ICM Essential

Competencies for
Midwifery Practice

2024
ICM Essential Competencies (2024)

© 2024 by the International Confederation of Midwives

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ICM Essential Competencies 2

Content
Introduction 4

The Evolution of the Essential Competencies 4

Midwife Scope of Practice and the Competencies 5

The Structure of the Essential Competencies 6

Explanation of Competency Components 7

Language 8

Using the Competencies 8

CATEGORY 1 Cross-functional
Competencies for Midwifery Practice 9

CATEGORY 2 Sexual and

Reproductive Health and Rights 20

CATEGORY 3 Antenatal Care 28

CATEGORY 4 Care During Labour and Birth 35

CATEGORY 5 Ongoing Care

of Women and Newborns 39

Recommended Reading 44

Endnotes / References 46

ICM Essential Competencies 3

Introduction
The International Confederation of Midwives (ICM) Essential Competencies for Midwifery Practice
(2024) outline the minimum set of knowledge, skills and professional behaviours required to use the
designation of midwife as defined by ICM (1) when entering midwifery practice. The Competencies
are presented in five categories that set out those competencies considered to be essential and that
“represent those that should be an expected outcome of midwifery pre-service education” (2). The
Competencies are linked to authoritative clinical practice guidance documents used by the World
Health Organization” (3-16) and ICM’s core documents and position statements (17).

Guidance documents undergo revision based on ever-evolving research. ICM’s Essential Competencies
are also evaluated and amended regularly (now a regular five-year review cycle) to include emerging
relevant evidence concerning sexual, reproductive, maternal, newborn and adolescent health care
(SRMNAH) and midwifery practices. The Competencies presented in this document have been updated
through such a review process.

The Evolution of the Essential Competencies

ICM’s Essential Competencies for Basic Midwifery Practice were first developed in 2002 and updated in 2010,
2013 and 2019. Between 2014 – 2017 the competencies were reviewed through a research study led by a
team from the University of British Columbia (UBC), Canada (18) and supported by a core working group
of midwifery educators (19) and a taskforce of stakeholders (20).

In 2019, two consultants, a learning designer (21) and a midwife educational expert (22), were contracted
to revise the format of the draft framework (2017) and draft competencies with the aim of increasing the
accessibility, usability, and measurability of the framework by multiple audiences. Changes were based
on the 2017 draft competencies and retained their integrative approach. The consultants redesigned the
framework, and reworded and reorganised the competencies, drawing on ICM’s core documents (17) and
position statements to ensure alignment. The final version, renamed as ICM Essential Competencies for
Midwifery Practice, was completed in April 2018 and accepted by the Board in May 2018. In August 2019
a further update was made to correct an error in competency 4e (skills and behaviours section) of the
English version.

In 2023 ICM commenced its five-year review and update of the competency framework to reflect
changes in midwifery practices, ICM core documents and position statements, guidance documents,
climate adaptation and humanitarian issues. A learning design consultant and midwifery education
expert were contracted to undertake an iterative review and modified Delphi process involving two
rounds of feedback from ICM Member Associations, midwifery educators, midwifery regulators, ICM
Regional Professional Committees, the ICM Board and partner organisations, including WHO and UNFPA.

ICM Essential Competencies 4

A comparison between the 2019 and 2024 Essential Competencies
Between 2019 and 2024, the primary change to the Essential Competencies was the addition of category
2 focusing specifically on sexual and reproductive health and rights (SRHR), contraception and pre-
conception care. The 2019 ICM Essential Competencies addressed SRHR; however, with new guidance
documents published by the World Health Organization (WHO) and requests for more clarity and
specificity regarding SRHR competencies the new category was added, described in the table below:

2019 2024
Title Title

Category 1 General competencies Category 1 Cross-functional Competencies

for Midwifery Practice

Category 2 Sexual and Reproductive Health

and Rights

Category 2 Pre-pregnancy and antenatal Category 3 Antenatal Care

Category 3 Care During Labour and Birth Category 4 Care During Labour and Birth

Category 4 Ongoing Care of Women and Category 5 Ongoing Care of Women and
Newborns Newborns

With the additional category the total overall competencies increased from 31 in 2019 to 37 in 2024.
There was also an increase in the overall number of knowledge (from 132 to 245), skills and behaviours
(from 186 to 293) indicators to address the addition of the new category and new information provided
through key guidance documents.

It is important to note that the ICM International Definition and Scope of Practice of the Midwife
remains the same. Even with the additional category, competencies and supporting knowledge, skills
and behaviour indicators there is no increase to the ICM Scope of Practice of the midwife. Instead,
the additions and revisions to the Essential Competencies provide more specificity and clarity on the
requirements for a midwife graduate to practise across the full scope at a level necessary for entry to
practice.

