International Credentialing of Midwives

by Christine Hindle Verber, EdD, RN, SCM

© 1995 Midwifery Today, Inc. All rights reserved.

[Editor's note: This article first appeared in International Midwife Issue 2, Spring 1995.]

The world has become a global village. With this freedom to share information comes the ability to travel and relocate. When midwives move from one country to another, they should, with equivalent education and credentials, be able to practice their profession wherever they live. However, cultures, languages, customs, values and attitudes can cause midwifery practices to vary from one country to another. Prerequisites and the curricula of midwifery education, as well as the credentialing process, may differ from place to place.

Yet, we could easily identify the similarities of midwifery learning, then use that information to compile a list of variations in curricula and legal requirements in different countries. The midwife who is moving to another country could look at this list, assess what she needs to know or do to get licensed, acquire that knowledge, negotiate the licensing process and be prepared to practice upon arriving at her new home.

For example, the Japanese midwife wishing to practice in the United States could look at the list of midwifery requirements before she leaves her country and see what she needs to know in order to practice in the United States. The Nigerien midwife could move to Europe and prepare to practice. The Colegio de Matronas de Chile could better evaluate the credentials of a midwife from Burkina Faso by comparing the countries' requirements to practice midwifery.

The database for international credentialing could be compiled by utilizing a simple "needs assessment" questionnaire. Each midwifery credentialing authority could complete this questionnaire, which would standardize comparisons between countries. Please note that this proposal makes no suggestion that any region or country must make provisions for allowing an internationally-trained midwife to practice, nor does it judge an individual country's requirements. Each country has unique conditions for midwifery practice; some countries have two or three licensing boards, others may not have written requirements. The licensing process is not suggested in this proposal.

The international credentialing questionnaire might include the following topics:

Selection criteria for entering midwifery training:

Age; educational level; personal, social and legal requirements such as citizenship, knowledge of the language

Education:

Knowledge and clinical experience with antepartum, intrapartum, postpartum and newborn care; academic and clinical curriculum; philosophy (formal or informal); duration; outcome evaluations; written records

Exit competencies:

Minimum number of deliveries and vaginal examinations; physical assessment; medications; artificial rupturing of membranes; fetal scalp monitors and scalp blood testing; episiotomy; cutting and suturing; circumcision; electro-fetal monitoring; phlebotomy; testing and microscope lab work; newborn assessment and resuscitation; family planning; well-woman health; nutrition; pre- and postnatal care; community and patient teaching

Knowledge of the culture:

Language; political issues; alternatives to "traditional" midwifery; health team relationships; the reputation of the training school (faculty, content, standards); credibility of evaluating person/institution

Legal credentials:

Licensing; registration; certification required for practice

This questionnaire includes topics that generally are considered necessary for someone who is beginning her practice; the survey need not be limited to the above topics.

In addition to the database, a written, international listing detailing the profession of midwifery could enhance its image. From the information gathered, all midwifery credentialing authorities and individual midwives would be able to evaluate their own scope of practice. They would see what is currently considered "midwifery" by another region. Midwifery education could be both standardized and flexible, allowing for the richness of regional differences.

However, the evaluator's credentials are very important when deciding a midwife's eligibility to practice in another country. Although the criteria are objective, the subjective judgments of the evaluator are critical. I suggest that the evaluator be an experienced midwife, with international experience and education in midwifery educational theory, curriculum and evaluation.

International credentialing

There are 53 countries represented in the International Confederation of Midwives (ICM); in addition, seven countries have two or more Member Associations. Joan Walker, executive secretary of ICM, said the organization does not have a policy statement on international credentialing, nor does it have a mechanism for comparing requirements. She believes that the European Union's Midwifery Directive is the only international, standard mechanism for easy relocation of midwives.

Since 1983, the European Union has had a legal process called "European Community Directives for Midwifery" for registered midwives of member states to gain practice privileges in other member states. The qualified authority in the home country issues a certificate of eligibility to the qualified authority with whom the midwife wishes to be recognized.

Maternity Care in the World is a book that lists requirements for midwifery training by different countries. This book is perhaps the best source of international midwifery training requirements, and this proposal is an extension of that information. However, the last edition was published more than 10 years ago.

I have looked at midwifery course curricula from England, the United States, India, Nepal, Japan and Australia. At the 1984 ICM convention in Sydney, I interviewed many midwifery educators about the possibility of international reciprocity for midwives. Each of them said that reciprocity would be very desirable, but that administration of the process would be difficult. However, I confirmed my belief that midwifery core knowledge is the same internationally. Thus, only the regional differences would have to be made known and negotiated, in order to become licensed to practice as a midwife.

In the United States, the nursing profession has a Commission on Graduates of Foreign Nursing Schools (CGFNS) which "screens and examines foreign nursing school graduates while they are in their own countries to determine their probable eligibility for professional practice in the United States." The standard for eligibility is for a beginning, "first-level" nurse. CGFNS only facilitates immigration of nurses to the United States. Currently, there is nothing like this in the United States for midwifery. The International Confederation of Midwives or the World Health Organization could facilitate the ongoing compilation of this information. As requirements change, the information will need to be updated.

Someday, midwifery may control its own destiny as an international profession. Perhaps the International Confederation of Midwives will provide international licensure just as the European Union has done for Europe. Until then, this proposal suggests a first step in the direction of international credentialing for midwives.

Editor's Note: The author is compiling a list of internationally-trained midwives who would like to be credentialed to practice midwifery in the United States, and especially in New York State. If you wish to be part of the Coalition of International Midwives, send Christine Hindle Verber the following information: your name, address, phone number, when you came to the United States or when you plan to arrive, type of midwifery education (what country? when?) and if you have had any training in the United States (nursing? when? where?). In turn, Christine will share information about American midwifery and the status of credentialing. She is not charging for this service, but would appreciate a donation for postage and phone calls. You may write her at: 49 Eastern Drive, Ardsley, NY 10502, USA, or call (914) 693-9054.

For more information, you may wish to contact the following:

• International Confederation of Midwives, 10 Barley Mow Passage, Chiswick, London, W4 3PH, England
• Commission on Graduates of Foreign Nursing Schools (CGFNS), 3600 Market St., Fourth Floor, Philadelphia, PA 19104-2651
• Directives for Midwifery 1983, Office for Official Publications of the European Communities, Boite Postale 1003, Luxembourg
• Maternity Care in the World, Report of a Joint Study Group of the International Federation of Gynecology and Obstetrics and the International Confederation of Midwives, (out of print but was available through Worthy Publications, 3 Wykeham Close, Winchester Road, Bassett, Southampton, Hampshire, England).

Christine Hindle Verber received her doctorate in education from Columbia University. She is a British nurse and midwife, as well as an American nurse. She is assistant professor at Lehman College, City University of New York.

Related information:

• IAM (International Alliance of Midwives)
• International Midwife back issues

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