Bachelor of Midwifery in Australia

The ACM Midwifery History Project is grateful to Nicky Leap for much of the following information, excerpts, and references, which are taken from her Professional Doctorate, Rhetoric and Reality: Narrowing the Gap in Australian Midwifery (2005).

The introduction of ‘direct entry’ midwifery courses in Australian Universities:

Myths, rhetoric, reality and strategies

From the mid 1990’s there was recognition of the need to reorganise the way that maternity services were provided to accommodate a ‘woman centred’ focus including the need for a new and fresh approach to educating midwives. The call for a collaborative effort to develop national standards for the introduction of a BMid program in Australia, and an exploration of the resistance to this, were first expressed in a 1999 article by Nicky Leap, The introduction of ‘direct entry’ midwifery courses in Australian Universities: Issues, myths, and a need for collaboration. ACMI Journal of Midwifery, 12(2), pp. 11-16.

Is a midwife a nurse?

Astonishingly this has been one of the most challenging questions to answer amongst health professionals, especially so in the context of developing a Bachelor of Midwifery program. What is unique to midwifery and what identifies it as separate from nursing and medicine is the continuity of skills and care across a clearly defined spectrum of time in a woman’s life.

There is considerable evidence to support midwifery continuity of care as the cornerstone of ‘best practice’ in maternity care (Brown & Lumley, 1998; Hodnett, 1996; Oakley et al., 1996; Page, 1995; Rowley et al., 1995; Tew et al., 1991; Tucker et al., 1996; Turnbull et al., 1996). The continuum of care and practice which is unique to midwifery involves antenatal care, all of labour and birth care and the early post-partum period. Central to this continuum of care is the relationship that develops between a woman and her midwife that has an impact on health outcomes and morbidity (WHO, 1996).

Leap, Barclay, Nagy, Sheehan, Brodie, &Tracy. (2002). Midwifery education: literature review and additional material. National Review of Nursing Education 2002: Literature reviews. Department of Education, Science, & Training, Canberra. http://hdl.voced.edu.au/10707/94092

 

A collaborative birth – South Australia, August 1999

Nicky’s 1999 article was the precursor to a major project that would change the face of Australian midwifery education. Universities across Australia started developing innovative collaborative approaches to midwifery education that included a three-year Bachelor of Midwifery, now commonly referred to as the BMid.

Flinders University and the University of South Australia were committed to the introduction of direct entry midwifery, hosting a ‘Direct Entry’ Midwifery Stakeholders’ Forum in August 1999. South Australia [SA] ultimately held their plans to move ahead until universities in other States were also ready to start. It was thought this would provide support for students and eventual graduates, and prevent marginalisation of BMid by establishing it as a viable alternative with uniform standards. It would also allow time for industry issues to be addressed and ensure the best possible climate for success.

A Project Officer – Jackie Kitschke – was employed by the SA universities to co-ordinate the local working party, and begin to coordinate interest across other States.

Twenty key people from across Australia came together in a workshop held in SA, 7-8 December 1999, with a vision to design consensus guidelines concerning a national framework for a 3-year Bachelor of Midwifery programme. It was proposed that this programme should eventually be the national route of entry to midwifery, reduced appropriately for nurses and others following assessment of prior learning and experience.

At the meeting a national BMid taskforce was named, agreement was reached on guidelines for a national framework for BMid education.  A recommendation was also made that the ACM should become the accrediting body, in conjunction with the registering authorities, of BMid courses.

A timeline for the progression of the BMid project was formulated, and a plan that a proposal be sent to the ACMI requesting endorsement and funding for the BMid Education Project was established.

A key outcome of the two-day workshop in Adelaide was a commitment from participants to set up a taskforce that would develop national standards for the accreditation of BMid programmes under the auspices of the Australian College of Midwives (ACM). Members of the inaugural ACM BMid Taskforce made a commitment to representing their states/territories and to ensuring that information concerning the BMid was both gathered and disseminated at a local level. This included holding public forums and engaging with universities, health services, regulatory bodies and consumers.

