International Confederation of Midwivesʼ
Model Curriculum Outlines forProfessional Midwifery Education

ICM Resource Packet #2
Model Midwifery Curriculum Outlines

1

Introduction

This resource packet contains a suggested outline of the organization and content for a threeyear direct-entry pre-service (basic) midwifery education programme and a separate
suggested outline for a pre-service midwifery programme when the applicant comes withanother health provider registration. The content is taken directly from the ICM Essential
competencies for basic midwifery practice (2010). The rationale for the organization ofcontent by module and by year of study is based on the following precepts:1•

Learning is enhanced when one moves from the familiar to the unfamiliar (build uponprior knowledge and experience before introducing new knowledge, skills andbehaviours (KSBs)•

Learning is enhanced when one moves from simple concepts to increasing levels ofcomplexity2 (healthy woman and newborn, then selected complications)•Learning is retained longer when it is put to immediate use (theoretical and practicallearning in the same time frame)•

Learning is enhanced by repetition (some of KSBs are intentionally repeated foremphasis, and multiple opportunities for practical experience are planned throughout
the midwifery programme)© ICM June 20121

A review of each ICM competency with its KSBs also influenced the placement of specificcontent and practical experiences in a given year and a given module. A decision wasmade as to whether that specific competency and each of its KSBs was best learned inyear one, two or three of the direct entry programme, and whether there was a cluster of
KSBs that fit logically with other KSBs in a specific module. It has been noted3 that ICM
Competency #1 and its domains of ethics, epidemiology and infection prevention; humanrights; legal and regulatory frameworks; and administration and management KSBs arefoundational to the six other competencies, though the content increases in complexity ofknowledge and skills as the learner advances (See Sample Division of ICM Competency #1& its KSBs in Appendix D). The authors also noted that professional behaviours areintegrated and expected throughout the curriculum as are critical thinking and clinicalreasoning, requiring an initial introduction to each of these areas with reinforcement
throughout the curriculum.
Practical hints:
As there are many ways to design a curriculum and to organize the content within, thefollowing practical hints are offered for consideration in designing a three year direct entry
midwifery curriculum1.
1. Review the programme mission and philosophy statements for guidance in how toorganize the content based on the ICM competencies (e.g., normal to abnormal
midwifery care, simple or introductory to complex midwifery care, observational
experiences to autonomous practice).
2. Begin by reviewing each of the seven (7) ICM competencies and their related KSBs,
affirming understanding and importance to midwifery practice in one’s country.
3. Understand that all competency domains and core KSBs must be included, thoughsome/all of additional KSBs may be needed depending on country health needs.
4. Have each midwifery teacher assign a temporary placement of each of thecompetencies and related KSBs by year or level throughout the three years of the
programme (may use a common worksheet to record initial decisions or mark1

The ICM accepted a consensus decision in 2011 that the most common time length to allow the average learner timeto acquire, apply and demonstrate competence in each of the seven (7) ICM competencies and their related
knowledge, skills and behaviours, was three years. There are programmes that are attempting to demonstrate that theICM competencies can be demonstrated in less than three years, but further research is needed to determine whether
such graduates have reached that goal.

© ICM June 20122

directly on a printed copy of the ICM competency document).
5. Discuss the temporary placement of content from step #2 above with a group of
experienced midwifery teachers, exploring rationale for each placement and mindfulof the programme’s mission and philosophy statements.
6. Make an intentional assignment of content to a given level of the curriculum, noting
rationale for placement in keeping with philosophy of teaching and learning.
7. Group together KSBs that are similar into one module/course unit and makedeliberate decisions on which KSBs will be repeated for reinforcement of learning;e.g. components of health assessment in each practical area.
8. Determine how much time should/can be allocated to each module or course unit,
given the weeks and hours available for the programme.
9. Determine which modules/course units fit together and can be offered in the sametime frame, given the realities of available learning resources (teachers, supplies,
simulation labs and/or practical sites and qualified preceptors) and the level ofmaturity of the learners (first, second, or third year).
10. Decide whether modules/course units that require practical experiences will havethose experiences concurrently with learning theory, or whether the theory will comefirst (block teaching) followed by practical experience.

Eighteen-month Post-Registration Programme:
In those countries that choose to provide basic midwifery education following completion ofa prior health provider programme, such as nursing, the steps outlined above can be usefulas well. The major difference in approach for a post-registration midwifery programme isthe need for teachers to define/distinguish the content that was learned in the prior healthprovider programme that contributes to midwifery competency so that it can bedemonstrated (usually some form of challenge mechanism) prior to continuing with theadditional midwifery KSBs. Some midwifery programmes will set pre-requisites for postregistration health providers to be completed/challenged prior to entering an 18-month preservice midwifery program.2 These pre-requisites often include basic sciences
2

A second ICM decision was based on consensus that, on average, a post-registration learner will need about 18
months to be able to demonstrate all the ICM competencies. Again this time frame has not been based on formal
research, and is subject to alteration if a post-registration graduate can demonstrate competency in full-scope© ICM June 20123

(pharmacology, biology, human anatomy/physiology and pathophysiology), psychology
and sociology, nutrition and basic health skills.4 Once this list of pre-requisitecompetencies is completed, the midwifery teachers can follow the suggested steps above
to determine which midwifery competencies with their remaining KSBs will be placed wherein the 18 month programme. The curriculum outline for a suggested 18-month preregistration midwifery programme is included in Appendix A.2.
Combined direct-entry and nurse-midwifery basic programme
A third model of pre-service midwifery education is the combination of direct-entry andpost-nursing learners in the same programme. That model will not be discussed here, but
one example from State University of New York Downstate Medical Center can be reviewed
at http://www.downstate.edu/CHRP/midwifery/program_summary.html In this combined
programme, the direct entry, non-health professional learner is required to take threecourses that the nurses do not have to take, These courses include basic health skills,
integrated medical sciences I & II. All learners have completed a baccalaureate degree
prior to entry into the midwifery programme and all learners take the midwifery courses
together.
Organization of the Packet
There are two sections to this packet. The first section provides an overview in narrative
form of the allocation of ICM competency statements 1-7 and their related knowledge, skills,
and behaviours to each year3 of study in a direct entry curriculum and each six months ofstudy in a post-registration midwifery curriculum. A brief discussion of how competencies
and KSBs can be grouped within a suggested module follows. Appendix A.1 offers a
midwifery practice.
3

One of the most difficult areas to address in the ICM Education standards was the concept of time
allocated to the description of the pre-service midwifery curriculum (programme) since competency-based
outcomes are expected rather than number of hours spent in learning. Teachers understand that given thevariety of learning styles, motivation, and resources available, it may take one learner more time todemonstrate competency than another learner. So why use years or months or weeks to describe directentry and post-registration pre-service midwifery programmes? The simple answer is that we do not yet
have valid research evidence of how long, on average, it takes a learner to achieve all of the ICM
competencies with their individuals KSBs. In the absence of such evidence, the ICM relied on global
consensus and expert opinion to provide the probable time frames for both types of pre-service midwifery
education programmes. The important point is if a country/education programme can demonstrate that
graduates have achieved the re-determined level of competency for full scope midwifery practice in lesstime or in designated hours of supervised midwifery practice, the ICM would consider that programme ashaving met the competency standard.
© ICM June 20124

graphic representation of a suggested three-year direct entry curriculum and Appendix A.2.
offers a graphic representation of suggested modules/instructional units for an 18-month
post-registration midwifery education curriculum, recognizing that a reasoned decision has
been made as to which pre-requisite content and KSBs have been demonstrated from theirprior education and health provider practice. In both of the narratives, each module will
have sub-units that do not appear on the graphic representations but will be discussed laterin this packet.
Please note: There is no attempt in this resource packet to allocate every one of the KSBs
under a specific competency statement in the suggested modules. Examples of some of
the KSBs are included, but anyone organizing/evaluating an existing midwifery curriculum
needs to make sure all the basic KSBs are included. Programme teachers may include the
KSBs agreed as “additional” as needed, along with additional competencies needed withinthat particular country or region. Each of these additions need additional time allotted forthem.
It is important to note that the ICM Competency statements 2-7 include midwifery care ofindividuals who are healthy as well as those with complications in a given practice area
(e.g., antenatal). Since the narrative descriptions of module content in the sample
curriculum outlines focus primarily on the separation of normal or healthy aspects of the
reproduction/childbearing experiences from those complications encountered throughout
the reproductive cycle, the KSBs in each competency have been separated into normal
and complications. The third or highest level of curriculum content (3rd year in direct-entry
and final 6 months in post-registration curricula) has the learner providing competent,
autonomous midwifery care across the full scope of midwifery practice in which they care
for all women regardless of normalcy or complications. The dominant or primary
competency statement is reflected at the beginning of the year/level or in each module forease of reference, knowing that some KSBs from other competencies may also be
included/repeated for emphasis.
The second section of this packet includes a more detailed explanation of how amodule/unit of instruction might be set up. Two sample modules (one primarily theoretical© ICM June 20125

and one with both theory and practical components) are included to demonstrate how
midwifery teachers might organize the required content in the two types of pre-service
midwifery curricula. Here it is important to note that the length of time spent in a given
module is directly related to the quality and availability of midwifery teachers, learning
resources, and practical experiences. Practicality also enters the time equation if a
midwifery programme is housed within an academic setting where semesters or quarters
have a defined length in weeks and/or hours spent and credit allotment. Credit allotment
normally follows a 1:1 hour ratio for theoretical learning and 1:3 hours ratio for practicallearning. Weeks are often used to describe the length of time in a particular module, basedon the host institution’s requirements along with midwifery teachers’ estimation of theavailability of practical learning sites for the number of students in the programme.
Whatever method of describing the length of time spent in a given module, the importantfactor to remember is that competency demonstration is the key to success as a competent
midwife. Some learners require more practical experiences to demonstrate competency
while other learners require fewer practical experiences. All of these factors are taken into
account when designing a midwifery education programme.

