in Midwifery will work together with doctors and will have the ability to practice within a specialized field in hospitals, clinics, industries and communities in both public and private sectors. The ever-increasing demand for applicants requires flexibility in terms of the offering of the qualification. The Western Cape Department of Health and Wellness, Nursing Services identified the gap of 150 midwives/accoucheurs with a Postgraduate Diploma in Midwifery, to be trained. Through training of midwives/accoucheurs with a Postgraduate Diploma in Midwifery, the training needs of the Department will be met.

The reduction of maternal and child mortality is one of the government's strategic outputs that the health sector must achieve (NSDA 2010). South Africa's' health care system requires midwives/accoucheurs with a Postgraduate Diploma to have the competence and expertise to manage the country's burden of disease thereby meeting the health care needs. One of the five recommendations for preventing maternal deaths includes the training of healthcare workers (Pattinson: 2012) with a specific focus on midwives.

According to the guidelines for maternity care in South Africa (NDOH: 2015) advanced midwives must render care from a community health care clinic, district hospital, regional hospital or a tertiary hospital. It is expected of advanced midwives to practice independently and as part of a team. They must perform specialised skills and have specific knowledge to contribute to the reduction of maternal, foetal and neonatal mortality and morbidity (NDOH: 2015).

There is a health workforce crisis which is characterised by critical shortages, imbalanced skills mix, migration and uneven geographical distribution of health professionals, sub-optimal population health outcomes and millions of people without access to health services (National Strategic Plan: 14). Pattinson (2013) emphasise that every clinic and community health care centre must be able to provide basic emergency obstetric care. He further states that the lack of advanced midwives at clinics and community health care centres is a vast shortcoming and is not a safe place for women to deliver (Pattinson:2013).

The Nursing Act No. 33 of 2005 created the legislative framework for the review of Scope for different categories, in such a way as to ensure that the healthcare needs in South Africa are aligned with the needs of the healthcare system.

Recognition of Prior Learning (RPL)

The institution has an approved Recognition of Prior Learning (RPL) policy applicable to equivalent qualifications for admission into the qualification. RPL will be applied to accommodate applicants who qualify. RPL thus provides alternative access and admission to qualifications, as well as advancement within qualifications.

RPL for access

• Learners who do not meet the minimum entrance requirements or the required qualification that is at the same NQF level as the qualification required for admission may be considered for admission through RPL.
• To be considered for admission in the qualification based on RPL, applicants should provide evidence in the form of a portfolio that demonstrates that they have acquired the relevant knowledge, skills, and competencies through formal, non-formal and/or informal learning to cope with the qualification expectations.

RPL for exemption of modules

• Learners may apply for RPL to be exempted from modules that form part of the qualification. For a learner to be exempted from a module, the learner needs to provide sufficient evidence in the form of a portfolio that demonstrates that competency was achieved for the learning outcomes that are equivalent to the learning outcomes of the module.

RPL for credit

• Learners may also apply for RPL for credit for or towards the qualification, in which they must provide evidence in the form of a portfolio that demonstrates prior learning through formal, non-formal and/or informal learning to obtain credits towards the qualification.
• Credit shall be appropriate to the context in which it is awarded and accepted.

Entry Requirements

The minimum entry requirement for this qualification is

• Advanced Diploma in Midwifery, NQF level 7.

Or

• Advanced Diploma in Medical and Surgical Nursing Science, NQF Level 7.

Or

• Bachelor of Nursing, NQF Level 7.

Or

• Bachelor of Nursing Science, NQF Level 7.

And

• Minimum of two years' experience, inclusive of a year of community service, as a Professional Nurse or General Nurse and Midwife, according to SANC regulation R 635 4(3).

This qualification consists of the following compulsory modules at National Qualifications Framework Level 8 totalling 120 Credits.

Compulsory modules, Level 8, 120 Credits.

