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The development of the role of Advanced Midwife Practitioner

The development of the role of Advanced Midwife Practitioner

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An essay for the 2011 Undergraduate Awards (Ireland) Competition by Sally Hanford. Originally submitted for LM156 at University of Limerick, with lecturer Carmel Bradshaw in the category of Nursing
An essay for the 2011 Undergraduate Awards (Ireland) Competition by Sally Hanford. Originally submitted for LM156 at University of Limerick, with lecturer Carmel Bradshaw in the category of Nursing

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Published by: Undergraduate Awards on Aug 31, 2012
Copyright:Attribution Non-commercial


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“Midwifery practice is based on the best available evidence and involves advocacy for theindividual woman and her family” An Bord Altranais, 2001
Ireland currently has the highest birth rate in Europe at 15.2 births per 1000 people; this hasled to an increase in demand for maternity services nationally with emphasis on greaterchoice in type of care received and location in which women can give birth. Evidence showsthat supportive high quality maternity care contributes to ensuring a healthy start fornewborns and also facilitates parents in becoming confident and caring (NCNM, 2008b).While the target result of healthy and satisfied mother and baby are still the aim and driveof midwifery care, midwifery practice has had to evolve and respond to client needs bothnationally and internationally, through shifting the emphasis of choice, continuity andcontrol from the professional to the woman (Andrews, 2004). The role of the midwife hasbeen developed and expanded to address and encompass these needs through new andinnovative enhanced roles. The demographic and dynamic nature of the Irish populationcoupled with the need for evidence based practice in a period of diminishing resourcescontinues to have an impact on the management and delivery of care (NCMN, 2005a). Thedevelopments in Ireland so far include the introduction of further educational opportunitiesand career pathways developed by the National Council for the Professional Developmentof Nursing and Midwifery (NCNM), such as the introduction of the midwife prescriber,clinical midwife specialist (CMS), advanced midwife practitioner (AMP), the development of midwifery led units and the commencement of the direct- entry midwifery degreeprogramme. Midwives are increasingly involved in co-ordinating care and liaising across
both acute and community settings in order to meet client expectations of service andimprove quality of care for women and babies (NCNM, 2005a).In this assignment the development of the advanced midwife practitioner will be discussedby reviewing the background, rationale, implementation and evaluation of the post andrelating this to the impact on care for mothers and babies and the midwifery profession.Background and rationale for the development
of AMP’s.
 In the US, Canada and New Zealand the role of advanced practitioner has been in operationfor a few decades but the role is a relatively new development in UK and Australia, since the
1990’s (Begley
et al, 2007). In Ireland the first advanced nurse practitioner (ANP) post waspiloted in 1996 which led to the establishment of the National Council for the ProfessionalDevelopment of Nursing and Midwifery (NCNM) in 1999. Currently in Ireland there are sixtyseven advanced nurse practitioner (ANP) posts and one advanced midwife practitioner(AMP) post filled;
although two further posts have met criteria, in the areas of women’s
health and diabetes, as yet they have not received funding (NCNM, 2008b). TheDepartment of Health (2003) and Health Strategy (2001) highlighted the need for thedevelopment of the advanced midwife practitioner (AMP) role as a continuing and essentialcomponent of the health service reform (Begley et al, 2007 & NCNM, 2008b). The Instituteof Obstetrics and Gy
naecology (2006) recognised the crucial role midwives play in ‘normal’
pregnancy and supported the expansion of DOMINO services and early transfer homeservices nationally, along with the further development of CMS and AMP posts (NCNM,2008b).
Begley et al (2007) identified that the delay in developing and implementing the AMP postswas due to the reluctance in the midwifery profession to support the role until clearparameters were delineated. Concerns in the profession identified fears of creating sub-specialities in midwifery which would be detrimental to the philosophy of midwifery care, inthat, the holistic approach to care would be lost (NCNM, 2003). It was felt that with anemphasis on normality and the provision of continuity of carer to the woman duringpregnancy, birth and the postnatal period, the AMP would be able to uphold normal, holisticmidwifery practice (Begley et al, 2007). The definition of advanced practitioner as opposedto specialist practice has been debated by midwives and managers for several years,centring on skills and knowledge of expanding the role of the midwife versus the need todevelop more holistic care (Charlton, 1996, Sookhoo & Butler, 1999) and focusing on needsof mothers and families rather than employer needs. Lewis (2003) states that advancedpractice presupposes an end point of lifelong learning and suggests the concept of 
‘advancing practice’ being
applied where stages of development at appropriate levels of education are mapped against current and evolving roles and responsibilities of themidwife.The NCNM (2009) stated the role of the AMP was to promote wellness and advocatehealthy choices for women, babies and their families in collaboration with other health careprofessionals, by utilising advanced clinical knowledge, critical thinking skills and providingindependent women-centred care, while working within their scope of midwifery practice.The role is grounded in theory and practice incorporating research, management andleadership skills. The AMP is an autonomous, experienced practitioner who is responsible,accountable and competent in his/her own practice carrying their own caseload. It wasdecided that
s should demonstrate competency in all areas of normal midwifery , with

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