Standards of Clinical & Cultural Competence & Conduct
The Midwifery Scope of Practice
The Midwifery Council is required by the HPCA Act to prescribe the scope of practice of a midwife. This is the definition of midwifery in New Zealand. The scope provides the broad boundaries of practice across the profession. It is not specific to an individual however all midwifery care provided by midwives must sit within it.
The scope of practice of a midwife has been defined by the Midwifery Council and is as follows:
The midwife works in partnership with women, on their own professional responsibility, to give women the necessary support, care and advice during pregnancy, labour and the postpartum period up to six weeks, to facilitate births and to provide care for the newborn.
The midwife understands, promotes and facilitates the physiological processes of pregnancy and childbirth, identifies complications that may arise in mother and baby, accesses appropriate medical assistance, and implements emergency measures as necessary. When women require referral midwives provide midwifery care in collaboration with other health professionals.
Midwives have an important role in health and wellness promotion and education for the woman, her family and the community. Midwifery practice involves informing and preparing the woman and her family for pregnancy, birth, breastfeeding and parenthood and includes certain aspects of women's health, family planning and infant well-being.
The midwife may practise in any setting, including the home, the community, hospitals, or in any other maternity service. In all settings, the midwife remains responsible and accountable for the care they provide.
Standards of competence
Under the HPCAA (2003), Te Tatau o te Whare Kahu, the Midwifery Council is required to determine the level of competence required for a midwife to work within the Midwifery Scope of Practice. This level of competence is defined in the Council Competencies for Entry to the Register of Midwives.
The Competencies for Entry to the Register of Midwives detail the skills, knowledge and attitudes expected of a midwife to work within the Midwifery Scope of Practice. Where the Midwifery Scope of Practice provides the broad boundaries of midwifery practice, the competencies provide the detail of how a registered midwife is expected to practise and what she is expected to be capable of doing. By defining the minimum competence standards for registration as a midwife in New Zealand, the Council has established the minimum standard that all midwives are expected to maintain in their ongoing midwifery practice.
There are four competencies and they are as follows:
The midwife works in partnership with the woman/wahine throughout the maternity experience.
The midwife applies comprehensive theoretical and scientific knowledge with the affective and technical skills needed to provide effective and safe midwifery care.
The midwife promotes practices that enhance the health of the woman/wahine and her family/whanau and which encourage their participation in her health care.
The midwife upholds professional midwifery standards and uses professional judgement as a reflective and critical practitioner when providing midwifery care.
Further explanation and performance criteria can be found on the Competencies for entry to the Register.
Code of conduct
The HPCA Act (2003) requires the Midwifery Council to develop standards of conduct and in 2020 published its Code of Conduct. This was informed by the work of the Professional Conduct Committee.
The purpose of the Code is two-fold. Firstly it is to make explicit the minimum expectations of every professional midwife with regard to conduct as they engage in their professional activities.
Secondly to make explicit the Code of professional behavior to members of the public, employers and other health professionals.
Midwives are accountable for their practice and for their conduct. They are accountable to the woman, the profession and to the community.
The public and midwifery profession expect that midwives:
- Work under the laws, regulations and codes of Aotearoa, New Zealand
- Work within the Midwifery Scope of Practice and hold a Practising Certificate
- Demonstrate continuing competence through participation on the Midwifery Council
- Recertification Programme
- Work in partnership with women
- Work in partnership with professional colleagues ensuring that the woman’s interest remain paramount
- Maintain professional linkages with colleagues for consultation, practice support and advice whilst ensuring that the woman’s interests remain paramount
- Maintain linkages with midwifery colleagues through participation in the activities of the midwifery profession
- Conduct themselves personally and professionally in a way that maintains public trust and confidence in the midwifery profession
- Act with integrity
- Do not discriminate unfairly against women or colleagues
- Do not abuse the woman’s trust in themselves or the midwifery profession
- Treat colleagues with respect and dignity
- Avoid making public comment which may bring the profession into disrepute.
The Code should be read in conjunction with the following:
- Scope of Practice of a Midwife
- Competencies for entry to the Register of midwives
- Statement on Cultural Competence
If a concern is made about a midwife then this can be referred to a professional conduct committee (PCC). PCC are comprised of one lay person and two midwives. Determinations made by the PCC can include referral to the Health Practitioners Disciplinary Tribunal (HPDT).
The HPDT was created through the Health Practitioners Competence Assurance Act.Its purpose is to hear and determine disciplinary cases brought against health practitioners. Proceedings can be brought to the Tribunal by the Director of Proceedings (HDC) or via a PCC.
The HPDT is comprised of a chair person, two deputy chairs and a panel that is comprised of laypeople and health practitioners.
Midwife members of the Tribunal are appointed by the Minister of Health through the appointments process.
Statement on cultural competence
Section 118(i) requires Te Tatau o te Whare Kahu, the Midwifery Council, to set standards of clinical competence, cultural competence (including competencies that will enable effective and respectful interaction with Māori), and ethical conduct to be observed by health practitioners of all professions.
The Midwifery Council has integrated cultural competence into its competencies for entry to the register of midwives. These competencies provide details of the knowledge, skills and attitudes expected of a midwife to work within the Midwifery Scope of Practice. In 2007 Turanga Kaupapa was integrated into the competencies for entry to the Register and they introduced into the midwifery pre-registration programme standards in 2008. Cultural competence for midwives requires the application of the principles of cultural safety to the midwifery partnership and integration of Turanga Kaupapa within the midwifery partnership and midwifery practice.
The Council recognises that acquiring cultural competence is an accumulative process occurring over many years and in many contexts. It relies on understanding one’s own cultural values and the influence these have on relationships and interactions with clients. Formal education about cultural competence is a component of the pre-registration midwifery programmes approved by the Midwifery Council of New Zealand. However, midwives will continue to develop cultural competence throughout their professional careers.
For midwives, cultural competence means both recognising the impact of their own culture and beliefs on their midwifery practice and being able to acknowledge and incorporate each woman’s cultures into the provision of individualized midwifery care. It means having the knowledge, skills and attitudes to understand the effect of power within a healthcare relationship and to develop respectful relationships with people of different cultures.
The Council recognises that those midwives seeking registration from overseas will not have competencies that enable effective interaction with Maori. In October 2020 the Council made it mandatory for this group of midwives to complete the Cultural Competence course which is part of the Overseas Competence Programme, before they can be granted their first Aotearoa, New Zealand practising certificate.
Further information can be found in the Council’s Statement on Cultural Competence for Midwives.