• Nursing research and professional ethics for the midwife specialist, 12 Credits
• Leadership and management in advanced nursing/ midwifery practice, 12 Credits.
• High-risk midwifery, 20 Credits.
• Managing the high-risk foetus and neonate, 20 Credits.
• Communicable diseases impacting on midwifery, 20 Credits.
• High-risk labour and birth, 20 Credits.
• Mental health and women's health aspects in specialised midwifery, 16 Credits.

Exit Level Outcomes

1. Practice and facilitate midwifery, nursing education or health services management within the ethical-legal parameters of the profession.
2. Apply the knowledge of and facilitate evidence-based practice, nursing education or management in the midwifery field to solve contextual problems and develop policies and guidelines.
3. Engage in planning, commissioning and managing a midwifery unit, an educational entity, or a health service.
4. Engage in scholarly activities to inform evidence-based practice, education, or management in midwifery.
5. Utilize, manage, and communicate data to support decision-making and research in midwifery.
6. Render and co-ordinate patient-centred midwifery practice within a continuum of care using the scientific approach, integrating biomedical and psychosocial sciences including advanced pharmacology.
7. Mobilize appropriate resources to implement standards of practice relevant to the area of midwifery, to ensure quality midwifery care and safety.
8. Develop and implement institutional policies, protocols, and midwifery guidelines, utilising the process of change management in the improvement of the quality of midwifery care.
9. Facilitate advocacy for the profession and provision of professional midwifery support for personnel, patients, families, and communities.
10. Appraise and develop self, peers, and the midwife specialist students by facilitating self-directedness leadership and lifelong learning to maintain competence.
11. Collaborate within the inter-professional team by engaging in health dialogue, shared leadership, decision-making and sound clinical judgment in midwifery.
12. Participate in the design, development, implementation and evaluation of midwifery policies, programmes, and projects at provincial or national level.

Associated Assessment Criteria for Exit Level Outcomes 1.

• Manage ethical dilemmas in a midwifery clinical unit or facility.
• Apply ethical and theoretical, principles, and moral decision-making or reasoning skills in the holistic care of women and their family members/ carers in the midwifery unit or facility.
• Utilise communication and ethical reasoning skills to address ethical challenges associated with moral distress in midwifery practice.

Associated Assessment Criteria for Exit Level Outcomes 2.

• Participate in interprofessional team activities in the midwifery unit or facility to advocate for evidence-based care.
• Utilise the research process in evidence-based midwifery research.
• Implement evidence-based practice in midwifery through reflecting on the importance of research and clinical evidence-based guidelines.
• Deliver care to enhance quality care in midwifery by employing leadership and role-modelling theories.
• Develop strategies for using research as evidence in midwifery practice.

Associated Assessment Criteria for Exit Level Outcomes 3.

• Engage in professional activities in the interprofessional team to identify and discuss possible need for extension of the current midwifery unit/facility.
• Submit midwifery unit/facility needs for inclusion in the capital budget as an operational manager.
• Participate in the entire process of planning, commissioning, and management of a midwifery unit/facility on all levels including all role-players.

Associated Assessment Criteria for Exit Level Outcomes 4.

• Apply leadership and management skills in the management of the midwifery unit or facility based on evidence from audits.
• Explore evidence-based research in midwifery.
• Conduct a needs analysis of the midwifery nursing staff training needs.
• Develop a proposal to the midwifery unit/facility management for training activities to be included in the annual institutional CPD plan.
• Support learners in the midwifery unit or facility with the carrying out of practical patient/neonatal care procedures.

Associated Assessment Criteria for Exit Level Outcomes 5.

• Interpret qualitative and quantitative data related to midwifery nursing clinical research and communicate these findings to the interprofessional team to improve midwifery practice.
• Analyse and interpret the relevant literature about the content, methodological patterns, differences, similarities, and study limitations in midwifery nursing research.
• Analyse morbidity and mortality prevalence during the pregnancy, intrapartum, postpartum, and neonatal period and communicate these findings to the interprofessional team.