Leap, Brodie & Tracy, (2017), p171.

The Adelaide planning days led to the formation of the Australian College of Midwives (ACM) BMid Taskforce, that developed ACMI Standards for the Accreditation of three-year Bachelor of Midwifery Education Programs. The ACM took the lead in continuing to develop a national framework, and the complex and sensitive negotiations with State Nurses Boards concerning how best to ensure excellence, and compatibility in the standards and accreditation of midwifery education programmes. The taskforce consciously employed feminist process and consensus decision making and information sharing. To have consistency nationally, the term ‘direct entry midwifery’ (DEM) was replaced with the Bachelor of Midwifery (BMid) to describe three year midwifery courses.

The ACMI BMid Taskforce members made a commitment to representing their states/territories and to ensure that information concerning the BMid was both gathered and disseminated at a local level. This included holding public forums and engaging with universities, health services, regulatory bodies, and consumers.

The Taskforce developed an information package to support extensive consultation and information sharing with consumers, providers of maternity services, professional organisations, and regulatory authorities. The goal was for every ACM branch to give the presentation in as many venues as possible using the same PowerPoint presentation (with notes in hard copy and on CD-ROM). It was hoped this would help generate support for student placements, and assist the process of registering and employing BMid graduates.

The rationale for the introduction of an Australian BMid was presented in the information package in terms of the overall aim of the ACM to increase the number of competent midwives and midwifery graduates in all areas of Australia:

‘the bottom line for any developments has to be improvements to the services offered to childbearing women, their families, and communities’.

Misconceptions and concerns were directly addressed, and the package appealed to key stakeholders around the following themes:

• The identification of midwifery as a discreet profession in its own right, separate from nursing;

• The need to develop national standards for midwifery education embedded in regulation;

• Appropriate education to enable midwives to work in continuity of care models according to the international definition of the midwife;

• Addressing midwifery workforce shortages;

• International trends in midwifery education and the evaluation of programs in the UK and NZ; and

• Australian midwives needing to complete further studies and/or midwifery practice placements in order to register in other western countries.

The ACM Inaugural BMid Taskforce

• Vanessa Owen (National ACM President)
• Nicky Leap (Project Coordinator)
• Jackie Kitschke (Project Officer)
• Alana Street (ACMI Executive Officer)
• Dianne Cutts (Vic)
• Jenny Browne (ACT)
• Trish David (Tas)
• Kathleen Fahy (Qld)
• Hilary Hunter – later replacement: Lin Lock (NSW)
• Jan Pincombe (SA)
• Carol Thorogood (WA)
• Bev Turnbull (NT)
• Sally Tracy (Australian Midwifery Action Project)
• Maree Markus (Advisor on Regulatory Issues)

International Reference Group

• Lesley Page (UK)
• Anne Thompson (UK)
• Sally Pairman (NZ)
• Anne Nixon (Canada)

The International Reference Group supported the introduction of BMid in Australia by sharing their expertise and experience with ‘direct entry’ midwifery programs, and offering guidance on the development of the ACM Standards for the Accreditation of Bachelor of Midwifery Courses, policy, and curriculum documents. They also verified the compatibility of the Australian and international standards in terms of clinical practice requirements and ‘follow through’ (continuity of care) experiences.

Universities across Australia began to explore the potential of forming a consortium or partnership approach to developing BMid programs.

These developments would not have been possible without the evidence generated by the Australian Midwifery Action Project (AMAP), especially the AMAP Midwifery Education Survey. The AMAP study was funded by the Australian Commonwealth Government through the Australian Research Council as part of the then ‘Strategic Partnerships with Industry Research and Training’ (SPIRT) program. A three-year project, AMAP was set up in April 1999 to identify and investigate barriers to midwifery within the provision of mainstream maternity services in Australia and strategies to address these barriers. This included studying workforce; regulation; education; service delivery; and midwifery practice issues across the country.

