Course Syllabus ©National College of Midwifery 2017 11/2017

Course Title: Midwifery Protocols

Credits: 1.0

Course Description:In this course, students explore the difference between protocols and practice guidelines including the legal implications for midwives and patients. Students explore the elements that are necessary to design practice protocols or guidelines for all aspects of midwifery care: antepartum care, intrapartum care, newborn care, postpartum, and well woman care. As the North American Registry of Midwives and many states require either practice protocols or guidelines, this course is essential for student midwives learning how to draft their own upon graduation to be used in their own private practice.

Learning Activities:

  1. Student reads appropriate sections from the Learning Materials/Resources.
  1. Student answers the questions listed in the Learning Objectives by researching the Learning Materials/Resources for the course and correctly cites the sources and page numbers for each of their answers.
  1. Student presents answers the questions listed in the Learning Objectives for review by preceptor.
  1. Student participates in preceptor elaboration/discussion of Learning Objectives.
  1. The student must research, prepare & present a summary of current best midwifery care/practices appropriate to a topic covered in this course from a current journal article/study, less than 5 years old.
  1. Recommended Role-playing and/or Clinical Interactions

Note: The clinical requirement of NARM /Clinical Skills is completed at any time throughout the ASM apprenticeship during actual clinical practice and is NOT a requirement to complete this academic course.

Activities specific to NARM skills or MANA Core Competencies learned in this section:

  1. Collect examples of practice guidelines and protocols from midwives that you know. Review and compare them.
  2. Practice writing a set of guidelines for prenatal care for your practice.
  3. Practice writing a set of guidelines for intrapartum care for your practice.
  4. Practice writing a set of guidelines for postpartum care for your practice.
  5. Practice writing a set of guidelines for newborn care for your practice.
  6. Practice writing an Emergency Care Form/Emergency Transport/Transfer Form for your practice

Learning Materials / Resources:

Please use textbooks less than 5 years old or most recent edition.

  1. Instructions for Completing the Emergency Transfer/Transport Form and Instructions for completing the Practice Guidelines ,or the combined instructions are available online at the following link:
  1. North American Registry of Midwives Website. CPM Practice Guidelines. 2017.
  1. Midwives Alliance of North America (MANA) website. 2017. Direct-entry state laws and regulations. Essential documents.
  1. National Association of Certified Professional Midwives Website. Essential Documents: Standards for Practice. 2004.
  1. American College of Nurse-Midwives Website. Code of ethics and explanatory statements.
  1. New Zealand College of Midwives Website. 2017. Quality Practice: Standards of Practice.
  1. New Mexico Midwives Association and the Public Health Division of the Department of Health. Practice Guidelines for New Mexico Midwives-2008 edition .NM Department of Health. 2008.
  1. Tennessee Midwives Association Website. 2001. Practice Guidelines.
  1. Florida Emergency Transfer Form
  1. MEAC Abbreviated NARM Skills Form:
  1. MEAC Essential Competencies:
  1. Midwives Model of Care®:
  1. Students must find 1 article/study less than 5 years old. Recommended internet links as needed for latest developments in midwifery care:

Evaluation Tools / Methods:

Minimum passing grade for each course is a cumulative 80% / B-. Students and preceptors are encouraged to work together until the student masters the information.

Final grade for the course is based on preceptor evaluation of the following:

A. Learning Objectives count for 50% of the final grade.

The preceptor evaluates each answer based on three elements:

  1. Answers should reflect a thorough review of current literature regarding best current practices in midwifery care.
  2. Each answer should be formed in the student’s own words or paraphrased from the text. The answer should be minimal, not a re-write of the entire text, but enough to show appropriate comprehension of the learning objective.
  3. Student identification of sources and page numbers for each of the Learning Objectives. (Preceptor should do a random check to determine that sources cited are correctly identified.)

B. Enrichment Activities, including research essays and summaries of articles and development of Practice Protocols and Emergency Transfer Form: 20%

C. Discussions: 15%

D.Tests and Exams: 15%

Course credit:

One Academic credit equals approximately 15 hours of formal time plus 30 hours of additional study or homework. Formal time is defined as the amount of time taken to answer the Learning Objectives to the level of 80% and to complete any learning activities to the preceptor's satisfaction, including any time spent face to face with the preceptor. Informal time includes any time spent actively reading relevant sources and textbook/s, researching Learning Objectives, and studying for examinations.

Learning Objectives:

A-1. In the case that other scholarly resources used are more than five years old, the student must research, prepare & present a summary of an aspect of current best midwifery care/practices appropriate a topic from this course from a current journal article/study.

A-2: Write a summary listing your local and state regulations concerning dispensing, furnishing and/or administering antibiotics, anticonvulsants, antimalarials, antihypertensives, antiretrovirals, vitamin K, and rhogam if you are allowed to in the jurisdiction you plan to practice. If your jurisdiction does not have specific legal language for your responsibilities in these areas then write your practice protocols for each.