© ICM June 20126

2

Section 1: Overview of Suggested Organization of Midwifery Content

Generic three-year direct entry pre-service midwifery program (Appendix A.1)

Year 01: Foundations of Midwifery [32-36 weeks; 9 modules]
Competency 1: Midwives have the requisite knowledge and skills from obstetrics,
neonatology, the social sciences, public health and ethics that form the basis of highquality, culturally relevant, appropriate care for women, newborns and childbearing
families.
1. Midwifery Sciences: Biology (embryology & human development), basic chemistry
and microbiology, human anatomy and physiology, pharmacology andpharmacokinetics of common drugs used during childbearing.
2. Basic Health Skills for Midwives: Knowledge and skills generic to performing
health assessment (history, common laboratory tests, and physical examination) ofhealthy women and newborns, record keeping. Review of adult cardio-pulmonary
resuscitation (CPR), basic management of shock including starting intravenous lines,
administering blood products, administration of oxygen, and basic first aid.
[Selected midwifery KSBs taken from Competencies 2-7]
3. Life Cycle Nutrition: Basic knowledge of nutritional needs for healthy women
throughout their life; newborn nutritional needs including breast milk; infant nutritional
needs.
[Selected KSBs taken from Competencies 2-7 with focus on healthy individuals]
4. Introduction to Midwifery Care: Midwifery philosophy and model of care; midwiferycare process including critical thinking and clinical decisions-making; overview ofscope of midwifery practice; and roles and responsibilities of the midwife.
[Also includes selected midwifery KSBs taken from Competency 2-7]

© ICM June 20127

5. Becoming a Midwife I: Effective communication strategies, teamwork, professional
and personal identity. Global health status of women and childbearing families(reproductive health), global status of professional midwifery and introduction to ICM,
country perspectives and challenges for professional midwifery.
[Selected KSBs taken from Competencies 1-7.]
6. Midwifery (MW) Care: Healthy Pregnancy: Anatomy and physiology of
reproduction, confirmation of pregnancy and weeks of gestation, monitoring growthand development of foetus, care during pregnancy, common complications ofpregnancy, physiological and psychological adaptation and changes.
[Competency 3: Midwives provide high quality antenatal care to maximize healthduring pregnancy and that includes early detection …of selected complications.]
7. Midwifery (MW) Care: Healthy Labour/Birth: Physiology of labour and birth;
indicators of need for timely intervention; care and support during labour; pain relief;
attendance of birth and immediate care of mother and newborn; inclusion of support
persons for labouring woman; different models of birth and maternity care.
[Competency 4: Midwives provide high quality, culturally sensitive care during
labour, conduct a clean and safe birth and handle selected emergency situation to
maximize the health of women and their newborns.]
8. Midwifery (MW) Care: Healthy Postpartum/Newborn/Families: Normal
physiological involution; physiology of lactation, care and support of new family,
encouragement and support of exclusive breastfeeding (keeping mother, baby,
family together as unit of care).
[Competency 5: Midwives provide comprehensive, high quality, culturally sensitive
postpartum care for women.]
Physiological adaptation to extrauterine life, immediate care needs of the newborn,
characteristics of healthy newborns with common variations, normal newborn andinfant growth and development, immunization needs, elements of health promotion
and disease prevention in newborns and infants; healthy family development.

© ICM June 20128

[Competency 6: Midwives provide high quality, comprehensive care for the
essentially healthy infant from birth to two months of age.]
9. Well Woman Health Care: Theory and practice related to pre-conception care;healthy family development; sexual development and sexual activity; healtheducation targeted to sexual and reproductive health; provision of traditional andcontemporary family planning methods; screening for cervical cancer.
[Healthy aspects taken from ICM Competency 2: Midwives provide high quality,
culturally sensitive health education and services to all in the community in order toprogram healthy family life, planned pregnancies and positive parenting.]
Year 02: Midwifery Care of Common Complications of Childbearing and Newborns[32-36 weeks; 9 modules]

1. Public Health for Midwives: Definitions of health and wellness, determinants ofindividual health; principles of public health including health promotion and disease
prevention; basic epidemiology; community assessment strategies; individual, family
and community support systems including agencies that provide maternal-childhealth and illness services. Direct and indirect causes of maternal and neonatal
morbidity and mortality in the region/country; concept of alarm and transport; cultural
traditions surrounding pregnancy; safe birth settings; universal precautions; basic
demography including population characteristics; adolescent reproductive healthstatistics; global and local principles of primary health care.
[Selected KSBs taken from Competency 1 & 2]
2. Midwifery Ethics & Law: Codes of moral behaviour; values, human rights,
standards of practice; influence of values and beliefs on health and illness
conditions; moral reasoning and ethical decision-making; legal aspects of midwifery
care.
[Selected KSBs taken from Competency 1]© ICM June 20129

3. Midwifery Teaching & Counselling: Active listening; counselling skills specific toreproductive health; principles and practice of health education. Application ofcounselling skills with women experiencing psychosocial challenges during
pregnancy; anticipatory guidance during reproductive years with focus onchildbearing; bereavement counselling for pregnancy loss.
[Selected KSBs taken from Competencies 2-7]
4. Becoming a Midwife II: Advanced communication skills; interdependent teampractice; professional identity; regulation of midwifery practice; core ICM documents.
[Selected KSBs taken from Competencies 1-7]
5. Pharmacology for Midwives: Advanced principles of pharmacology; review ofbasic pharmacology principles; indications, doses, routes of administration, and side
effects of common drugs used for common complications of childbearing, such as
magnesium sulphate; teratogenic non-prescription and street drugs, such as
cocaine or ergot plants; prescribe, dispense, furnish or administer (however
authorized to do so in the jurisdiction of practice) selected, life-saving drugs[Selected KSBs taken from Competencies 2-7]
6. Midwifery (MW) Care: Complications Pregnancy: Diagnosis, treatment and/orreferral as indicated for complications prior to and during pregnancy, including
sexually transmitted infections, urinary tract infections, common acute and chronic
diseases specific to a geographic region such as malaria, tuberculosis, HIV; gender
based violence; spontaneous and induced abortion; pre-eclampsia/eclampsia;
preterm pregnancy; multiple foetuses; placental disorders; gestational diabetes.
[Complications and advanced KSBs from competencies 2-3; 7]
7. Midwifery (MW) Care: Complications Labour/Birth: Diagnosis, treatment and/orreferral as indicated complications during labour and birth, including fetal distress,
pre-term labour, malpresentations, cord prolapsed, shoulder dystocia, uterine
bleeding, retained placenta, cephalo-pelvic disproportion, infection, premature© ICM June 201210

rupture of membranes.
[Selected KSBs from Competency 4]
8. Midwifery (MW) Care: Complications PP/NB & Families: Diagnosis, treatment
and/or referral as indicated complications during the postpartum period and of
newborns, including sub-involution, mastitis, postpartum haemorrhage, anemia,
embolism, severe maternal depression; newborn jaundice, hypoglycaemia,
hypothermia, premature infant, congenital abnormalities, infection, dehydration;
dysfunctional family unit
[Selected KSBs from Competencies 5-6]
9. Basic Life Saving Skills for Midwives: Review of adult CPR; administration of
selected life-saving drugs such as anticonvulsants, antibiotics, antiretroviral
medications; Immediate management of shoulder dystocia, prolapsed cord, severematernal bleeding, shock, fetal distress; active management of third stage of labour,
manual removal of the placenta, uterine compression for postpartum haemorrhage[Select KSBs extracted from all competencies.]Year 03: Autonomous Midwifery Practice & Ongoing Professional Development[32-36 weeks; 5 modules]
1. Advanced Midwifery: Maternal death audits, legal and regulatory framework
governing reproductive health for women of all areas, advocacy and empowerment
strategies for women, leadership role in practice areas, beginning level
administration and management tasks and activities, importance of involvement inpolicy development for women’s health and safe motherhood.
[Selected KSBs taken primarily from Competency 1-2]
2. Professional Issues in Midwifery: ICM core documents relating to strengthening
midwifery education and regulation; midwifery association development; thebusiness of midwifery; history of midwifery in country and region; health policy© ICM June 201211

