MANA Core Competencies for Basic Midwifery Practice
Approved by MANA Board 10/3/94

I. Guiding Principles of Practice:
The midwife provides care according to the following principles:

A. Midwives work in partnership with women and their chosen support community throughout the caregiving relationship.

B. Midwives respect the dignity, rights, and the ability of the women they serve to act responsibly throughout the caregiving relationship.

C. Midwives work as autonomous practitioners, collaborating with other health and social service providers when necessary

D. Midwives understand that physical, emotional, psycho-social and spiritual factors synergistically comprise the health of individuals and affect the childbearing process.

E. Midwives understand that female physiology and childbearing are normal processes, and work to optimize the well-being of mothers and their developing babies as the foundation of caregiving.

F. Midwives understand that the childbearing experience is primarily a personal, social and community event.

G. Midwives recognize that a woman is the only direct care provider for herself and her unborn baby; thus the most important determinant of a healthy pregnancy is the mother herself.

H. Midwives recognize the empowerment inherent in the childbearing experience and strive to support women to make informed decisions and take responsibility for their own well-being.

I. Midwives strive to insure vaginal birth and provide guidance and support when appropriate to facilitate the spontaneous process of pregnancy, labor, and birth, utilizing medical intervention only as necessary.

J. Midwives synthesize clinical observations, theoretical knowledge, intuitive assessment and spiritual awareness as components of a competent decision making process.

K. Midwives value continuity of care throughout the childbearing cycle and strive to maintain continuous care within realistic limits.

L. Midwives understand that the parameters of "normal" vary widely and recognize that each pregnancy and birth are unique.

II. General Knowledge and Skills:
The midwife provides care incorporating certain concepts, skills, and knowledge from a variety of health and social sciences, including, but not limited to:

A. Communication, counseling, and teaching skills.

B. Human anatomy and physiology relevant to childbearing.

C. Community standards of care for women and their developing infants during the childbearing cycle, including midwifery and bio-technical medical standards and the rationale for and limitations of such standards.

D. Health and social resources in her community.

E. Significance of and methods for documentation of care through the childbearing cycle.

F. Informed decision making.

G. The principles and appropriate application of clean and aseptic technique and universal precautions.

H. Human sexuality, including indication of common problems and indications for counseling.

I. Ethical considerations relevant to reproductive health.

J. The grieving process.

K. Knowledge of cultural variations.

L. Knowledge of common medical terms.

M. The ability to develop, implement and evaluate an individualized plan for midwifery care.

N. Woman-centered care, including the relationship between the mother, infant, and their larger support community.

O. Knowledge and application of various health care modalities as they apply to the childbearing cycle.

III. Care During Pregnancy:
The midwife provides health care, support, and information to women throughout pregnancy. She determines the need for consultation or referral as appropriate. The midwife uses a foundation of knowledge and/or skill which includes the following:

A. Identification, evaluation, and support of maternal and fetal well-being throughout the process of pregnancy.

B. Education and counseling for the childbearing cycle.

C. Preexisting conditions in a woman's health history which are likely to influence her well-being when she becomes pregnant.

D. Nutritional requirements of pregnant women and methods of nutritional assessment and counseling.

E. Changes in emotional, psycho-social and sexual variations that may occur during pregnancy.

F. Environmental and occupational hazards for pregnant women.

G. Methods of diagnosing pregnancy.

H. Basic understanding of genetic factors which may indicate the need for counseling, testing, or referral.

I. Basic understanding of the growth and development of the unborn baby.

J. Indications for, risks, and benefits of bio-technical screening methods and diagnostic tests used during pregnancy.

K. Anatomy, physiology, and evaluation of the soft and bony structures of the pelvis.

L. Palpation skills for evaluation of the fetus and uterus.

M. The causes, assessment and treatment of the common discomforts of pregnancy.

N. Identification of, implications of, and appropriate treatment for various infections, disease conditions and other problems which may affect pregnancy.

O. Special needs of the Rh- woman.

IV. Care During Labor, Birth, and Immediately Thereafter:
The midwife provides health care, support, and information to women throughout labor, birth, and the hours immediately thereafter. She determines the need for consultation or referral as appropriate. The midwife uses a foundation of knowledge and/or skill which includes the following:

A. The normal process of labor and birth.

B. Parameters and methods for evaluating maternal and fetal well-being during labor, birth, and immediately thereafter, including relevant historical data.