Results of the Australian Midwifery Action Project (AMAP) Education Survey

During the life of the AMAP project there was also a review of midwifery education commissioned by the Commonwealth Department of Education, Science and Training (DEST) as part of a National Review of Nursing Education.

The National Review of Nursing Education: Midwifery Education Literature Review (below) included the preliminary findings of the AMAP Education Survey about the state of midwifery education across Australia. It conducted an extensive literature search drawing on databases, policy documents, research, and other resources, in collaboration and with assistance from national and international experts (Leap & Barclay, 2002). Midwifery education experts from other countries were identified, several of them having already provided information and advice to the ACMI Bachelor of Midwifery National Taskforce. The contributors were Tina Heptinstall (UK); Anne Nixon (Canada); Beatrijs Smulders (the Netherlands); Sally Pairman (New Zealand); and Holly Powell Kennedy (USA). These international experts were informed of the purposes of the Review, and invited to comment on an initial draft of an overview of midwifery education and development in their country.

The Midwifery Education Literature Review made an important contribution to the analysis and recommendations of the AMAP Education Survey. It presented an opportunity to gather the evidence that enabled international comparisons in the development of standards that aim to ensure midwives are educated to fulfill their potential role. This opportunity to make national and international comparisons added strength to the rhetorical positioning of the research, which made a robust case for the introduction of the BMid across Australia. Evidence from other countries, in particular the UK, guided the arguments employed as well as the processes involved in convincing others of the value of a three-year undergraduate midwifery degree as a major strategy to improve the standard of midwifery education and practice across Australia.

I believe despite, and perhaps helped by, the controversy this piece of work was instrumental in getting up our BMid programs across the country!

Emeritus Professor Lesley Barclay, AO

In 2002, over 150 students commenced study in a three-year BMid in four universities – Australian Catholic University (Melbourne), University of South Australia, (SA) Flinders University (SA), and Victoria University (Vic).

Also in 2002, one University introduced a double degree in nursing and midwifery as an alternative path to the BMid. This prompted the writing of a monograph identifying the issues that raise concern regarding different routes of entry to midwifery (Leap, N. 2003. Educating Australian midwives: current debates and concerns. Monograph published by the Centre for Family Health and Midwifery, University of Technology, Sydney.). Although it was considered a contentious piece at the time and may still provoke debate even today, this important document captures an historical place in our professional development.

The ACMI BMid Taskforce was disbanded in 2003 and replaced by the ACMI National Standards and Education Taskforce (ANEST) with representation from each state and territory. This group developed standards and position statements for the ACMI using the same consensus building techniques as those employed by the ACMI BMid Taskforce.

One of the first crises that the new taskforce had to negotiate was a heated debate regarding an ACMI Position Paper that stated the College’s opposition to the notion of a double degree in nursing and midwifery. This position paper was challenged as divisive and unwise through a motion at the 2003 Annual General Meeting. The motion was unsuccessful, but a commitment was made to re-write the statement on midwifery education. A successful rhetor in the new ANEST group managed to persuade the rest of the group to think laterally about the double degree with assurances that the graduates of these programs would meet the ACMI Standards for the Accreditation of three-year BMid Programs. The ensuing debate prompted a major shift in thinking during meetings and email conversations throughout 2003 and the first half of 2004.

The ACMI Standards for the Accreditation of three-year BMid Programs were finally adopted as the ACMI Education Standards for Midwifery Education with an aim for these to be the standards of all programs leading to initial license to practise midwifery in the future, regardless of routes of entry to the profession. The rhetoric in the new position paper was one of inclusivity with the setting of standards acting as a leveller. The process of arriving at this position paper can be seen as one of testing and refining ideas.