development and implementation; the global context of midwifery care. Basic
research designs and how to critique research reports; definition of evidence-based
practice and how to implement valid research outcomes in professional practice;indicators of quality health care.
[Selected KSBs from all competencies]
3. Midwifery Care of Women with Abortion Needs: Unintended pregnancy, medical
eligibility criteria for early termination of pregnancy, laws and regulations related toabortion care services, spontaneous abortion, incomplete abortion, uterine involution
and sub-involution, pregnancy loss/bereavement[Competency 7: Midwives provide a range of individualised, culturally sensitive
abortion-related are services for women requiring or experiencing pregnancy
termination or loss that are congruent with applicable laws and regulations and inaccord with national protocols.]
4. Being a Midwife & The Business of Midwifery: Professional identity; criteria forlicensure/regulation; plan for continuing professional development; business plansfor professional midwifery practice (e.g. organizing a birth centre or maternity home);
exploration of various models of midwifery care including homeopathy, water birth,acupuncture[Selected KSBs related to professional behaviours from each competency]
5. Autonomous Midwifery Care during the Reproductive Years: This module uses
the seven competency statements with their KSBs (application and synthesis) as the
expected learning outcomes at the end of the midwifery programme. The learnerprovides full scope midwifery practice in a variety of settings.

© ICM June 201212

Post-registration pre-service midwifery programme (Appendix A.2)

First level: Foundations of Midwifery [First 6 months; 9 modules]
1. Introduction to Midwifery: Global health status of women and childbearing families(reproductive health), global status of professional midwifery and introduction to ICM,
country perspectives and challenges for professional midwifery; definition of roles
and responsibilities of the midwife and expectations of professional status[Selected midwifery KSBs taken from Competency 1: Midwives have the requisiteknowledge and skills from obstetrics, neonatology, the social sciences, public healthand ethics that form the basis of high quality, culturally relevant, appropriate care forwomen, newborns and childbearing families.]
2. Midwifery Model of Care & the Care Process: ICM core documents (philosophy
and model of care) and elements of the midwifery care process (Appendix B) that
requires critical thinking, reflection, and clinical judgment throughout in preparation
for providing midwifery care for essentially healthy women, families and newborns[Included in all competencies]
3. Public Health for Midwives: Definitions of health and wellness, determinants ofindividual health, principles of public health, epidemiology, and community
assessment strategies; global and local principles of primary health care; individual,family and community support systems, and agencies that provide health and illness
services[Selected KSBs from Competency 1-2]
4. Ethics for Midwives: Codes of moral behaviour, values, human rights, standards ofpractice, influence of values and beliefs on health and illness, critical thinking andmoral reasoning; analysis of midwifery codes of ethics.
[Selected KSBs from Competency 1 and professional behaviours from allcompetencies]© ICM June 201213

5. Midwifery Standards of Practice: Analysis of standards of midwifery practicerequired in legal jurisdictions of practice; professional identity; interdisciplinary
teamwork[Selected professional behaviours from all competency statements]
6. Midwifery Communication & Counselling skills: Active listening; counselling skills
specific to reproductive health; principles and practice of health education
throughout the childbearing cycle[Selected KSBs from competencies 1-7]
7. Health Assessment of Women: Knowledge and skills required for taking healthhistory and performing physical and pelvic examination of healthy non-pregnant andpregnant women; common laboratory tests used with women in their reproductive
years; record keeping[Selected KSBs from competencies 2-5; 7]
8. Midwifery Care: Reproductive Health: Human sexuality, child spacing and preconception counselling and care; methods of family planning[Competency 2: Midwives provide high quality, culturally sensitive health educationand services to all in the community in order to program healthy family life, planned
pregnancies and positive parenting.]
9. Midwifery Care: Healthy Pregnancy: Anatomy and physiology of reproduction,
confirmation of pregnancy and weeks of gestation, monitoring growth anddevelopment of foetus, care during pregnancy, common complications of pregnancy[Competency 3: Midwives provide high quality antenatal care to maximize healthduring pregnancy and that includes early detection …of selected complications.]
Level 2: Healthy & Complicated Childbearing [Second 6 months; 9 modules]© ICM June 201214

1. Demographics of Maternal Child Health: Direct and indirect causes of maternal
and neonatal morbidity and mortality in the region/country, concept of alarm andtransport, cultural traditions surrounding pregnancy, safe birth settings, universal
precautions, professional ethics, partnership model of care with women and families,
collaborative teamwork for women’s health.
[Selected KSBs taken from Competencies 1, 2, 3]
2. Midwifery Care: Normal Labour & Birth: Physiology of labour and birth; indicatorsof need for timely intervention, care and support during labour; attendance of birthand immediate care of mother and newborn; inclusion of support persons forlabouring woman.
[Competency 4: Midwives provide high quality, culturally sensitive care during
labour, conduct a clean and safe birth and handle selected emergency situation to
maximize the health of women and their newborns.]
3. Midwifery Care: Abortion Related Services: Unintended pregnancy; medical
eligibility criteria for early termination of pregnancy; laws and regulations related toabortion care services; spontaneous abortion, incomplete abortion; uterine involution
and sub-involution; pregnancy loss/bereavement[Competency 7: Midwives provide a range of individualised, culturally sensitive
abortion-related are services for women requiring or experiencing pregnancy
termination or loss that are congruent with applicable laws and regulations and inaccord with national protocols.]
4. Basic Live Saving Skills for Midwives: Review of adult CPR; administration of
selected life-saving drugs such as anticonvulsants, antibiotics, antiretroviral
medications; immediate management of shoulder dystocia, prolapsed cord, severematernal bleeding, shock, fetal distress; active management of third stage of labour;
manual removal of the placenta, uterine compression for postpartum haemorrhage[Select KSBs extracted from all competencies.]© ICM June 201215

5. Pharmacology for Midwives: Review of basic pharmacology principles; indications,doses, routes of administration, and side effects of common drugs used for healthy
pregnancies and newborns and drugs used for common complications ofchildbearing, such as magnesium sulphate; teratogenic non-prescription and street
drugs, such as cocaine or ergot plants; prescribe, dispense, furnish or administer(however authorized to do so in the jurisdiction of practice) selected, life-saving
drugs[Selected KSBs taken from Competencies 2-7]
6. Midwifery Care: Healthy Newborns: Physiological adaptation to extrauterine life,
immediate care needs of the newborn, characteristics of healthy newborns with
common variations, normal newborn and infant growth and development,
immunization needs, infant nutrition needs, elements of health promotion anddisease prevention in newborns and infants.
[Competency 6: Midwives provide high quality, comprehensive care for the
essentially healthy infant from birth to two months of age.]
7. Midwifery Care: Healthy Postpartum: Normal physiological involution; physiologyof lactation, care and support of new family, encouragement and support of
exclusive breastfeeding[Competency 5: Midwives provide comprehensive, high quality, culturally sensitive
postpartum care for women.]
8. Professional Issues in Midwifery I: Professional identity development; ICM core
documents relating to strengthening midwifery education and regulation; history of
midwifery in country and region; current issues in midwifery education and practicein the country; membership in the midwifery association.
[Selected KSBs from all competencies]
9. Common Complications of Childbearing I: Diagnosis, treatment and/or referral as
indicated for common complications prior to and during pregnancy, during labour© ICM June 201216

and birth, the postpartum and postnatal periods.
[Complications and advanced KSBs from competencies 1-6]

Level 3: Autonomous Midwifery Practice & Ongoing Professional Development [Final
six months; five modules]
1. Advanced Midwifery: Maternal death audits, legal and regulatory framework
governing reproductive health for women of all areas, advocacy and empowerment
strategies for women, leadership role in practice areas, beginning level
administration and management tasks and activities, importance of involvement inpolicy development for women’s health and safe motherhood.
[KSBs primarily from Competency 1]
2. Professional Issues in Midwifery II: Professional identity; criteria forlicensure/regulation; plan for continuing professional development; business plansfor professional midwifery practice (e.g. organizing a birth centre or maternity home);
exploration of various models of midwifery care including homeopathy, water birth,acupuncture; health policy development and implementation.
[Selected KSBs related to professional behaviours in each competency]
3. Evidence-based Midwifery Practice: Basic research designs, how to critiqueresearch reports, definition of evidence-based practice and how to implement valid
research outcomes in professional practice; indicators of quality health care
[Selected KSBs from Competencies 1-7]
4. Midwifery Care: Complications Reproductive Years II: Advanced diagnosis andtreatment and/or referral of severe complications of childbearing, such as diabetes
and cardiac disease; newborn anomalies, preterm infants, complications of induced
abortion.
[Selected KSBs from competencies 2-7]