B. The student must submit an Emergency Transfer/Transport Form to NCM (see instructions sheet-link in Learning Materials/Resources, above).

C. The student must submit Practice Guidelines to NCM (see instructions sheet-link in Learning Materials/Resources, above).

D. Student answers the questions below and cites the sources and page numbers.

  1. Discuss why NARM does not set protocols for all CPMs to follow.
  1. Define a protocol.
  1. Describe the difference between protocols and guidelines. What is the legal impact of each?
  1. Discuss the difference between a protocol for the use of a medication and a protocol for a given medical condition.
  1. Describe the many resources that are available to guide a new midwife in creating practice guidelines.
  1. Discuss how a document such as the Midwifery Model of Care is integrated into practice guidelines
  1. How do state practice guidelines affect the way that an individual midwife practices?
  1. Describe the Scope-of-Practice for the National Association of Certified Professional Midwives. (NACPM-standard document)
  1. How do the Standard of Practice for NACPM members relate to the NACPM Philosophy?
  1. Summarize the topics covered under Standard One of the Standards of Practice for NACPM members.
  1. Summarize the topics covered under Standard Two of the Standards of Practice for NACPM members.
  1. Summarize the topics covered under Standard Three of the Standards of Practice for NACPM members.
  1. Summarize the topics covered under Standard Four of the Standards of Practice for NACPM members.
  1. Summarize the topics covered under Standard Five of the Standards of Practice for NACPM members.
  1. Summarize the topics covered under Standard Six of the Standards of Practice for NACPM members.

Use the Tennessee Midwives Association Practice Guidelines to answer the following questions:

  1. How do the Practice Guidelines work in relationship to a midwife’s clinical judgment?
  1. How specific are the Practice Guidelines regarding Informed Consent? Why is this?
  1. How does the TN Practice Guideline on Record Keeping relate to other record keeping recommendations?
  1. How do the guidelines direct the assessment of a “safe environment”?
  1. Briefly describe the aspects of a prenatal visit that are indicated in the Practice Guidelines.
  1. How do these practice guidelines recommend fetal monitoring be carried out during labor?
  1. What is the recommendation on the frequency of vaginal exams during labor?
  1. How are immediate and on-going postpartum care guidelines different?
  1. How long is the duration of newborn care by the midwife according to these guidelines?
  1. Briefly describe how the TN practice guidelines address the referral relationship between the midwife and a physician.
  1. What medications are midwives in TN authorized to use?
  1. What types of procedures are prohibited for midwives to perform under the TN practice guidelines?
  1. What is the purpose of identifying prohibited procedures?
  1. How are the TN Practice guidelines related to the Midwives Model of Care?
  1. Discuss the purpose of an Emergency Transfer Plan.
  1. What elements should be included in an Emergency Transfer Plan?

Use the New Mexico Midwives Association Practice Guidelines to answer the following questions:

  1. How do the New Mexico Practice Guidelines define the midwife’s scope of practice?
  1. Discuss how the NM Practice guidelines talk about rights and responsibilities of the client and midwife.
  1. How is the NM Practice guidelines related to MANA’s Essential documents?
  1. How do the NM Practice Guidelines address client education?
  1. How do the NM Practice guidelines address disagreements between clients and midwives?
  1. How do the NM Practice guidelines address the treatment of Sexually Transmitted Infections?
  1. How do the NM Practice guidelines address a transfer of care?
  1. Discuss how the NM Practice guidelines address cancer screening in well-woman care.
  1. What other practice guidelines were referenced for the NM cancer screening protocol?
  1. How do the NM Practice guidelines address vaginal birth after cesarean section (VBAC)?
  1. Discuss some of the antepartum complications that are included under the NM Practice guidelines.
  1. Discuss the NM guideline for the use of ultrasound.
  1. Discuss the NM guidelines in regard to emergency transport.
  1. Discuss the NM guidelines in regard to a surprise breech presentation.
  1. Discuss the NM guidelines in regard to surprise multiple birth.
  1. Discuss the NM guidelines on postpartum depression.
  1. Discuss the bibliography section of the NM practice guidelines. What types of sources were used to develop these guidelines?
  1. Overall, how do the NM and TN practice guidelines compare with one another?
  1. Give an example of three strengths of the TN Practice guidelines.
  1. Give an example of three weaknesses of the TN Practice guidelines.
  1. Give an example of three strengths of the NM Practice guidelines.
  1. Give an example of three weaknesses of the NM Practice guidelines.
  1. Why do you think that practice guidelines vary so much state-to-state?
  1. Review the Practice Guidelines that are used in your intended jurisdiction of practice.
  1. How does your set of practice guidelines compare to the ones we have reviewed?

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