MSF CV TEMPLATE: MIDWIFE
Last Name (s) (maiden if applicable) ________________________________________________________First Name ____________________________________________________________________________
Email Address__________________________________________________________________________
Home Phone___________________________________________________________________________
Mobile________________________________________________________________________________
Home Address__________________________________________________________________________
Current Address (if different from home address)__________________________________________________________________________________________________________________________________________________________________________Skype NamePERSONAL DETAILS
Date of Birth ___________________________EDUCATION
Midwifery Education

Place of birth__________________________All current nationalities:____________________________________________________________________________

Place (State University/ City/ Country)

Gender: Male
FemaleCustom______________________________________

Duration of Studies(years/months):___________________

Mother tongue:

From_______________ To___________________EnglishFrench Spanish
ArabicOther: _______________________________

Type of Diploma or Certificate
obtained________________________

Other Language (s): you can speak & understand

Date obtained____________________________

fluently (written and spoken) in a working environment:___________________________________________

Professional Number_________________LEVEL
English_______________________

French_______________________

Spanish_______________________

Arabic_______________________

Other: _________________________________

Other Education

University Degree ____________________________

Place (State University/ City/ Country)_______________
From_________________ to ____________________

Professional Licences/Registration

Master’s Degree ________________________________

Place (State University/ City/ Country)_______________
Place of Midwife License_____________

From_________________ to ____________________

Number _________Date of Expiry___________

Speciality Diploma_______________________________

Place of Midwife License_______________

Place (State University/ City/ Country)_______________

Number __________Date of Expiry___________

From_________________ to ____________________

MSF CV TEMPLATE: MIDWIFE
PROFESSIONAL EXPERIENCE
Employment History Summary Including CURRENT employment
Please complete with the most recent post first and give a brief description of your activites

DATE (start-end)

PositionType of Activity

City/Country

Type of Activity

City/Country

OTHER PROFESSIONAL EXPERIENCE (MEDICAL OR NON-MEDICAL)DATE (start-end)

Position

OTHER MEDICAL TRAINING OR RELEVANT COURSES (ALSO, Neonatal Resuscitation)

DATE (start-end)

Position

Type of Activity

City/Country

ADDRESSCONTACT DETAILSPLEASE PROVIDE THREE REFERENCES
NAME
123TITLE

This checklist below is intended for midwives who may be expected to have responsibilities in obstetrics/reproductive health. It should be filled according
to your current practice level. Part 1 covers basic skills and key competencies while Part 2 includes emergency obstetrical procedures. This information
will be useful for better matching of staff to postings, and to identify specific training/coaching needs. It may also be used as a tool for follow up of
personal development of our expats during their MSF career.

The skills listed here may be required in any MSF mission at any time in an emergency. The purpose of this assessment is to establish current knowledge/skill levelin order to facilitate the most appropriate placement. Lack of competency will not prevent you departing on mission, so please be honest in your self-assessment.

Instructions:

The checklist covers levels of competency, including theoretical knowledge, practical clinical experience (under supervision), competence to perform
independently, and confidence to train others. Please fill the columns according to your current level. Mark "1" for yes or "0" for no.
In the last column, we ask for the date (year) you last performed that function. Use the comments column to give detail if needed.

PART 1: BASIC MIDWIFERY / OBSTETRIC SKILLS
to be completed by midwives an active role in obstetriccare

Theoreticalknowledge
onlyPracticalclinical
experience

Competent to Confident toperform
train to others
independently in the field

ANTENATAL CONSULTATION
Antenatal Skills: pregnancy confirmation; estimate
gestational age and due date; antenatal care
(history, focused physical examination, ordering andinterpreting results of basic screening laboratory
tests, and counselling); educate women about
dangers signs in pregnancy and support them withcreating a birth plan
Identify co-existing disease; commence first line
treatment according to protocol for antenatalcomplications

Date lastComments
performed(year)

Theoreticalknowledge
onlyPracticalclinicalexperience

Competent to Confident toperform
train to others
independently in the fieldBasic ultrasound skills, e.g. foetal position, placental
location, foetal viability
Malaria and infectious disease screening in
pregnancy

LABOUR, DELIVERY, AND IMMEDIATE POSTPARTUM CARE
Labour Management: identify labour onset;
identify coexisting disease and commence 1st line
treatment; monitor maternal and foetal well-being
during labour; manage a normal delivery; provide
active 3rd stage management; inspect placenta andmembranes for intactness
Follow labour progress using a partograph (WHO orother)
Stimulate labour using physiologic measures, e.g.,
ambulation/position changes, shower, massage, etc.
State here the number of deliveries you haveconducted independently (not supervised) in thepast 2 years. Give best estimate.