© ICM June 201217

5. Autonomous Midwifery Care during the Reproductive Years: This module uses
the seven competency statements with their KSBs (application and synthesis) as the
expected learning outcomes at the end of the midwifery programme. The learnerprovides full scope midwifery practice in a variety of settings.
3

Section 2: Sample Modules

Introduction
There are many ways to package the content (ICM Competency statements and relatedKSBs) needed in an educational curriculum and many different terms to describe thepackages. For example, the more traditional term within universities is ‘course’. Others
use ‘instructional unit’ to describe the content that is included in a specific area of study.
The choice of ‘module’ for these ICM resource packets was deliberate and based on the
self-study approach to adult learning and the required demonstration of practicecompetency as a beginning midwife.
A module is a self-contained unit of instruction that provides clear directions to bothlearner and teacher on what is to be demonstrated at the end of the unit (learning
outcomes), the elements of knowledge and specific skills needed and the professional
behaviours expected to successfully complete the learning outcomes. Competency in
midwifery practice in all three domains of learning is evaluated by learner selfassessment and direct observation by a qualified midwifery preceptor based on thelearning outcomes expected. One suggested approach to developing a module can befound in Appendix C: Module Development Worksheet.
This section of the resource packet includes an outline of two sample modules:•

Introduction to Midwifery•

Midwifery Care During Healthy Pregnancies

These modules were chosen as they represent foundational theory (Introduction to
Midwifery) and how antenatal KSBs are demonstrated in practice (Midwifery Care during
Healthy Pregnancies). They also illustrate how a given module may be broken down into
sub-units based on like or similar content. Sub-units may exist in some or all of the© ICM June 201218

modules, depending on who will be the teacher of record (expert) and the logicalgrouping of content. For example, the Basic Sciences module most likely will have subunits on biology/microbiology, general chemistry, human anatomy and physiology,
pathophysiology and pharmacology with different teachers for each. Another example isthat the Reproductive Health module may have sub-units such as women’s health care,parent education, and family planning or the Labour and Birth module may have subunits on labour care, care during birth and the immediate postpartum period, andcommon life-threatening maternal and newborn complications. However midwifery
teachers decide to group content into modules and sub-units, the decisions need to becarefully thought out and in keeping with the needs of adult learners and available
experts to facilitate learning of both theory and practice.
Sample Modules

It is important to note that these two sample modules include a suggested organization ofcontent and also a broad outline of what might possibly be included along with examplesof the types of learning activities and resources available. Using the ICM Essential
Competencies for Basic Midwifery Practice 2010 as the primary reference point, themidwife teacher decides how to group like content and word the KSBs in language
appropriate to the educational setting and country. This means there is some flexibility inuse of the ICM competencies in that they can be adopted as is, adapted to the common
language of the country, or added to as country needs demand. However, each of the
KSBs that have been indicated as “basic” must be included in the curriculum; none canbe deleted when one is preparing a fully qualified midwife in keeping with the ICM
definition.

© ICM June 201219

Introduction to Midwifery
Four (4) weeks4
Module Introduction/Description
This module is an introduction to the profession of midwifery and how midwives andmidwifery care can promote the health of women and childbearing families globally. It
will be divided into three sub-units: 1) factors affecting the status and health of women
globally, 2) the International Confederation of Midwives, and 3) the roles andresponsibilities of the professional midwife. Each sub-unit has its own learning outcomes,
content list, and suggested learning activities. Once all sub-units are successfullycompleted, you will have met the Overall Learning Outcomes. Welcome to the exciting
world of midwifery!
Overall Learning Outcomes
At the end of this module, the learner will be able to:
1. Understand the range of factors that affect the health of women globally
2. Describe the global importance of the International Confederation of Midwives
3. Discuss the roles and responsibilities of the professional midwife
Overall content taken primarily from ICM Competency #1:
Midwives have the requisite knowledge and skills from obstetrics, neonatology, the social
sciences, public health and ethics that form the basis of high quality, culturally relevant,appropriate care for women, newborns and childbearing families. Additional content on
ICM added.

Note to learner: It is recommended that you take time to read through the entire module
first before selecting one of the sub-units to begin study. In this module it does not makeany difference which of the sub-units you begin with as each is an independent area andall three are needed to complete the overall learning outcomes. If you have any questions
4

This module most likely would be offered during the same time frame as Public Health, Professional Ethics
and Research and Evidence-Based Practice for the direct entry learner as much of the content iscomplementary. It would be offered at the beginning of midwifery content for the post-registration learner.
© ICM June 201220

about this module, contact the teacher for clarification. You are encouraged to discuss
your learning with peers, but do not depend on others to prepare the needed content.
Your sharing will be richer when all have prepared ahead of time.
Sub-unit 1: Factors that affect the health of women globally
At the end of this sub-unit, the learner will be able to:
1.1
Identify how poverty, malnutrition, low levels of education and various formsof discrimination affect the health of women in many areas of the world
1.2
Discuss how denial of the basic human right for safety affects the health ofwomen globally
1.3
Describe the society-maintaining and society-enhancing roles of women in
the world that could lead to poor health
1.4
Present a plan of action to improve the health of women in the learner’s
country of origin
Content listØ Review of the community and social determinants of health (e.g., income, literacy
and education with focus on young girls and womenØ Review of basic human rights and their effect on health of women and girls if
denied; e.g., domestic violence, female genital mutilation (FGM), HIV/AIDSØ Local culture and beliefs, including gender roles and statusØ Indicators of quality health services

Suggested learning activities (self-study)
1. There are several websites you may wish to peruse that report on the health statusof young girls and women in various countries of the world. Most notable among
these are:•Save the Children’s State of the World’s Women 2011 at
www.savethechildren.org/•

Women Deliver reports on adolescents and women atwww.womendeliver.org•

UNICEF The State of the World’s Children 2011 at www.unicef.org/sowc/© ICM June 201221•United Nations’ Development Program (UNDP) reports on progress towardtargets of the eight Millennium Development Goals (MDGs) at
http://www.undp.org/content/undp/en/home/mdgoverview.html•

UNFPA has a focus on women and midwives. Browse their website for
information on gender equality, reproductive health and other topics ofinterest. www.unfpa.org•

World Health Organization website has excellent resources on human rights
and health. www.who.ch•

The Partnership for Maternal, Newborn and Child Health (PMNCH) also has

a information website and frequent electronic communication with those
supporting their advocacy efforts (you can join as individual).
www.pmnch.org
2. You are encouraged to visit your local health department’s centre for vital statistics
to obtain the most recent report on the state of health for young girls and women,
including morbidity and mortality ratios in your local area or country.
3. If there are peers from other countries in your midwifery class, you may find it
helpful to compare the health status of young girls and women by country as agroup and explore possible reasons for any differences.
4. You are encouraged to review any worksheets provided by the teacher to organize
your thinking about women’s health in your country,
Other learning resources available
1. Thompson, J. B. (2007). Poverty, development, and women: Why should wecare? JOGNN 36: 6: 523-530.
2. Thompson, J.B. (2005). International policies for achieving Safe Motherhood:
Women’s lives in the balance. Health Care for Women International 26: 6, 472-483,(June-July).
3. Thompson, J.B (2004). A human rights framework for midwifery care. Journal of
Midwifery & Women’s Health, 49:3,175-181 (May/June).
4. Fill in country-specific resources here that are available to the learners.