C. Assessment of the birthing environment, assuring that it is clean, safe and supportive, and that appropriate equipment and supplies are on hand.

D. Emotional responses and their impact during labor, birth, and immediately thereafter.

E. Comfort and support measures during labor, birth, and immediately thereafter.

F. Fetal and maternal anatomy and their interactions as relevant to assessing fetal position and the progress of labor.

G. Techniques to assist and support the spontaneous vaginal birth of the baby and placenta.

H. Fluid and nutritional requirements during labor, birth, and immediately thereafter.

I. Assessment of and support for maternal rest and sleep as appropriate during the process of labor, birth, and immediately thereafter.

J. Causes of, evaluation of, and appropriate treatment for variations which occur during the course of labor, birth, and immediately thereafter.

K. Emergency measures and transport for critical problems arising during labor, birth, or immediately thereafter.

L. Understanding of and appropriate support for the newborn's transition during the first minutes and hours following birth.

M. Familiarity with current bio-technical interventions and technologies which may be commonly used in a medical setting.

N. Evaluation and care of the perineum and surrounding tissues.

V. Postpartum Care:
The midwife provides health care, support, and information to women throughout the postpartum period. She determines the need for consultation or referral as appropriate. The midwife uses a foundation of knowledge and/or skill which includes but is not limited to the following:

A. Anatomy and physiology of the mother during the postpartum period.

B. Lactation support and appropriate breast care including evaluation of, identification of, and treatments for problems with nursing.

C. Parameters and methods for evaluating and promoting maternal well-being during the postpartum period.

D. Causes of, evaluation of, and treatment for maternal discomforts during the postpartum period.

E. Emotional, psycho-social, and sexual variations during the postpartum period.

F. Maternal nutritional requirements during the postpartum period including methods of nutritional evaluation and counseling.

G. Causes of, evaluation of, and treatments for problems arising during the postpartum period.

H. Support, information, and referral for family planning methods as the individual woman desires.

VI. Newborn Care:
The entry-level midwife provides health care to the newborn during the postpartum period and support and information to parents regarding newborn care. She determines the need for consultation or referral as appropriate. The midwife uses a foundation of knowledge and/or skill which includes the following:

A. Anatomy, physiology, and support of the newborn's adjustment during the first days and weeks of life.

B. Parameters and methods for evaluating newborn wellness including relevant historical data and gestational age.

C. Nutritional needs of the newborn.

D. Community standards and state laws regarding indications for, administration of, and the risks and benefits of prophylactic bio-technical treatments and screening tests commonly used during the neonatal period.

E. Causes of, assessment of, appropriate treatment, and emergency measures for neonatal problems and abnormalities.

VII. Professional, Legal and Other Aspects:
The entry-level midwife assumes responsibility for practicing in accord with the principles outlined in this document. The midwife uses a foundation of knowledge and/or skill which includes the following:

A. MANA's documents concerning the art and practice of Midwifery.

B. The purpose and goal of MANA and local (state or provincial) midwifery associations.

C. The principles of data collection as relevant to midwifery practice.

D. Laws governing the practice of midwifery in her local jurisdiction.

E. Various sites, styles, and modes of practice within the larger midwifery community.

F. A basic understanding of maternal/child health care delivery systems in her local jurisdiction.

G. Awareness of the need for midwives to share their knowledge and experience.

VIII. Woman Care & Family Planning:
Depending upon education and training, the entry-level midwife may provide family planning and well-woman care. The practicing midwife may also choose to meet the following core competencies with additional training. In either case, the midwife provides care, support, and information to women regarding their overall reproductive health, using a foundation of knowledge and/or skill which includes the following:

A. Understanding of the normal life cycle of women.

B. Evaluation of the woman's well-being including relevant historical data.

C. Causes of, evaluation of, and treatments for problems associated with the female reproductive system and breasts.

D. Information on, provision of, or referral for various methods on contraception.

E. Issues involved in decision-making regarding unwanted pregnancies and resources for counseling and referral.