The five practices standards of midwifery care

Practice Standard 1

Midwifery practice is underpinned by a philosophy that protects and promotes the safety and autonomy of the woman and respects her health, wellbeing, experiences, choices, priorities, beliefs and values. 

Standards of Conduct

• Your practice should promote and protect pregnancy and childbirth as a healthy and normal physiological event and a profound event in a woman’s life.
• You should advocate on behalf of women and their babies to so that their rights and interests are protected including the woman’s right to choose how and where to give birth.
• You must respect a woman’s legal right to a termination of pregnancy within the provisions of the Health (Regulation of Termination of Pregnancy) Act 2018.
• You should respect the diversity of beliefs, values, choices and priorities of the woman and her family.
• You must provide women with sufficient, evidence-based information to empower them to make informed decisions about their care and the care of their babies.
• You should support every woman to engage with, access and participate in maternity care.
• You must respect the woman as the primary decision-maker in all matters regarding her own health and that of her baby unless a court of law orders otherwise.
• You must respect the woman’s right to choose whether to follow advice and recommendations about her care. If a woman chooses not to follow recommendations about her care, you are expected to continue to provide care to her that is reasonable and appropriate in the circumstances.
• At the same time, you must document the discussions and decisions and refer to and collaborate with other relevant healthcare professionals regarding plan of (agreed) care. The outcome of this referral must be shared with the woman and documented in the healthcare records.

Practice Standard 2

Midwives practise in line with legislation and professional guidance and are responsible and accountable within their scope of midwifery practice. This encompasses the full range of activities of the midwife as set out in EC Directive 2005/36/EC and the definition of the Midwife (ICM 2017) as adopted by NMBI. 

Standards of Conduct

• The title of ‘midwife’ and their function is protected in the Nurses and Midwives Act 2011. You must act at all times within the law and follow the rules and regulations of the NMBI and any other applicable bodies. 
• In providing safe, evidence-based care to the woman and her baby, you are accountable for your practice to the woman, to the midwifery profession, to the NMBI and to the wider community. You owe a duty of care at all times.
• You should ensure that no act or omission by you places the woman, her baby, her family, your colleagues or yourself at any unnecessary risk.
• In an emergency, or any situation where something occurs that is outside your scope of practice, you must continue to provide care and refer to the most appropriate healthcare professional who you reasonably expect to have the necessary knowledge, skills, competence and experience to help you.
• You should consider the location of the emergency when deciding who to call for assistance. At all times, the best interests of the woman and baby should be the priority.
• The outcome of this call for assistance must be shared with the woman and documented in the healthcare records.
• You should give and record the reasons for your decision to take necessary emergency measures in the absence of the most appropriate healthcare professional.
• If you have a conscientious objection based on religious or moral beliefs to participating in the care of a woman or her baby, you must inform your line manager and your employer and if appropriate the women as soon as possible and give details about alternative timely care arrangements to protect the woman and her baby.
• You should ensure that arrangements for transfer of care are done in a safe, effective and timely manner. You should help make it as easy as possible for the woman.
• Where there is a risk to the life or of serious harm to the health of the woman or baby, you must continue to provide care to the woman and her baby until you are relieved of your duties, regardless of your conscientious objection.
• If you have a conscientious objection in relation to a termination of pregnancy being carried out or participating in a woman’s termination of pregnancy you are required by law to make arrangements for the transfer of care of the pregnant woman as may be necessary, to avail of the termination of pregnancy concerned.
• You must uphold and act in line with the law by ensuring that you have adequate clinical indemnity (insurance) in place for your area of practice.

Supporting information

If you are employed in the public health service (the Health Service Executive) or in certain voluntary organisations, you are covered by the Clinical Indemnity Scheme (CIS) (www.stateclaimsagency.ie) Those working in the private sector may be indemnified by their employer’s insurance. If you are working in the private sector, you should confirm that you are provided with adequate indemnity insurance by your employer.  

In the interest of safety for users of maternity services and protecting the public, you must ensure that you have adequate professional indemnity insurance.

Practice Standard 3

Midwives use comprehensive professional knowledge and skills to provide safe, competent, kind, compassionate and respectful care. Midwives keep up to date with midwifery practice by undertaking relevant continuing professional development. 

Standards of Conduct

• You should provide safe, competent, kind, compassionate and respectful professional care, which is informed by the best available evidence, your own expertise, and the experiences, preferences and values of the woman.

• You must meet the competencies for midwife registration as set out in NMBI's Midwifery Registration Programme Standards and Requirements for the Midwife Registration Education Programme. You are required to maintain the required knowledge and skill base for safe effective practice.

• You must keep your midwifery knowledge and skills up to date by engaging with continuing professional development in areas relevant to your practice. You should be able to demonstrate your competence and give evidence of professional development to the NMBI or your employer when and if you are asked to do so.

• You must help and promote the development of a quality learning environment by teaching, supervising, supporting and assessing all learners.

• You should support and take part in midwifery and healthcare practice developments with particular emphasis on quality, safety and clinical governance initiatives.

• You should support quality measures such as audits of practice and research projects that are being conducted ethically.

Practice Standard 4

Midwives work in equal partnership with the woman and her family and establish a relationship of trust and confidentiality. 

Standards of Conduct

• You must ensure that the woman and her baby are the primary focus of your practice.
• You should provide care that is safe, evidence-based, supportive, responsive, and compassionate taking into account the needs of the woman, her baby and her family.
• You should plan all midwifery care in partnership with the woman and document this plan of care.
• You must respect a woman’s right to privacy and confidentiality by protecting her personal information.
• You should use your professional judgement and act responsibly when you have to disclose and share information. There may be exceptional circumstances where you might need to share confidential information, for example:

                 a)   if required by law to do so, 
                  b)  to protect the woman’s or baby’s interests, 
                  c)  to protect the interests of society, or 
                  d)  to protect the interests of other people. 
                  e)  In these circumstances, you must only disclose the minimum amount of information necessary to the
                       appropriate person.

Practice Standard 5

Midwives communicate and collaborate effectively with women, women’s families and with the multidisciplinary healthcare team. 

Standards of Conduct

• You should ensure that you provide information in a format that is understandable and accessible to all women and their families.
• You should communicate appropriately and effectively with women, their families and with the multidisciplinary healthcare team by recognising barriers and making all reasonable efforts to remove them.
• You should collaborate with women, the women’s families and with the multidisciplinary healthcare team using communication tools that suit the needs of the woman and her baby to ensure timely referral to other appropriate healthcare professionals.
• Your documentation and other communication of the care you are giving must be carried out in a clear, objective, accurate and timely manner. This includes the appropriate use of information technology and the avoidance of jargon and abbreviations unless the terms are drawn from a list of defined and approved terms.
• You must supervise the care provided by midwifery students and other students and countersign all documentation carried out by them.
• You should address differences of professional opinion with colleagues by discussion and informed debate in a professional and timely manner and prevent conflict through effective collaboration and teamwork.