© ICM June 201222

Sub-unit 2: International Confederation of Midwives (ICM)
At the end of this sub-unit the learner will be able to:
2.1
Define the aims and objectives of the ICM
2.2
Discuss how the ICM organizational structure and priorities can strengthen
midwifery in the learner’s country of origin
2.3
Analyse the ICM core documents for relevance to the learner’s country oforigin2.4
2.5

Identify key global challenges and opportunities for the profession of
midwifery that might be addressed by the ICM
Create a draft ICM position statement to address a global midwifery
challenge

Content ListØ ICM Priorities/Aims and Objectives (Pillars)Ø Organizational structure: membership, decision body, regions, headquartersØ Core documents and position statements: Definition of midwife, scope of practice,code of ethics, standards for education and regulation
Ø State of the World’s Midwifery Report 2011Ø Midwifery’s global influence (Millennium Development Goals)
Suggested learning activities (self-study)
1. If you have access to the internet, browse the ICM website to locate the most upto-date information about the Confederation. www.internationalmidwife.org
2. Another source of ICM information is the new International Journal of Childbirth thatis available in both paper copy and online.
3. It is suggested that you find out whether there is a midwifery association in yourcountry and if it is a member of the ICM. If so, visit their headquarters to see what
resources they might have on international midwifery and the ICM.
Learning resources available© ICM June 201223

1. The primary source for information on the International Confederation of Midwives
is their website at www.internationalmidwife.org
2. Review ICM Position Statements on education, regulation, partnership with womenand families, human rights.
3. The State of the World’s Midwifery Report 2011 is available on a CD from UNFPA
or online at www.internationalmidwives.org
4. Thompson, J.E., Herschderfer, K., Duff, E. (2005). The midwife takes center stage
in the global arena in 2005: The International Confederation of Midwives (ICM).
Journal of Midwifery & Women’s Health 50: 4, 269-271, (July/August).
5. Add other specific resources here that are available to the learner. May direct thelearners to the WHO or UNFPA countries offices, if they exist in the country.
Sub-unit 3: The professional midwife
At the end of this sub-unit, the learner will be able to:
3.1
Compare the definition of the midwife in your country with the ICM Definitionof the Midwife (2011)
3.2
Discuss the advantages and disadvantages of the variety of education
pathways for midwifery
3.3
Evaluate the midwifery scope of practice in your country for its ability tomeet the needs of women and childbearing families
3.4
Discuss the advantages and disadvantages of the variety of regulatory
recognition of midwives
3.5
Define the core responsibilities of the midwife based on the profession’scode of ethics, scope and standards of practiceContent ListØ Definition of midwife and scope of midwifery practiceØ Actions consistent with professional ethics, values and human rightsØ Actions consistent with standards of practiceØ Responsibility and accountability for clinical decisions and actions
Ø Maintenance of midwifery knowledge and skills in order to remain current in© ICM June 201224

practiceØ Respect for individuals and of their culture and customs, regardless of status,
ethnic origins or religious beliefs
Ø Requirements of the regulatory body for midwifery practiceØ Required local reporting regulations for birth and death registrationØ ICM Essential competencies for basic midwifery practice 2010Ø ICM Global standards for midwifery education 2010 with Guidelines
Suggested learning activities (self-study)
1. Visit the midwifery regulatory authority in the country to learn the local definition ofa midwife and scope of practice allowed. Then compare these documents with the
ICM Definition of a Midwife and Scope of Practice (2011).
2. Review the variety of health professional education programmes in your country
and discuss with peers the background and type of midwifery programme you areenrolled in. Is this the same pathway to professional practice as that for doctors
and nurses in your country? If not, why not?
3. You may also wish to discuss why there is a need for educational standards forhealth professionals.
4. Explore the following questions with peers and teachers. Is midwifery aprofession? Are midwives professionals? Explain reasons for responses
5. Explore whether there is a code of ethics or moral behaviour for midwives in yourcountry. If so, compare its contents to the ICM International Code of Ethics 2008. If
there is no code of ethics specific for midwives, work with your peers to begin todevelop one.
6. Examine the midwifery standards of practice and begin to discuss the roles andresponsibilities of midwives in your country.
7. Request the specific reporting requirements for births and deaths in your country
during your visit to the local health department/Ministry vital statistics department.
Other learning resources available
1. Fullerton, J.T., Johnson, P.G., Thompson, J.B., Vivio, D. (2010). Quality
considerations in midwifery pre-service education: Exemplars from Africa.
© ICM June 201225

Midwifery. doi:10.1016/j.midw.2010.10.011
2. Fullerton, J.T., Gherisi, A., Johnson, P.G., Thompson, J.B. (2011). Competence
and competency: Core concepts for international midwifery practice. International
Journal of Childbirth 1:1, 4-12.
3. Fullerton, J.F., Thompson, J.E., Severino, R. (2011). The International
Confederation of Midwives Essential competencies for basic midwifery practice:
An updated study 2009-2010. Midwifery 27: 399-408. doi:
10.1016/j.midw.2011.03.005
4. Thompson, J.E., Fullerton, J.T., Sawyer, A. (2011). The International Confederationof Midwives’ Global Standards for Midwifery Education (2-010) with companion
guidelines. Midwifery 6 May 2011. Doi:10.1016/j.midw.2011.04.001
5. Country-specific references need to be added here along with any worksheets orcase studies teachers have prepared for use by learners.
Overall Assessment of Learning Strategies and Timing
1. There will be two paper-pencil tests given in this module. The first will be planned
for midway through the module (give specific day and time) and the second isplanned at the end of the module: 50% module grade
2. Each learner will be expected to actively participate in peer and group
discussions, having prepared prior to those discussions: 25% module grade
3. Each learner will submit a 5-page paper addressing the question: “How do
professional midwifery and midwives promote the health of women andchildbearing families in the world?” (add specific date due): 25% module grade

Overall Module Evaluation5
You are expected to complete the following Module Evaluation and discuss withteacher(s): Please circle the response that most closely represents your evaluation of thefollowing parts of this module:
1. I was able to meet the following learning outcomes in time allotted:
5

The module evaluation can be brief or very detailed, depending on choices of the midwifery teachers.
© ICM June 201226

a. Understand the range of factors that affect the health of women globally
Yes

PartiallyNo

b. Describe the global importance of the International Confederation of
Midwives

Yes

PartiallyNoc. Discuss the roles and responsibilities of the professional midwife
Yes

PartiallyNo

2. The learning activities helped me to learn

Yes

PartiallyNo

3. The group work helped me to learn

Yes

PartiallyNo

4. The learning resources were available and helpful

Yes

PartiallyNo

5. The teacher was an effective facilitator of my learning Yes

PartiallyNo

6. The teacher stimulated me to learn

Yes

PartiallyNo

Yes

PartiallyNo

7. The teacher was fair and unbiased in assessing
my learning

8. The most helpful aspect(s) of the module was: (please explain)

9. Suggested changes in the module (Please be specific)

Name ___________________

Date________________

Note: It is suggested that learners sign their evaluation so that details can be discussedwith the midwifery teacher. This is an important lesson in being accountable for one’s
critique and often eliminates unwarranted comments on those aspects of teaching andlearning that cannot be changed; e.g., clothing, physical features, personalities.
Likewise, any learner evaluation by a teacher needs to be openly discussed with thelearner.

© ICM June 201227

Midwifery Care During Healthy Pregnancies
8 weeks6
Module Introduction/Description
This module introduces the learner to the knowledge, skills, and professional
behaviours needed to provide high quality antenatal care that maximizes health during
pregnancy along with early detection of potential threats to the health of the pregnant
woman or her developing foetus. This module is a continuation of your practicalapplication of knowledge, skills and professional behaviours to the care women andfamilies during one of the most important life events – that of pregnancy and preparing forbirth. This module offers you many opportunities to work together with women andfamilies to achieve the best outcomes of each pregnancy. Enjoy!
Overall Learning Outcomes
At the end of this module, the learner will be able to:
1. Provide high quality, evidence-based antenatal care for women seeking midwifery
services
2. Conduct a series of childbirth education classes with a group of pregnant women
Overall Content taken primarily from healthy aspects of ICM competency #3: Midwives
provide high quality antenatal care to maximize health during pregnancy and that
includes early detection and treatment or referral of selected complications.
Note to learner: In this module, there are many KSBs related to the provision of antenatal
care (sub-unit 1) and each needs to be understood prior to working with pregnant womenand families to help them prepare for childbirth and parenting (Sub-unit 2). Wheneverpossible, you will be applying knowledge and skills to the actual care of pregnant womenwhile you are continuing to learn the KSBs of antenatal care.
6

It is the midwife teachers’ decision on how to sequence modules in year 02. The Healthy Pregnancy
module with its practice component most likely would come after an initial 3-4 weeks of study for
Demographics and Midwifery Care Process, and 8 weeks of Reproductive Health. It would be then followedby 12-16 weeks (depending on volume of practical experiences available) for a combination of Healthy
Labour/Birth, Healthy Postpartum, Healthy Newborn, and Life Saving Skills. Note that the content of thelatter is divided into separate modules, but the practical component should focus on keeping themother/baby care together whenever possible.
© ICM June 201228

Sub-unit 1: Components and Practice of Antenatal CareAt the end of this sub-unit, the learner will be able to:
Theoretical outcomes:
1.1
1.2
1.3
1.4
1.5
1.6
1.7
1.8

Understand key elements of reproductive anatomy, physiology, genetics,
and biology
Articulate the principles for correctly dating a pregnancy
Identify the components of a health history and focused physicalexamination for each antenatal visit
Know the normal findings (results) of basic screening laboratory tests
Describe the normal progression of pregnancy for the woman and herdeveloping foetus
Know the basic principles of pharmacokinetics of drugs taken by women
during pregnancy and effects on woman and foetus
Understand comfort measures used to relieve common complaints of thepregnant woman
List the components of a new and repeat antenatal visit

Practical/clinical outcomes:
1.1

Conduct a complete antenatal visit according to the midwifery care process

1.2

Perform health assessment of the pregnant woman safely with minimum
discomfort to the woman and obtaining accurate results

1.3

Perform an abdominal examination of the woman in a systematic mannerusing correct techniques

1.4

Correctly confirm pregnancy and its normal progression

1.5

Accurately determine normal foetal growth and development throughout
pregnancy© ICM June 2012

29

1.6

Teach and/or demonstrate measures to decrease common discomforts ofpregnancy

1.7

Identify the pregnant woman’s specific concerns and/or needs during each
visit and work with her to develop and implement a plan of care

1.8

Correctly identify common variations from normal during pregnancy andinstitute appropriate first line management based on evidence-based
guidelines, local standards and available resources.

