Italian midwives' education needs analysis on essential competencies for childbirth care. A cross-sectional study

In 2002, the International Confederation of Midwives (ICM) (International Confederation of Midwives 2002) developed the first version of “Essential Competencies for Basic Midwifery Practice,” a document that describes the essential knowledge, skills and competencies required to practice the profession of midwife. ICM (International Confederation of Midwives 2018, International Confederation of Midwives 2019) has divided the essential competencies into four categories: general competencies; specific competencies for pre-pregnancy and antenatal care; competencies for caring, labour, and delivery; and competencies for postpartum and newborn care. However, the education and training of midwives changes according to the legislation of the different countries, so the content, extent and level of the skills curriculum of midwives varies widely around the world (United Nations Population Fund, International Confederation of Midwives 2014). Regarding Italy, the professional status of the nearly 21,000 registered midwives is influenced by both partial application of laws and regulations on their autonomy and responsibility for low-risk cases and some educational criticalities, explained below. Currently, Article 1 of Law n. 42 of 1999 states that the field of activity and responsibility of the healthcare professionals (HCPs) is identified by the contents of three pillars: the Ministerial Decree that describes the professional profile of each healthcare profession, the deontological code, and pre- and in-service educational programmes. Ministerial Decree n. 740 of 1994 recognizes the complete and absolute competence and autonomy of the midwife around low-risk pregnancy, labour and childbirth care. In line with this, the Ministerial Decree of 24 April 2000 has defined a national programme according to which midwives should care for healthy pregnant women and mothers in family care centres (Ministry of Health 2000). The autonomous management of low-risk pregnancies by midwives has been then reaffirmed by the Agreement of 16 December 2010 on reduction of caesarean section (Ministry of Health, 2010) as well as guidelines on healthy pregnancy (Ministry of Health and Italian National Institute of Health, 2011) More recently, the Ministry of Health (2017) has produced guidelines for the organization of Alongside Midwifery Units (AMUs), where the framework for caring for healthy pregnant women, mothers and newborns is the midwifery-led care model (Ministry of Health 2017). Despite all these policies, the road ahead is still long. In fact, there are only three AMUs in Italy, and the main care approach in most maternity hospitals is the medical-led model (Ricchi et al., 2019) Also, Italian independent midwives assist low-risk births at home or in private freestanding midwifery units; however, the national prevalence of out-of-hospital deliveries is limited (Campiotti et al., 2020 Apr 15). In Italy, the current education for midwives includes three levels: 1) a three-year bachelor's degree, as for all health professions; 2) a two-year master's degree in Nursing and Midwifery Sciences focused on the fields of training, health management, and research; and 3) a three-year Ph.D. programme, which is not exclusive for midwives but provided in partnership with other HCPs. Also, professional masters have been developed to create new job opportunities and provide evidence-based practices, such as the three recent professional masters on pelvic floor rehabilitation, medically assisted procreation, and family and community midwifery approved by the Ministry of Health and the Ministry of Education, University, and Research and aimed exclusively at midwives. Although the post-graduate offer is quite wide, some critical issues persist for pre-graduate education. The Italian Federation of Midwives (FNOPO) has been declaring for several years that limiting the acquisition of knowledge, skills and competencies by midwives to a three-year course has created a gap between pre-service education and the wide attribution of responsibility, which is recognized to midwives by legislation (Federazione Nazionale Ordini Professione Ostetrica 4 November 2020). For this reason, the FNOPO is formulating a proposal to revise midwifery university education to transform it into a five-year degree course(Federazione Nazionale Ordini Professione Ostetrica 2021).