Supporting the National Strategy for Midwifery in the United Arab Emirates
In this second article (see the first here ), Gina (Georgina Sosa) PhD, Midwife, Assistant Professor of midwifery reflects on the progression of the #MidwiferyinAbuDhabi journey
Our journey to develop a high-quality midwifery degree programme in the United Arab Emirates (UAE) is still at the embryo stage, but like embryo development, progress is happening fast in many different areas. It is important to understand that this is learning in progress so our insights may change as our connections and knowledge increase.
Our overall aim is to start a new degree programme at Fatima College of Health Sciences (FCHS), incorporating the global standards of midwifery to enable student midwives to learn and practice the full scope of midwifery knowledge, behaviours and skills as outlined by the International Confederation of Midwives (ICM, 2019). We feel part of the global midwifery family, but it is vital to first understand the local context of midwifery in the United Arab Emirates (UAE) and how we and other midwives fit into this local context. Immersing into the UAE, we realise that the reason we have been appointed as Midwifery Professors is part of the UAE National Strategy for Nursing and Midwifery to increase the nursing and midwifery workforce (WAM, 2022). This is not a new agenda and includes the aim to attract Emirati nationals to healthcare professions (UAE NMC, 2013). Much work has been completed as there has been a rapid increase in nursing students in the last 10 years, including Emirati nationals. The same success is hoped for recruiting student midwives. Such ‘scaling up’ of midwifery numbers is also a recognised global priority (Renfrew, 2021).
Thinking about the future midwifery workforce, our first task was to answer the question: ‘What does Midwifery look like in the UAE now?’ To help us answer this question we had the MATE tool (Midwifery Assessment Tool for Education – tool designed by the World Health Organisation (WHO) Collaborating Centre for Midwifery Development at Cardiff University, at the request of the WHO European region) in hand, when attending meetings in Government and Private hospitals in Abu Dhabi to speak to hospital management teams, midwives and obstetricians leading the maternity services. Meetings were arranged in Abu Dhabi at this point, rather than the whole of the UAE as this is where the midwifery degree programme will start before progressing to the other Emirates. These meetings have been so helpful for maternity staff to share contributions to the future midwifery curriculum. Additionally, we have gained an understanding that midwives are not currently working their full scope of practice. Midwives are mainly working on the labour wards as there are not enough of them. Antenatal care is mostly provided by obstetricians although midwives are providing health education and parent craft classes in some hospitals. Postnatally maternity nurses are mostly providing the care for mothers and babies until discharge. We are fortunate that we are teaching and supporting student nurses as they complete their maternity nursing courses as this is helping our insight into their roles. Understanding the sphere of practice of maternity nurses is important as they will be helping to teach the student midwives in some areas. Reflecting on the information gained from the hospitals, two more questions emerged:
- What are the barriers and facilitators to supporting student midwives to learn the full scope of practice aligning with ICM standards and competencies of midwifery education?
- How will student midwives at FCHS be supported to work in full scope of practice to achieve the ICM competencies to be eligible to graduate with a BSM?
At present the obstetricians would need to support student midwives to carry out antenatal assessments while midwives can educate student midwives about health promotion and parent craft classes. Midwives and obstetricians would support the student midwives in the labour ward, while maternity nurses will support the students in the postnatal wards. The current education process relating to clinical placement enables midwifery professors to be onsite at the hospitals. This has potential for us to translate the learning achieved to a midwifery scope of practice. The obstetricians we have spoken to have been very supportive to help support and educate student midwives. We now plan to arrange meetings at each hospital with the obstetric teams and complete a SWOT analysis to ascertain the strengths, weakness, threats, and opportunities of having obstetricians rather than midwives supporting student midwives with antenatal assessments. Writing this we realise that we also need to meet with maternity nurses to gain the same information.
There is currently no home care, antenatally and postnatally. When women go home, they can access an obstetrician, paediatrician and lactation specialist for postnatal follow up as outpatients. At present student midwives will have no access to women in the community to provide antenatal and postnatal care. We are hoping that access to community care can be started. There has been hospital support for this, and it is also an UAE vision, that non acute care will be transferred from acute hospital settings to community-based setting (UAE NMC 2013). When thinking about the women’s perspective, originally, we were going to ask the women in which areas they accessed midwifery care. Following the hospital visits the questions towards the women changed as we now know where the midwifery care is centred. Our curiosity is now focused about whether women would be happy to access midwifery care and whether women understand the role of the midwife.
At the same time, we are creating a midwifery curriculum and that is so exciting, but there are moments that Maeve and I look at one another and feel our efforts are like a ‘needle in a haystack’ as there is so much to do. We are very fortunate to work with a brilliant nursing team (with special thanks to Dr Gleason and Annie Rosita) and we have also reached out to our global midwifery family to learn how the ICM competencies have been translated into international curriculums. Midwifery family from Chile (Astrid Balmaceda Francois), India (Indie Kaur) Ethiopia (Samuel Abdu Aliyu) UK (Professor Kenda Crozier and Dr Lindsay Gillman) have met with us virtually to share their creative knowledge and experience regarding curriculum development. The global perspective was vital as we needed to learn about experiences of new midwifery courses being started where the midwifery infrastructure was not present initially in the clinical placements, to learn about who taught the students and the results of such teaching. We are reassured that a multidisciplinary approach works. We now have a curriculum near to completion!!
Where do we go from here? Will we pass the 61 requirements for the accreditation team?
All to be revealed in our next blog. Fingers and everything crossed!!!
ICM (2019) Essential Competencies for Midwifery Practice. International Confederation of Midwives https://www.internationalmidwives.org/assets/files/general-files/2019/10/icm-competencies-en-print-october-2019_final_18-oct-5db05248843e8.pdf
UAE NMC (2013) UAE Nursing and Midwifery Education Strategy. UAE Nursing and Midwifery Council http://www.uaenmc.gov.ae/en/Publications.aspx
Renfrew, M (2021) Scaling up care by midwives must now be a global priority. Lancet. Jan, Vol 9: e2-e3 https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(20)30478-2/fulltext
WAM (2022) Ministry of Health launches National Strategy for Nursing and Midwifery – Roadmap for 2025. Emirates News Agency-WAM https://www.wam.ae/en/details/1395302924914