1.9

Record findings accurately and completely for each antenatal visit

1.10

Accurately assess the effectiveness of your midwifery care

Content list for theory and practiceØ Reproductive anatomy, physiology, menstrual cycle, process of conceptionØ Signs and symptoms of pregnancy
Ø Dating pregnancy by menstrual history, size of uterus, fundal growth patterns anduse of ultrasound (if available)Ø Calculating expected date of birthØ Placental development, circulation, and functionØ Components of health history and focused physical examination for antenatal visitsØ Normal findings basic laboratory tests used in countryØ Pregnancy body changes, common discomforts, normal fundal growthØ Normal psychological changes during pregnancy
Ø Measures to assess fetal well-being during pregnancy
Ø Nutritional needs of pregnant woman and developing foetusØ Safe, locally available non-pharmacological substances for relief of common
discomforts of pregnancyØ Pharmacokinetics of drugs prescribed, dispensed or furnished to pregnant woman© ICM June 201230

Ø Effects of prescribed medications, street drugs, traditional medicines, and overthe-counter drugs on pregnant woman and foetusØ Prevention of STI and HIV infectionØ Signs and symptoms and indications for immediate intervention of referral ofcommon complications of pregnancy, including HIV infection, malaria, vaginal
bleeding, pre-eclampsia, syphilis
Ø Indications for use of selected life-saving drugs such as antibiotics,
anticonvulsants, antimalarials, antiretrovirals

Suggested learning activities (self-study)
1. Complete the required/recommended readings selected by the teacher as thebest available on the topics to be learned.
2. Given the availability of a midwifery textbook, it is helpful to read those chapters
related to the provision of prenatal care to understand and learn the required
content.
3. Analyze selected antenatal case studies prepared by teachers based on actual
situations in a small group of peers.
4. You may find it useful to review female anatomy and reproductive physiology froma medical or obstetric text, common drugs used in pregnancy in a pharmacology
text, and normal laboratory test values from a laboratory manual.
5. Understanding the menstrual cycle and fertilization of the human egg may be achallenge initially. Review the programme’s audio-visual aids or charts thatgraphically represent the interaction of hormones needed for conception.
6. If the programme has plastic models available, handling a female pelvis may help
you understand the relationship of pelvic bones, where the developing uterus fits,
and what effect early and late pregnancy have on associated structures such as
the bladder and intestines. Group work with peers using the plastic model can also
be a helpful learning strategy.

© ICM June 201231

7. You may also wish to browse the World Wide Web for the most up-to-date
information on prescription drugs, over-the-counter drugs, and traditional
remedies.
8. Talking with women from the community (focus groups) may give you additional
insight into how, when and why they use traditional remedies during pregnancy.
9. You may wish to plan some observation days early in the module to watch an
experienced midwife conduct an antenatal visit, with permission of the pregnant
woman, the midwife, and the practical site.
10. Follow the schedule of your practical days and hours in an assigned setting.
Prepare for each site by reviewing written policies or protocols for antenatal careand request an orientation to the site and records. Plan for daily discussion ofprogress in learning with the midwife preceptor and identify your specific learningneeds prior to each day of practical work.
11. If you are having difficulty in taking an organized history, you may wish to obtain
permission to audio record the session for review afterwards.
12. Clinical laboratory practice of hand skills needed during antenatal care, such as
abdominal palpation or pelvic examination, can provide good learning
experiences in a safe environment.
Other learning resources available
1. Search the WHO website for the Midwifery Modules and review the Community
Module. The other modules address the common causes of maternal death, sucha pre-eclampsia/eclampsia, haemorrhage, obstructed labour, and infection. These
will be used more in year 03 when addressing complications of childbearing.
2. Some programmes have videos of teachers providing antenatal care that can beviewed by learners as needed.
3. Audiovisual aids, PowerPoint slides, and simulation models may be available foruse.
4. Worksheets, case studies, and sample questions to stimulate application ofknowledge to practice and reflection on practice are helpful teacher-designed
tools to facilitate learning.

© ICM June 201232

5. Insert specific journal citations, preferably from the country or region that reflectcurrent evidence-based practice during normal pregnancy.

Assessment of Learning Strategies and Timing
1. There will be three written examinations to sample test theoretical knowledge andits application to clinical cases. Each will be offered (date, time) approximately
three weeks apart. (60%)
2. Learners will be expected to lead a seminar on a selected topic. (20%)
3. Participation in discovery-based learning with a small group. (20%)
4. Formative assessment of clinical care ongoing throughout module.
5. Final demonstration of competent midwifery care in practical setting by end of
module. (Pass/fail)© ICM June 201233

Sub-unit 2: Health Counselling and Childbirth Education
At the end of this sub-unit of study, the learner will be able to:
2.1.1 Provide need-based advice and health counselling (anticipatory guidance) fora variety of pregnant women
2.1.2 Design a series of childbirth education sessions that includes basic preparation
for labour, birth and parenting
Content ListØ Measures to alleviate common discomforts of pregnancy
Ø Health education (hygiene, sexuality, work inside and outside home)Ø Danger signs and symptoms
Ø Emergency preparednessØ Selection of safe site for labour and birthØ When and how to contact the midwifeØ Essential elements of birth planningØ Physiology of lactation and methods to prepare women for breastfeedingØ Preparation of home and family for the newbornØ Signs and symptoms of labour onsetØ Techniques for increasing relaxation and pain relief measures for labour
Suggested learning activities (self-study)
1. Begin by reading assigned readings.
2. Refer to your midwifery text to learn about health education needs of pregnant
women and peruse the web for childbirth preparation classes.
3. In discussion with peers, begin to think about what anticipatory guidance
throughout pregnancy is needed when and design a plan for anticipatory
guidance for each trimester; e.g. first trimester: effects of early hormonal changes,
nausea, urinary frequency; second trimester: nutritional needs as pregnancy
advances, fetal growth and development; third trimester: preparation for labourand birth, newborn care, breastfeeding, emergency preparedness.
© ICM June 201234

4. You may find it helpful to role play with peers the provision of advice about how to
alleviate round ligament pain, backache, leg oedema, for example.
5. You may decide to observe another midwife leading a formal childbirth education
class before you design the content for your own bench/clinic conferences orformal classes for pregnant women and their partners.
6. Work with peers to design a series of four-six classes with content and activities tohelp pregnant women and their partners, if available, prepare for labour, birth, andcare of their newborn.
7. Work with teacher to schedule childbirth classes, and learn about the setting andwomen who will participate in the class. If classes are not routine in the setting,
may need to advertise availability and recruit some pregnant women to attend.
Remember, pregnant women are important partners in your learning journey, andmany will be willing to help you gain the experiences needed to become a good
midwife.
8. Keep of diary of learning progress in providing prenatal care, reflecting on
progress and future learning needs to discuss with the teacher.
Other learning resources
1. The programme may have teaching aids that can be used during childbirthpreparation classes.
2. Request time to be observed teaching a childbirth education class with feedback
from teacher and peers.
3. Add country-specific articles and materials as options to enhance learning.

Assessment of Learning Strategies and Timing
1. Small group plan for anticipatory guidance by trimester of pregnancy. (25%)
2. Simulation presentation of measures to relieve common discomforts of pregnancy.
(25%)
3. Teacher and parent feedback on childbirth education classes. (50%)© ICM June 201235

Overall Module Evaluation7
You are expected to complete the following Module Evaluation and discuss withteacher(s): Please circle the response that most closely represents your evaluation of thefollowing parts of this module:
10. I was able to meet the following learning outcomes in time allotted:
a. Provide high quality, evidence-based antenatal care for women seeking
midwifery services Yes Partially No
b. Conduct a series of childbirth education classes with a group of pregnant
women

Yes Partially No

11. The learning activities helped me to learn

Yes

PartiallyNo

12. The learning resources were available and helpful

Yes

PartiallyNo

13. The teacher was an effective facilitator of my learning Yes

PartiallyNo

14. The teacher stimulated me to learn

Yes

PartiallyNo

Yes

PartiallyNo

Yes

PartiallyNo

Yes

PartiallyNo

15. The teacher was fair and unbiased in assessing
my learning
16. The practical experience was sufficient for
demonstrating antenatal care
17. The clinical teacher/preceptor was available to me
at all times

18. The most helpful aspect(s) of the module was: (please explain)
19. Suggested changes in the module (Please be specific)

Name ___________________

Date________________

It is suggested that learners sign their evaluation so that details can be discussed withthe midwifery teacher. This is an important lesson in being accountable for one’s critiqueand often eliminates unwarranted comments on those aspects of teaching and learning
7

The module evaluation can be brief or very detailed, depending on choices of the midwifery teachers.
© ICM June 201236

that cannot be changed; e.g., clothing, physical features, personalities. Likewise, anylearner evaluation by a teacher needs to be openly discussed with the learner.