Maternal basic life support (CPR)
Identify complications in labour and birth, e.g.
abnormal presentation, prolapsed cord,
haemorrhage, failure to progress
Initial management in case of complications, e.g. IV
access, bladder catheterisation
Management of mild/moderate postpartum
haemorrhage, fluid resuscitation (large bore IVs x 2),
administration of uterotonic agents, fundal
massage, bimanual compression

Date lastComments
performed(year)

Theoreticalknowledge
onlyPractical
clinical
experience

Competent to Confident toperform
train to others
independently in the field

Stabilise mother and newborn for transfer to ahigher level facility
Perform episiotomy
De-infibulation and post-delivery repair (NOT reinfibulation!) in presence of female genital cutting
Repair of episiotomy or 1st /2nd degree tear
Obstetric fistula care: secondary prevention offistula (bladder catheter routinely after obstructedlabour); conservative management of small, fresh
fistula (catheter as long as fistula seems to becomesmaller)

NEONATAL SKILLS
Assess newborn's vital signs; identify need for andmanage resuscitation
Perform initial (basic) physical exam of the newborn
Provide routine newborn care, including
administration of prophylactic eye ointment,
Vitamin K, and birth (first) doses of vaccines
Initiate and establish breastfeeding
Identify complications, e.g. infections, and provide
first line treatment
Instruct in and support use of kangaroo mothercare

POSTNATAL CONSULTATION
Postnatal skills: Postnatal care (history, physicalexamination of mother and infant, and counselling);
identify postnatal complications in mother andbaby; educate women about danger signs for selfand child
Provide first line treatment for postnatal maternal
complications, e.g. infection, postpartum
depression, etc.

Date lastComments
performed(year)

OTHER SEXUAL AND REPRODUCTIVE HEALTH CARE
Theoreticalknowledge
onlyPractical
clinical
experience

Competent to Confident toperform
train to others
independently in the field

Prevention of mother-to-child transmission of HIV(PMTCT) -- provide care during pregnancy,
childbirth, and the postnatal period
Perform a vaginal speculum exam
Manage sexually transmitted infection using
syndromic approach
Contraceptive counselling and prescription
Insertion of contraceptive implant
Insertion of intra-uterine contraceptive device
Perform termination of pregnancy on request,
including pre- and post-procedure counselling
Provide care for sexual assault (rape) survivors,
including history, physical examination, preventive
treatment, and counselling
Perform visual inspection of cervix for cervicalcancer screeningProvide treatment of early stage / non-invasive
cervical cancer (cryotherapy)

MANAGEMENT AND SUPERVISIONSupervise appropriate measures for infection
prevention and control practices, including use ofuniversal precautions, basic hygiene (e.g. cleaningof patient care areas), and sterilisation ofinstrumentsCollect and analyse data relating to sexual andreproductive health services; report-writing
Set up or evaluate a clinic / obstetric service
Teach on seminars / formal courses
Human resources management: hire staff, coachthem, and evaluate their performance

Date lastComments
performed(year)

PART 2: LIFE-SAVING OBSTETRICAL SKILLS
1ST TRIMESTER PREGNANCY COMPLICATIONS
Theoreticalknowledge
onlyPracticalclinicalexperience

Competent to Confident toperform
train to others
independently in the field

Post-abortion care, medical method: Misoprostol /Mifepristone
Uterine evacuation using Manual Vacuum
Aspiration (MVA)

INTRAPARTUM COMPLICATIONSManagement of pre-term labour
Induction/Augmentation of labour, including
Oxytocin/prostaglandin regimen
Management of (pre-)eclampsia, including MgSO4regimen
Advanced ultrasound skills, e.g. for assessment ofgynaecologic / obstetric complications
Internal version manoeuvre (e.g. transverse lie of2nd twin)
Breech delivery
Twin delivery (also triplets, etc)
Shoulder dystocia
Vacuum extraction (ventouse)
Forceps delivery
Symphysiotomy
Craniotomy (destructive delivery)
Monitoring patient under anaesthesia
Anaesthesia management- local- paracervical, pudendal- other (specify)First Assist in Caesarean Section

Date lastComments
performed(year)

IMMEDIATE POSTPARTUM COMPLICATIONS
Theoreticalknowledge
onlyPractical
clinical
experience

Competent to Confident toperform
train to othersindependently in the field

Date lastComments
performed(year)

Manual removal of placenta, uterine exploration forfragments
Correcting uterine inversion
Management of severe postpartum haemorrhage,
including institute massive transfusion protocol,
uterine packing / balloon tamponade (e.g. Bakri)
Management of severe postpartum haemorrhage,
including institute massive transfusion protocol,
uterine packing / balloon tamponade (e.g. Bakri)
Repair of 3rd / 4th degree laceration
Repair of anal sphincter rupture

Click here

to read a leaflet on pregnancy termination and give a statement regarding your PERSONAL POSITION ON PROVIDING THIS CARE:__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

I certify that the given information is complete, correct and true
Signature___________________________________
Date_________________