Practice Guidelines in Professional Midwifery Practice

Practice Guidelines are professional documents that layout an understanding of a core topic in midwifery, and what the protocol for managing that topic will be in an individual or group midwifery practice. They’re a blueprint for practice. They can look many different ways in different practices, but they often have a few core elements in common (As applicable per topic): a list of definitions or basic understanding, a list of risk factors or characteristics that make the topic more likely to occur, a description of the risk or consequences to a pregnancy if this thing were to occur, your planned protocol for management of the topic, and the circumstances upon which you would seek consultation or transfer of care to outside sources for complications.

In midwifery practice, these are used to guide practice in a few key ways:

  • to help midwives recall their planned protocols for circumstances that only come up rarely

  • to help ground midwives in agreed upon protocols when we have clients who are pushing our comfort boundaries or safety for midwifery care and out of hospital birth

  • to standardize care in group practices of midwives

  • as a reference document to build community standards of care

Holding such a document, and adhering to its protocols, is expected in community practice in midwifery. Your document does not have to be identical to other midwifery practices, it can be unique to your area and your approach! Having and following such a document will also be expected by NARM, and by state licensing agencies (if applicable).

NMI Assignments to craft Professional Practice Guidelines

There are two main assignments about practice guidelines at National Midwifery Institute:

  1. Practice Guidelines worksheets - complete these as you go, they’re an included assignment in most modules

  2. Practice Guidelines booklet - a final, culminating assignment turned in before graduation

As a final assignment at National Midwifery Institute before graduation, you will be asked to submit a Practice Guideline booklet for review. This booklet will include a long list of situations that typically come up in midwifery practice and how you as a midwife in professional practice plan to approach this. This document is personal to you and is a demonstration of your knowledge. It will also provide guidance to you in practice, standardize approaches if you plan to work in a group practice, and may be available to clients upon request. It is your guidebook! This is required for graduation from NMI, and also required by NARM if you apply for the NARM exam and CPM credential. If you are applying for state-specific licensure, some states also require this document.

To prepare you to craft this document, you are asked to create drafts of each guideline as you work through your relevant modules with the NMI Practice Guidelines Worksheets. These will serve as the templates and guide you for helpful structure and prompts for inclusion. As you turn these in with your modules, you will be provided feedback for reflection. When approaching your final Practice Guidelines booklet, we encourage you to review your worksheets, make adjustments and adaptations, and then reformat them in your own words and outlines for a unique professional document. This will be reviewed by an instructor prior to graduation.

 

Recording:

HIVE Lecture and Activity on new Practice Guidelines guidance project

June 14, 2023

 

Examples and Resources for Practice Guidelines

Having trouble picturing it? Below is a list of resources where you can look at models for practice guidelines. Additionally, your coursework instructors have generously offered copies of their own practice guidelines in their practices. Note how they are all different, but cover the same topics for different midwifery practices.

Resources

 

Frequently Asked Questions

  • NMI now provides Practice Guideline worksheets to guide your creation of these guidelines. Fill out the worksheet with the information you already have from your module. Think of it like a synthesis of practical learning from your module. If you already completed your module - you have all the info you need for the Practice Guideline! It’s just about adapting and formatting it to be practically useful to you. You can do this! Drafting them now saves you a whole lot of headache when yo need to create your Practice Guidelines booklet at the end of your studies.

  • You do not need to go back and complete worksheets for practice guidelines you have already turned in! But, you may find their outlines helpful when drafting your final Practice Guidelines booklet before graduation.

  • NO - your worksheets are to help you understand structure and what should be included in your practice guidelines. But, you need to reformat them and make them into stand alone personal practice guidelines for your final assignment. Consider your own practice logo, your own formatting that makes it easy for you to read and reference, etc. The info can remain the same - but make them your own for the final assignment!

  • It is a big undertaking! Luckily, we’ve had you draft each practice guideline as you completed your modules so it’s a matter of formatting, consolidation, and triple checking at this point. Given the volume of Practice Guidelines requested, this document is often over 100 pages long from students. An instructor will review your document and give feedback before graduation.

  • The Practice Guidelines worksheets serve as a good outline to what should be included in a practice guideline. You are welcome to change the formatting and delete sections that are absolutely irrelevant to your practice, but we encourage you to keep the bulk of the information.

  • Practice Guidelines should include expansive language to leave wiggle room for the midwife’s discretion and not be overly prescriptive so they box the midwife in. That could include phrases like “midwife may consider” at the beginning of a list of procedure steps, instead of “midwife will do the following”, so as to leave room for variation. At the ends of lists of indications, consider including “other indications at the midwife’s discretion” or similar phrasing so there is room for flexibility.

    Professional midwifery practice guidelines can be sparse while still getting across the core information. The should not only be procedure lists, they should include more in depth information to demonstrate ore understanding of the topics.

  • YES - you still have to make them for graduation from NMI. If you choose to remove them from your booklet when you are in professional practice, that is your own prerogative.

    Consider that certain “out of scope” practices may present themselves from time to time by surprise without enough time for consultation/transfer of care (ex: surprise breech birth in a quickly progressing second stage), so even if a topic is out of scope having an “emergency only” practice protocol is still reasonable.

  • NO - state practice guidelines for midwives tend to be very sparse and focus on a midwife’s scope and indications for transfer of care, rarely on the nuance on understanding of the myriad of topics we ask you to demonstrate before graduation. It is important you are aware of guidelines, if they exist in your state, but you ALSO need your own practice guidelines.

  • YES - you still need practice guidelines for your own practice, as per midwifery community standard. You also need them as a graduation requirement from NMI, and an application requirement to sit the NARM exam.

  • NO - you must turn in your own work with practice guidelines. Ensure that the guidelines you write are relevant to your style of practice, your local resources, and your clientele. If you use your preceptor’s guidelines as an outline, ensure that you give credit by including phrasing such as “adapted from guidelines by [name]” so you honor your sources.

  • NO - you must turn in your own work with practice guidelines. Ensure that the guidelines you write are relevant to your style of practice, your local resources, and your clientele. If you use your colleague’s guidelines as an outline, ensure that you give credit by including phrasing such as “adapted from guidelines by [name]” so you honor your sources.

  • Absolutely - make them your own! If they will differ greatly than the outlines we have provided, please ensure you include a description on where/how we can find the core elements in your work if it will not be obvious to a reviewer. Your guidelines will be reviewed by an instructor before graduation.

  • Absolutely - make this document work for you! Put them in the order you want them. Our suggestion is there if you need a starting place, but it is not mandatory. However - please ensure that all requested guidelines are present even if they are in a different order.

  • YES - however, if you do this, please include a note to the instructor evaluating your practice guidelines explaining which ones have been combined to make it easy for them to reference in review.