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Standards for pre-registration midwifery education programmes
						
				
		
		
				The Midwifery Council has presented to the five providers of pre 
		
		‐ registration midwifery education its new standards for accreditation of midwifery programmes and by implication midwifery education providers. The standards were developed following a ‘review’ of midwifery education in New Zealand. 
		
				
						The significant changes to pre ‐registration midwifery education are: 
				
		
		
				• An increase in minimum total learning hours from 3600 to 4800 (3 EFTS* to 4 
				EFTS) 
				• An increase in the number of programmed weeks each year from 37 – 45 weeks 
				• An increase in minimum midwifery practice hours from 1500 to 2400 
				• An increase in minimum theory hours from 1500 to 1920 
				• An increase in the minimum of facilitated births from 30 to 40 
				• A new requirement for a minimum of 25 follow through experiences • A new requirement for a minimum number of assessments related to antenatal 
				care, postnatal care and the newborn • A new requirement for involvement with a minimum number of women experiencing complications at any stage of pregnancy, labour, birth or the 
				postnatal period • A new expectation that programmes will be delivered flexibly and improve access to students from outside the main centres 
		
		
				One rationale for these changes in programme hours is that they will provide an increased opportunity for students to gain midwifery practice, thereby consolidating competence and improving levels of confidence in new graduates. 
		
		
				This rationale, of course, is an assumption, as pre ‐ registration midwifery education with a value of 4 EFTS, which normally equates to 4 years full time study, is to be undertaken in 3 years, as the Midwifery Council state “effectively a four year programme delivered over three years.” Fundamentally the Midwifery Council are dictating to the Higher Education Providers a variation in their Regulations that will lead to midwifery being atypical compared to other programmes offered. The required timetable changes that will be required, along with the increased workload of support staff that currently contribute to the midwifery programmes, e.g experts in the biological sciences, pharmacy, sociology and psychology, will have funding implications. The centralized processes such as the cycle of material production, exam timetabling and supervision, the ratification of results and the publishing of results will also be affected, and add yet more cost. A four year programme delivered over three years does not make pedagogical or androgogical sense and no educationalist with an eye on quality and a desire to provide students with a pleasurable education experience would contemplate such a plan. 
		
		
				The current midwifery programmes are already flexible in their delivery and students from outside the main centres are already being catered for within the current structures and systems, so this is not a new concept. On ‐ line teaching takes special skills and training to provide a quality experience. This is not a bad thing, just more costly on teacher time and resources as it has been demonstrated that students expect quick (almost immediate) responses to their on ‐ line submissions or emails. What can be lost, especially for programmes like midwifery, is the community of learners meeting over coffee or lunch breaks, and supporting each other in their learning and understanding. 
		
		
				Another rationale provided is that the requirement for 45 programmed weeks each year also brings New Zealand programmes into line with international standards and with midwifery requirements for the European Union. There are two errors in this way of thinking. First, 45 programmed weeks in other places are not squashed into 3 years. Many  programmes are 4 years because the qualification is at Hons level. Secondly New Zealand taxpayers should not be funding midwifery education to meet the needs of other countries. There is a worrying shortage of midwives globally and graduates are seeking positions where they can earn more than in their home countries. The position taken bythe Midwifery Council to provide graduates who will meet requirements for the European Union is a thoughtless one and is a disservice to our own New Zealand women.
		
		
				It surprises me that after many years of arguing by the NZCOM that it is quality of experience not quantity that counts, the Midwifery Council have turned around and are increasing the numbers of ‘cases,’ ‘catchings’ and ‘facilitations.’ How will quality be 
				
						measured?
				
		
		
				The Council anticipates increased numbers of midwives entering the workforce once 
				these standards for education are in place. There is no evidence for this assumption 
				unless prospective midwifery students have actually stated that the current education 
				is putting them off becoming midwives.
		
		
				Anecdotally reasons why women do not choose midwifery are because of increasing 
				litigation, burnout, horizontal violence, and earnings that do not compensate when 
				compared with earnings in less stressful jobs. Even if the standards do result in more 
				students and thus translate to more midwifery graduates entering the workforce the 
				possibility is that they will not remain in New Zealand, given the rationale above about 
				meeting requirements of the European Union.
		
		
				The new standards take effect from 2009 (an extension may be given until 2010) and 
				Schools of Midwifery are expected to submit the new programmes to the Council in 
				2008. This order from Council has not taken into account the processes within 
				educational institutes for quality assurance. For example, the development of a new 
				curriculum takes time, it has to be submitted to various committees including 
				institutional official academic committees, academic boards, Councils and, in the case 
				of Universities, the Vice Chancellors’ Committee for University Academic Preparation. 
				Along the way there is considerable consultation. At the same time as the work is being 
				undertaken to revise the curriculum, timetables and solve staffing issues, the Institutes 
				(Tertiary Education Organisations) have to reapply to the Midwifery Council for 
				accreditation.
		
		
				The Council acknowledges that the current funding only covers a three year 
				programme. It also acknowledges that the Ministry of Education funding has been 
				reduced recently to provide for Performance Based Research Funding (PBRF). The 
				Tertiary Education Commission has warned the Midwifery Council that increasing a 3 
				EFTS programme to 4 EFTS and delivering this in three years is outside their funding 
				policy although an Institute can apply for additional funding once a programme has 
				been approved.
		
		
				From 2008 Tertiary Institutes will be funded on the basis of their investment plans 
				rather than the volume of EFTS delivered. The Midwifery Council states “It is not clear how far funding for the 4 EFTS programme can be accommodated in the investment plan funding model.” The decision to impose new standards on the providers of midwifery education at this time thus appears very irresponsible. The Council is not clear, yet they are going ahead anyway??!!
		
		
				For a number of reasons, some highlighted above, as a CEO or Vice Chancellor, I would 
				be very reluctant to continue midwifery education in my Institute. Such a small 
				programme is costly and has to be subsidized by more lucrative programmes.
		
		
				As a CEO or Vice Chancellor, my consideration is the viability of my Institute. I would 
				not be interested in imposed conditions placed on one of my programmes by an 
				outside agency that does not appear to have thought through the implications or risks 
				of taking such action while, at the same time setting up an implied threat that my 
				programme may not be accredited anyway! There are very few experienced midwifery 
				educators, there are even less productive midwifery researchers. Under a PBRF model 
				my midwifery lecturers are not even contributing to research outcomes that bring in 
				additional Ministry of Education funding to my Institute.
		
		
				The Midwifery Council has not included in their strategy any indication of evaluating 
				the success of the new requirements. What is the Council up to? Is this a ‘political’ 
				strategy to provide private midwifery education because the current institutes will not 
				or cannot comply? Is this a move toward the domination of midwifery education in 
				New Zealand being provided by one institute only (say in the South Island)? Is this an 
				example of empire building?
		
		
				These are very serious questions that imply monopoly and power, not attributes we 
				value in New Zealand society.
		
		
				Midwives, is that what you want for your profession? Women, is that what you want 
				for a New Zealand midwifery profession? Obstetricians, you must be mystified.
		
		
				
						Professor Gillian White Education Consultant Ministry of Health Sultanate of Oman