1

Thompson JE, Kershbaumer RM, Krisman-Scott MA. Educating advanced practice nurses and midwives.
Philadelphia: Springer Publishing Company, 2002. Chapter 10: Teaching in the clinical setting, pp. 121122.
2
Benner P. From novice to expert. Menlo Park, CA: Addison-Wesley Publishing Company, 1984.
3
Fullerton JT, Gherissi A, Johnson PG, Thompson JB. Competence and competency: Core concepts forinternational midwifery practice. International Journal of Childbirth 1(1), 2011, p. 8. DOI: 10.1891/21565287.1.1.4
4
Accreditation Commission for Midwifery Education (ACME). The knowledge, skills and behaviors
prerequisite to midwifery clinical coursework. Silver Spring, MD: ACME, 2005.

© ICM June 201237

!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!ICM Resource Packet #2
ICM Professional Midwifery Curriculum Outline Appendix A.1
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ICM Professional Midwifery Curriculum Outline Appendix A.2
Graphic Representation of Suggested Modules for Professional Midwifery Programme
post-Registration Health Provider (18 months)	  First	
  
S
ix	
  
M
onths	
  
	
   	
  
	
  

Introduction	  to	
  Midwifery	
  Midwifery	
  Model	  of	
  Care	  Care	
  Process	
  

MW	
  
Communication	
  	
  
&	
  Counseling	
  Skills	
  Public	  Health	
  for	
  Midwives	
  Health	  Assessment	
  of	
  Women	  Ethics	  for	
  Midwives	
  Midwifery	  Standards	  of	
  Practice	  Midwifery	
  Care	  Reproductive	  Health	  Midwifery	
  Care	  during	  Healthy	  Pregnancy	  	  Second	  Six	  Months	  	  Demographics	
  
MCH	
  	
  Health	
  MC	
  Healthy	  Newborns	
  MC	
  Normal	
  Labour	  &	
  Birth	  MC	
  Abortion	
  Related	
  Services	
  MC	
  Healthy	  Postpartum	
  Basic	
  Life	  Saving	
  Skills	  for	
  Midwives	
  Professional	
  Issues	
  in	
  Midwifery	  I	
  Pharmacology	  For	
  Midwives	
  Common	  Complications	  of	
  Childbearing	
  I	
  

	
  

Third	
  Six	  Months	  Advanced	
  Midwifery	
  Professional	  Issues	  in	
  Midwifery	
  II	
  

Evidence-­‐based	
  Midwifery	
  Practice	  MC	  Complications	
  Reproductive	  Years	
  II	
  
	
  

Autonomous	
  Midwifery	
  Care	  during	
  Reproductive	  Years	
  Demonstration	
  of	
  all	  7	  ICM	  Competencies	  Successful	
  Programme	  Completion	  Appendix B
Midwifery Care Process1
This care process is dynamic, continuous, and circular when needed, following anorderly succession of steps and requiring critical thinking and various types andlevels of decision-making throughout. At times data collected or decisions made orunanticipated outcomes will require re-visiting an earlier step and re-planning withthe woman. See attached graphic illustrating the circular nature of the care process
1.

2.

3.

1

ASSESSMENT:
Includes:History and current needs expressed by woman,physical examination, laboratory findings.
[cognitive, psychomotor, affective functions]

Sources of data:

Woman, family, available records, observation.

Criteria for success:

Systematic and accurate data collection done inculturally appropriate, respectful manner.

DECISION-MAKING:
Includes:Organizing data collected to clarify actual or
potential midwifery diagnoses based on woman’sneeds/problems and determining if emergency
action required. [Cognitive & affective functions]

Sources of data:

See Step 1.

Criteria for success:Correct interpretation of data that results inaccurate midwifery diagnoses.

PLANNING:

This schemata of the midwifery model of care has been used with midwifery teachers and learners
in a variety of countries for the past 40 years. It was updated in keeping with the ICM Midwifery
Philosophy and Model of Care, Essential Competencies for Basic Midwifery Practice, and theInternational Code of Ethics for Midwives along with the ACNM Life-Saving Skills Manual for
Midwives 1991. J. Thompson, 4/12

4.

5.

4/12 jetIncludes:Prioritizing need for action in partnership with thewoman, determining which needs/problems will
be resolved by midwifery actions; need for
consultation or referral. [Cognitive & affectivefunctions]

Sources of data:

Steps 1 and 2.

Criteria for success:Comprehensive plan with input fromwoman/family, including alternates whenavailable based on evidence/sound rationale.

IMPLEMENTATION:
Includes:Timely, appropriate, safe midwifery care provided
with compassion and cultural sensitivity,
promoting self-care when possible. [Cognitive,
affective, psychomotor functions]

Sources of data:

Steps 1, 2, and 3.

Criteria for success:Timely intervention with safe, evidence-based,
efficient, ethical, compassionate care-giving
along with appropriate recording of data and planof care.

EVALUATION:
Includes:Feedback from woman/family on needs met,satisfaction; midwife self assessment andreflection on outcomes & whether new approachneeded; confirmation/validation from colleagues,
teachers. [Cognitive, affective functions]

Sources of data:

Self, woman, family, peers, supervisors.

Criteria for success:

Extent to which care given met needs of woman
and midwifery goals. Outcomes of midwifery careincludes improved health/well-being of womenand newborns.

Graphic Representation of Midwifery Care Process

Foundational Midwifery
Knowledge, Skills & Professional Behaviors(KSBs)

CriticalThinking

Assessment
A! History! Physical Examination! Laboratory Findings
Look
Feel

Ask
ListenEvaluation
!
!
!
!
!

Needs met?
Problems resolved?
Woman satisfied?
Midwife self-assessment
Reflection

Decision-Making

Womanʼs
Needs
Problems! Organize data collected! Clarify needs/potential
problems! Emergency action needed?

Appropriate
Action!"#$$%$&''

Implementation!
!
!
!

Timely, appropriate care
Promote self-careCompassionate, culturally
appropriate care
Safe care!
!
!

Prioritize needs
Create plan with woman
Need for consultation orreferral?

Appendix C
Module Development Worksheet1

Introduction to Module: Brief description of what is in the module. Should
convince the learner that the module is important and worth learning.
Module Title: Specific enough for learner to understand the central focus of thecontent.
Hours of Study: Estimate of time that will need to be spent learning to meetoutcomes. May also reflect the total time allotted for a given module.
Learning Outcomes: Very specific statements about what the learner is expected
to know, do, or feel at the end of the module. There are usually 5-20 outcomes ineach module, especially if sub-units are included. If sub-units included, begin withoverall learning outcomes, then the more specific learning outcomes for each subunit that, when completed, will allow the learner to demonstrate successful
completion of the overall module outcomes.
•

1

In writing outcomes use very clear and specific performance verbs2:
o list,o nameo describe
o outline a plano demonstrateo explaino computeo determineo perform

This document is based on original by M.K. McHugh, University of Pennsylvania Graduate Program in
Nurse-Midwifery. Used with permission.
2
Many educators refer to Bloom’s Taxonomy for levels of demonstration, from knowledge throughcomprehension.

Content included: This may be a list of the ICM Essential competency and KSBs
included, or a group of related concepts, such as health assessment or parent
education.
Learning activities for acquiring knowledge and skills:
These may be many types of activities. The midwifery teacher needs to use
different types of learning activities that promote competency development anddemonstration. Each module will use only a few activities, not all of them.
a. reading from the textbook
b. reading journal articles
c. completing a worksheetd. attending a lecture with significant time for dialogue with teacher
e. observing a procedure
f. practice on a model in the skills lab
g. viewing a film
h. reading from an Internet site

Resources: This section would include written materials, worksheets, case studies,
web-based articles, audio-visual aids.
Clinical outcome statements: Easy and efficient to organize clinical outcome
statements according to the steps of the midwifery care process (assessment,
decision-making, planning, implementation, and evaluation) tailored specifically tothe area of practice, e.g., intrapartum care. This is performance time for learners,
requiring affective, psychomotor skills, and knowledge application. Thus theoutcome statements should be written in such a way to ‘lead’ the learner tosuccessful performance
Learning activities for developing clinical competence: This is clinical practicewith a variety of women seeking midwifery care in a variety of practical sites,supervised by qualified midwifery teacher/preceptor.

