1. Workshop on Harmonisation of the Education for Nurses and Midwives, Serbia 21-22 nd January 2013 Mervi Jokinen MSc (Dist), PGCert, BSc (Hons), RM, RN Practice and Standards Development Advisor Royal College of Midwives UK President European Midwives Association

2. Directive 2005/36/EC Articles 40, 41 Specifies access to and duration of training Recognition of evidence of qualifications e.g. years/hours of training Articles 42, 43 and Annex V (i) The pursuit of the professional activities of a midwife (ii) Acquired rights specific to midwives (iii) Annex V sets the framework of (a) theoretical and technical instruction (b) practical and clinical training

3. Directive 2005/36/EC The strength of the Directive rests in its existence and is seen enabling: As it attempts to ensure agreed minimum standard Specifies access to and duration of training Clarifies the pursuit of activities The weakness of the Directive is seen in that though having been contemporary and fit for purpose at the time, it has been questioned if it is too low as minimum and some new criteria or updating would be expected

4. Current issues: 2005/36/EC Level of education Certificate - Diploma - Degree - Masters This influences practice Transfer of knowledge and skills Many countries have moved beyond the minimum requirements and content in their pre registration midwifery education programmes Research and evidenced based care Knowledge and skills of critical thinking Autonomy Focus on competence, professional responsibility and accountability and life long learning

5. Current issues: 2005/36/EC The Member States shall ensure that institutions providing midwife training are responsible for coordinating theory and practice throughout the programme of study There has been minimal monitoring on national level training; EU level accreditation and on-going professional development harmonisation is absent Some countries appear to fulfill the EU Directive requirements as a tick box exercise In many countries the persons responsible for delivery of midwifery education are medical personnel

6. European Midwives (EMA) surveys Baseline surveys to inform EMA of current midwifery practice linked to the activities as set in the Directive 2005/36/EC: antenatal, intrapartum and postnatal care (2009, 2011, 2010) Responding associations represent about 78,000 midwives in the 25 countries 5,622,722 deliveries per annum 65% spontaneous vaginal delivery rate (varying 86% to 50%) 25% caesarean section rate (varying 14% to 50%)

7. Pursuit of the professional activities of a midwife The Member States shall ensure that midwives are able to gain access to and pursue at least the following activities: b) diagnosis of pregnancies and monitoring normal pregnancies: carrying out the examinations necessary for the monitoring of the developments of normal pregnancies e) caring for and assisting mother during labour and monitoring the condition of foetus in utero by the appropriate clinical and technical means g) examining and caring for the new-born infant; taking all initiatives which are necessary in case of need and carrying out where necessary immediate resuscitation;

8. Findings Data accuracy Language Health systems Clinical data most congruent Less variation within intrapartum practice than ante- or postnatal practice Concurring themes: midwives in some countries are not able to practice within ante-, postnatal care restricted practice environment and varied level of women’s choice cannot practice autonomously, more of add-on to the obstetric care; obstetric nurses As midwives’ activities vary; it will impact on students’ ability to gain experience, midwives’ on-going CPD and competence It will also impact on mobility and safety of mothers and babies

9. Health Systems The organisation of health care varies considerably in Europe A national health service model where services are usually free at the point of delivery e.g. in UK, Sweden or Denmark, A health care services which are based on insurance schemes and a fee for service model e.g. in France, Belgium or Germany Private practices

10. Healthy women can choose to have their AN care with

11. Midwives allowed to diagnose pregnancy 11

12. Pregnant women must be seen by a Dr

13. Which of the following choices are offered to women as a place to give birth?

14. Are there national guidelines or standards that are written for the midwives in your country to help them manage labour safely? Answer OptionsResponse PercentResponse Count Yes 79.2%19 No 20.8%5 answered question24 skipped question0 Are there a separate set of guidelines for midwifery led care? Answer OptionsResponse PercentResponse Count Yes 41.7%10 No 58.3%14 answered question24 skipped question0

15. 1. Do midwives in your country use a partogram or graph to record progress in labour? Answer OptionsResponse PercentResponse Count Never 4.5%1 Every 1-2 hours 50.0%11 Every 3-4 hours 36.4%8 Every 5-6 hours 0.0%0 When the doctor orders it 9.1%2 Other (please specify) 4 2. How often do women in labour routinely have a vaginal examination in labour?

16. When a woman comes into hospital because she thinks she is in labour, which health professional normally checks that she is really in labour? CountryMidwifeDoctorBoth Albania  Austria  Belgium  Croatia  Cyprus  Denmark  Estonia  Finland  France  Germany  Greece  Ireland  Italy  Latvia  Lithuania  Malta  Netherlands  Norway  Portugal  Slovakia  Slovenia  Spain  Sweden  Switzerland  United Kingdom 

17. Legal definition of postnatal period 10 days -Luxembourg 36 days -The Netherlands, Spain 42 days -Cyprus, Estonia, Finland, France, Greece, Ireland, Italy, Latvia, Norway, Portugal, Slovenia, Turkey, UK 56 days - Germany 9 months - FYR Macedonia 12 months - Belgium Different county councils - Sweden

18. Availability of PN care Hospital and/or home Countries Hospital onlyCroatia, Cyprus, Estonia, France, FYR Macedonia, Ireland, Norway Home onlyLatvia and The Netherlands Hospital and homeUK, Sweden Spain, but very limited in hospital Not usually available Portugal

19. Modernisation of professional qualifications Directive 2005/36/EC Proposed change into the process - divide into 3 phases current amendments and IMCO proposals been through 2 stages and to be voted on by the EU parliament this 2013 Midwifery community (EMA and Network of Midwifery Regulators) recommendations re general education, training requirements, update of pursuit of professional activities a midwife - autonomous practice next phase –training programme and competencies third phase European Qualifications Framework (EQF)/ECTS

20. Conclusion EU Directive 2005/36/EC is about mobilisation of workforce; for sectoral professions it is about freedom of movement across EU countries under automatic recognition For women and their families (patients) it is about safety and quality of care (EU Directive on Cross Border Health care) On national level changing the education curricula in higher education institutes is not sufficient in fulfilling requirements Delivery of care models/systems have to be involved in the dialogue

21. Хвала за слушање Thank you for listening

22. Extra slides if required not for current presentation

23. How do the majority of women in your country have to pay for labour care and delivery? By paying for private insurance 37.5%9 By paying the doctor privately 25.0%6 By paying the midwife privately 25.0%6 Care by a midwife is free to all women 87.5%21 Care by a doctor is free to all women 87.5%21

24. Health professional involved in PN care