A global perspective on the 'architecture of midwifery education': Nester Moyo, ICM Programme Manager, presented the global view on the midwifery curriculum to a conference of the Royal College of Midwives, UK.

• Auteur: Moyo, Nester

Let us start from the end? A global midwifery curriculum must:

* Be fit for practice

* Recognise the political realities of the global village

* Be based on a professional midwifery ethos.

* Set a standard which gives midwives a sense of identity

* Prepare midwives for lifelong learning, and thereby contribute to the global demands and need for skilled attendants at birth

Midwifery practice currently presents a wide range of complex issues to the practitioner. The midwife is often 'thrown into the deep end' to care for women and newborns in:

* Fluid populations (in situations of war, refugee camps of displaced people due to civil unrest, or extremes of poverty.)

* Emerging ethical minefields (in genetics, assisted conception, and other areas, midwives need to make decisions about the rights of women and professionals where values are conflicting)

* Extreme 'high-tech' environments

* Changing health care environments where political and social structures are in a state of flux

* Challenging conditions for human rights and sensitivity to women's needs.

A curriculum should be able to adapt to these situations while enabling midwives to contribute to the global effort to reduce maternal and newborn mortality and morbidity. We know that some 80% of the maternal deaths occurring worldwide are still due to obstetric complications such as sepsis, haemorrhage, eclampsia, obstructed labour and complications of abortion. We also know that while some of these complications cannot easily be prevented, most of them can be effectively managed with skilled care.

Skilled care is when there is a skilled attendant offering care within a functioning health care system, with adequate facilities for the provision of essential obstetric and neonatal care.

A skilled attendant is an accredited health professional--such as a midwife, doctor or nurse--who has been educated and trained to proficiency in the skills needed to manage uncomplicated pregnancies, childbirth and the immediate postnatal period, and in the identification, management and referral of complications in women and newborns (taken from WHO, Making Pregnancy Safer, 2004).

If our curriculum is to contribute to the production of skilled attendants then we need to know:

What should 'skilled attendants' be able to do?

As an accredited health professional, she or he will be able to:

* Give the full range of care for pregnancy, childbirth and postnatal period to both mothers and newborns;

* Recognise...