Learner Assessment: The learner must be told how and when s/he will be
evaluated on the theory portion of the module. Sometimes a small quiz can be
attached that the student can take before the big exam(s). Timing of assessment ofclinical performance also needs to be specified, including learner self-assessment
at periodic intervals.
Module evaluation form: Can be a very short form to ask the learner what
aspects of the module (teacher, activities, resource, practical experiences) were
helpful. Learner should also be asked what changes in the module are needed. It
is vital that teachers use this feedback positively, and follow-up with individual
learners who need to talk further about their experiences during the module.

© ICM June 2012	
  Appendix D
Sample Division of ICM Competency #1 & its KSBs
2012
Introduction
One approach to the organization of midwifery content and its placement throughout amidwifery programme is to go through each of the seven ICM competencies with their
KSBs, making a note as to what level or sequence the KSBs might have for eachcompetency statement. This document illustrates what Competency #1 might look likewhen divided into three levels, from simple to advanced to complex theory and skills. It
is a suggested approach only, but may be useful to midwifery educators or consultantsin constructing a new midwifery curriculum or in evaluating an existing midwifery
curriculum. The same process could be followed to analyze the other six ICM
competency statements and their associated knowledge, skills and behaviors.
It is important to note that the suggested ‘levels’ may be used to determine what
modules or course units are offered when in the overall curriculum, but are not directive
for any particular year or month of placement. For example, in direct entry programmes,
the pre-midwifery competencies may be offered in the same time period as theintroduction to midwifery practice with healthy women, based on the premise thatlearners will be eager to begin providing midwifery care for women and childbearing
families. In post-registration midwifery programmes, the content needed as ‘prerequisite’ to midwifery content may be required prior to entry into the midwifery
programme, or it will be integrated with the midwifery content at the beginning of the
programme. In some programmes, the teachers may decide to integrate healthy andcomplicated childbearing content in the same course units or modules, following theway in which each of ICM Competencies #2-7 are structured while others will separate
normal or healthy reproductive content from reproductive complications. Whatever theapproach used in deciding what content to place where and when in the curriculum, theimportant point is that all ICM competencies with their KSBs are included and can be
identified by programme teachers and learners.
Note to readers: Many professional midwifery programmes have described the courses,
content, and placement on their programme website. Midwifery teachers may find it
	
  

	
  
© ICM June 2012	
  helpful to review such websites on direct entry and post-registration midwifery
programmes prior to making a final decision on what organizational pattern is best or
preferred in their situation (country). Sample websites are included in Resource packet#3.
Sample division of KSBs from ICM Competency #1:“Midwives have the requisite knowledge and skills from obstetrics, neonatology,
the social sciences, public health and ethics that form the basis of high quality,
culturally relevant, appropriate care for women, newborns, and childbearing
families.”	  First level content: Pre-midwifery competencies1
Knowledge• Basic sciences – biology (embryology & human development), basic chemistry
and microbiology, human anatomy & physiology, pharmacology• Sociology & psychology• Social determinants of health – income, literacy & education, water supply &sanitation, housing, environmental hazards, food security, disease patterns, common
threats to health• Public/community health – health promotion, disease prevention & control
strategies including relevant national programs, epidemiological principles,
community assessments, interpretation of vital statistics• Principles of community and population based primary health care
• Components of individual, family and community support systems and how tomobilize sources of support when indicated• Nutrition throughout life cycle• Principles of research & evidence-based practice• Indicators of quality health care services
	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
   	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  
1

The knowledge, skills and behaviors that come from other health provider education are generally agreed to include
basic sciences, social studies, professional ethics, and basic skills in physical assessment, clinical reasoning, etc.
Taken from ICM Competency #1 and Accreditation Commission for Midwifery Education (ACME) 2005 document
titled, “The knowledge, skills, and behaviors prerequisite to midwifery clinical coursework.” It is the responsibility of
midwifery programme faculty to determine if prior health provider education has included these competencies andthat the applicant can demonstrate them at the time of entry into the midwifery education programme. If the prerequisite post-registration content is integrated with the midwifery content, then the programme will need to determine
the criteria for beginning the midwifery content.

	
  

	
  
© ICM June 2012

•
•
•
•
•
•
•
•
•

	
  

Principles of health education – how, what, when, & where to teachNational & local health services & infrastructures including referral systems
Human rights & effects on health of individuals
Local culture and beliefs, & influences on values & behavior
Traditional and modern health practices (beneficial, harmful)
Critical thinking and clinical reasoning theoretical foundations
Professional behaviors – codes of ethics,
Basis and use of health screening & diagnostic tests
Theories of collaborative work relationships

Skills• Think critically, reason morally, and use problem-solving skills• Practice in accord with accepted standards (evidence-based care) and code of
ethics• Work collaboratively with others in health care
• Demonstrate principles of effective communication• Provide health education using appropriate teaching materials, aids andresources• Calculate correct dose and administer medications to adults and newborns byappropriate route• Use appropriate communication and listening skills• Take a comprehensive health history and perform a basic screening physicalexamination• Assemble, use and maintain equipment and supplies appropriate to setting ofpractice• Initiate emergency intervention to facilitate survival )e.g. basic cardiac life
support, manage shock, basic first aid and resuscitation, administer oxygen)• Record and interpret relevant findings, including what was done and what needs
follow-up• Evaluate outcomes of patient care and patient satisfaction
Professional behaviors• Willingness to think critically and reason morally

	
  

	
  
© ICM June 2012	  • Willingness to accept responsibility and accountability for decisions andoutcomes of those decisions (moral agent)• Acts consistently in accordance with professional ethics, values andhuman rights• Behaves in a courteous, non-judgmental, non-discriminatory andculturally appropriate manner with all clients• Is respectful of individuals, their culture & customs• Maintains confidentiality of all client information• Advocates for informed choice, participatory decision-making andthe right to self-determination• Maintains/updates knowledge and skills in order to remain current
in practice (e.g., self-evaluation, peer review, continuing education
to maintain and validate quality practice)
Note: Each of these content areas can be packaged with logical groupings of specificcompetencies. For example, a module on public health that might include community
assessment, social determinants of health, primary health care including healthpromotion and disease prevention and control strategies, and disease patterns(epidemiology) and vital statistics; a module on professional ethics that might include
what it means to be a moral agent, an advocate for client choice, and how to promote
human rights and ethical decision-making; a module on health assessment that most
likely will include history taking, physical examination, clinical decision-making,principles of asepsis; a module on health care systems that might include national andlocal health services and their infrastructure, referral and social services agencies
concerned with reproductive health, and relevant national programmes for maternal andchild health; a module on basic sciences including principles of pharmacology; amodule on social sciences including culture, human development, psychosocial
dimensions of childbearing, and psychological well-being of women.
Second level Content: Midwifery Care of Essentially Healthy Women & Newborns•	
  Social, Epidemiologic & Cultural Context of Maternal & Newborn Care (ICM
Competency #1)

	  © ICM June 2012	
  Knowledge
a. Direct & indirect causes of maternal and neonatal mortality & morbidity
in local community & strategies for reducing themb. The concept of alarm (preparedness), resources for referral to higher
health facility levels
c. Benefits & risks of available birth settings (birth planning)d. Strategies for advocating with women for a variety of safe birth settings
Skills & Behaviours
a. Uses universal/standard precautions, infection prevention and control
strategies & clean techniqueb. Maintains the confidentiality of all information shared by the womanc. Works in partnership with women and their families, enables andsupports them in making informed choices about their health..& theirright to refuse testing or intervention
d. Works collaboratively (teamwork) with other health workers to improvethe delivery of services to women and families
e. Comply with all local reporting regulations for birth and deathregistration
Third level content: Midwifery Care of Women & Newborns with Life-threatening
Conditions, including Advanced Midwifery Practice•Social, Epidemiologic & Cultural Context of Maternal & Newborn Care (ICM
Competency #1)
Knowledgea. Methodology for conducting maternal death review & near miss audits
b. Legal and regulatory frameworks governing reproductive health for
women of all ages, including laws, policies, protocols and professionalguidelines
c. Advocacy and empowerment strategies for women
Skills & Behaviours
a. Take a leadership role in the practice arena based on professional
beliefs and values

	
  

	
  
© ICM June 2012	  b. Assume administration and management tasks and activities, including
quality and human resource management (additional skill)c. Take a leadership role in policy arenas (additional skill)
As noted earlier, each of the ICM seven competencies can be intentionally divided intolevels prior to decisions on placement in a particular place in the curriculum.
	
  

	
  

	
  
© ICM June 2012