Associated Assessment Criteria for Exit Level Outcomes 6.

• Explain the pharmacological treatment available in the management of obstetric emergencies.
• Compare the pharmacological management for the different medical disorders during pregnancy and the post-partum period.
• Elaborate on the pharmacological management for high-risk neonates with medical disorders.
• Distinguish between the diagnostic and laboratory investigations associated with obstetric emergencies.
• Formulate a nursing care plan for a woman who presents with an obstetric emergency.
• Integrate promotive, preventive, curative, rehabilitative and palliative care during the antenatal and post-partum period of both fetus and neonate.
• Provide comprehensive midwifery integrated care for the current burden of diseases throughout pregnancy and the post-partum period across the different levels of healthcare provision.
• Construct a comprehensive individualised nursing care plan for women with medical and or surgical disorders during pregnancy and the post-partum period.
• Differentiate between the causes of bleeding during pregnancy and the post-partum period.
• Explain the effects of intimate partner violence during pregnancy on the mother, fetus and neonate.
• Evaluate resources available to women experiencing intimate partner violence.
• Elaborate on the management of mental disorders occurring during the preconception-, pregnancy and the post-partum period.
• Examine the barriers to health care delivery and maternal compliance.

Associated Assessment Criteria for Exit Level Outcomes 7.

• Develop and apply Midwifery Practice Standards in midwifery.
• Participate in interprofessional team activities to apply evidence-based care in midwifery.
• Apply ethical and legal principles to ensure that the human rights of vulnerable populations in the neonatology units are respected.
• Formulate appropriate audit tools to identify actual and potential risks to women and mothers' safety and security in midwifery.

Associated Assessment Criteria for Exit Level Outcomes 8.

• Debate standard precautionary measures in the maternal and neonatal health care settings.
• Design guidelines to ensure standards of care meet quality requirements in midwifery practice.
• Manage HIV/AIDS according to the latest protocols and guidelines during preconception, pregnancy, and the neonatal period.
• Create guidelines for dealing with disasters in the midwifery practice area.

Associated Assessment Criteria for Exit Level Outcomes 9.

• Participate in interprofessional team activities to advocate for evidence-based care in midwifery practice.
• Apply ethical decision-making processes to complex issues and ethical dilemmas within the management process of midwifery nursing practice.
• Advocate for professional midwifery role in women and mothers` care, communication with the community and lobbying for change.
• Formulate interventions in accordance with set standards, protocols, and guidelines for women with any form of abuse.

Associated Assessment Criteria for Exit Level Outcomes 10.

• Apply leadership and role modelling theories in delivering care to enhance quality in midwifery care.
• Illustrate midwifery-related practical procedures to learners in the midwifery unit or facility.
• Justify the advantages, and contribution of continuous professional development in midwifery practice.
• Participate in internal practices that support the organisational sustainability of the institution such as operational managers' meetings, general midwifery meetings and interprofessional team meetings.

Associated Assessment Criteria for Exit Level Outcomes 11.

• Collect and compile data for identification of need and envisaged improvement in midwifery-related service delivery.
• Participate in planning committee meetings and monitor adherence to identified midwifery-related needs and standards.
• Contribute towards the delivery of comprehensive individualised family-centred culture sensitivity.

INTEGRATED ASSESSMENT

Assessment consists of a continuous assessment system comprising formative and summative assessments.

Formative Assessment

• Quiz
• Draft of an essay or report
• Mock exam

Summative Assessment

• Test
• Assignment
• Essay
• Report
• Assessment
• OSCE
• Portfolio
• Workbooks

Assessments will be conducted in the subjects for both theory and clinical learning (WIL). In the subject templates the assessments are stipulated for both theory and clinical learning (WIL component) as well as the content that will be assessed.

The theory comprises 40% and Work Integrated Learning (WIL) comprises 60%. Learners must pass both the theory and WIL components to pass the subject.

To pass a subject, the learner must have at least 50% as a final mark.