ACMI Position Paper: Midwifery Education (2004)

• The ACMI recognizes multiple routes of entry into midwifery and values graduates from all programs.
• The ACMI strongly supports the establishment of undergraduate midwifery programs.
• The ACMI recognizes that midwifery and nursing are distinct professions each with its own philosophy, ethics, body of knowledge and scope of practice. The discrete and independent nature of the profession of midwifery is fundamental to all curricula that lead to registration as a midwife.
• Midwifery curricula must enable students to acquire the knowledge, skills, and attitudes necessary to practise to the full role and scope of midwifery as defined by the ICM/FIGO/WHO (1992). Programs of midwifery education must therefore reinforce and promote the recognition of midwifery as a separate professional identity.
• The theoretical and clinical practice components of all midwifery programs are underpinned by the ACMI Framework for Midwifery, which incorporates the: ACMI Midwifery Philosophy ACMI National Code of Ethics ACMI National Standards for Midwifery Practice ACMI National Midwifery Competencies ACMI National Midwifery Guidelines for Consultation and Referral ACMI Standards for Midwifery Education ACMI Framework for Continuing Professional Development.
• The ACMI is committed to collaborating with regulatory authorities on the accreditation of all midwifery education programs conducted in Australia.
• The ACMI promotes and expects all midwives as part of their professional obligations to engage in regular, relevant, and high-quality ongoing education and practice, supported by the ACMI Framework for Continuing Professional Development.

The introduction of the Bachelor of Midwifery course was one of the most significant developments in the history of midwifery education in Australia with standards for registration as a midwife being agreed for the first time.

Reference has already been made to the background leading to the release of the original ACMI* Position Paper on Midwifery Education in 2004. While this is not a current ACM Position Statement, the following points remain significant in the context of future developments in midwifery education:

• The ACMI recognizes multiple routes of entry into midwifery and values graduates from all programs.
• The ACMI strongly supports the establishment of undergraduate midwifery programs.
• The ACMI recognizes that midwifery and nursing are distinct professions each with its own philosophy, ethics, body of knowledge and scope of practice. The discrete and independent nature of the profession of midwifery is fundamental to all curricula that lead to registration as a midwife.

While the Bachelor of Midwifery has continued to be strongly supported by the ACM, education providers have inevitably progressed with the development of other courses under differing academic award requirements including graduate entry through bachelor’s degrees other than nursing, and qualifications for initial registration as a midwife being awarded at graduate, postgraduate and master’s level.

The introduction of a 4-year Bachelor’s degree course that combines nursing and midwifery – often referred to as the dual or double degree – has been an option in Australia since the early 2000’s. This course combines requirements for Registered Nursing, and Midwifery, each of which would usually takes 3 years to complete. This combination, which is not offered in most other developed countries, was initially met with some concern for the dilution of midwifery philosophy. Providers of the course in Australia have proposed that this might better meet industry needs, and offer a possible solution to impending workforce shortages especially in rural areas. Students have reportedly perceived this option as having increased opportunities for employment and career progression, although the majority of graduates appear to prefer working as midwives (Yates, Birks, Coxhead & Zhao, 2020).

It must be emphasised that all courses, however arranged, must meet the Standards for Practice as a Midwife, which were based on the original Bachelor of Midwifery Standards. Further developments in midwifery education will be important to capture from an historical perspective to better understand their influence on midwifery being recognised as a distinct and separate profession in Australia.

This summary, which has been written by members of the ACM Midwifery History Project Group, is not meant to represent the views of ACM and/or its members.

*Footnote: ACM was formerly known as the Australian College of Midwives Incorporated (ACMI)

Read what current course coordinators have to say about Bachelor of Midwifery courses including barriers and facilitators; impact of participants lacking a nursing qualification; graduate employment opportunities.

Responses have been received from Victoria, Queensland, and Western Australia – we would welcome responses from other States and Territories!

BMid in Australia today

In December 2022 there were 7,357 Midwives and 26,009 Nurse/Midwives on the register

Statistics published by The Nursing and Midwifery Board of Australia

There are currently 14 BMid courses being offered in Australia

with many other combinations for midwifery and nursing, details available on the AHPRA WEBSITE