Midwife Scope of Practice and the Competencies

The ICM International Definition and Scope of Practice of the Midwife sets out the boundaries of what a
midwife can do on their own responsibility. The Essential Competencies for Midwifery Practice (2024) set out
the knowledge, skills, and behaviours that midwives need to have to be able to work across the full scope
of practice at the point of entry to the profession. They are a minimum standard, and all midwives
should maintain at least this minimal level of competence across their professional careers.

While it is recognised that midwives will gain additional competencies throughout their careers,
related to the context in which they are working, the Essential Competencies are not focused on a
particular work setting but rather what midwives need to be able to do to work across the scope of
practice. Similarly, midwives will become more proficient as they gain experience as midwives, but the
expectation of the Essential Competencies is that they are entry level and a minimal standard for all
qualified midwives.

ICM Essential Competencies 5

The Structure of the Essential Competencies

mpetencies for M
al Co idw
n
ctio ife
ry
un

Pr
s

ac
os
Cr

tic
Sexual and

e
Reproductive
Antenatal Care
Health and Rights

Ongoing Care of
Care During
Women and
Labour and Birth
Newborns

There are five categories of competencies. Category 1 is a set of cross-functional competencies that
apply to each of the other four categories. They are categorised in this way to prevent the need to
duplicate in the other categories. Category 1 competencies relate to the midwife’s autonomy and
accountability as a health professional, the relationships with women and other care providers, and care
activities that apply to all aspects of midwifery practice. Categories 2 to 5 are more specific in outlining
the midwife’s competence across the scope of practice.
Category 1: Cross Functional Competencies for Midwifery Practice
Category 2 (new): Sexual and Reproductive Health and Rights
Category 3: Antenatal Care
Category 4: Care During Labour and Birth
Category 5: Ongoing Care of Women and Newborns

It is important to remember that, when reading any category, the competencies in Category 1 also apply.

There are 37 competency statements that are written as holistic statements of competence that reflect
the ICM’s Philosophy and Model of Midwifery Care in addition to the ICM International Definition and
Scope of Practice of a Midwife.

Each competency statement is further described by a list of knowledge, skills and behavioural
indicators that provide guidance on what is required to achieve the competency. These components
are not exhaustive, but they are the minimum required to achieve competence. The knowledge, skill
and behavioural indicators represent the key components required to achieve the competency but
depending on context and practice requirements within each country there may be a need for additional
indicators. ICM encourages midwifery educators, regulators, and policy makers to add to these
indicators as needed to meet the in-country practice requirements.

Please note: The examples listed in the indicators are to guide the interpretation of the indicator and
competency. These examples are meant to provide guidance and are not exhaustive.

ICM Essential Competencies 6

Step 1. Competency Structure

Explanation of Competency Components

CATEGORY #
1

Knowledge Skills & Behaviours

#Competency tittle

#Competency tittle

#Competency tittle

1 CATEGORY 3 COMPETENCY

2 DESCRIPTORS 4 INDICATORS
Category descriptors outline the primary focus of Each competency is accompanied by a list of indicators
each category. The high-level description acts as a that outline the necessary knowledge, skills and
linking mechanism between the category and the behaviours required to achieve the performance measure
competencies clearly showing the relationship between of the competency. In formulating indicators, skills
the higher order groupings (i.e. categories) and the and behaviours are grouped together since they are the
more detailed information concerning the actual observable components of a competency. Indicators for
competencies (i.e the competency description and its attitudes were not stipulated since attitudes are not easily
associated components/indicators). observable or measurable.

ICM Essential Competencies 7

Language
The ICM Essential Competencies for Midwifery Practice (2024) uses the words women and woman
throughout, reflecting the biology and identity of the vast majority of those who are childbearing. For
the purposes of the competencies, these terms include girls, adolescent girls and people whose gender
does not correspond with their birth sex or who may have a non-binary identity. All those receiving care
from a midwife should receive individualised, respectful care including the use of the gender nouns and
pronouns they prefer (23).

Using the Competencies

There is no single purpose for using the ICM Essential Competencies for Midwifery Practice (2024). The
Competencies are intended to support the development of midwifery services worldwide and as such
can be used by a variety of stakeholders and in multiple ways.

Here are a few examples of how people have used the framework:

• Governments to establish/strengthen midwifery services in-country and define the midwifery scope
of practice,
• Midwives’ associations to advocate for the strengthening of the midwifery profession and to create
continuing education opportunities for their members,
• Midwife educators to create midwifery programmes of study (e.g. Bachelor of Midwifery),
• Midwifery regulators to prescribe the scope of practice and establish the minimum competency
requirements for entry to practice,
• Midwives to guide them in their practice and continuing education development,
• Students to assess themselves against the requirements for competent practice,
• Midwife consultants and stakeholders for the establishment and evaluation of midwifery services.

The ICM encourages midwives’ associations and all persons providing maternal and newborn care to
continue to use the Essential Competencies to advocate for the education, regulation and continuing
competence of midwives globally.

ICM Essential Competencies 8

CATEGORY 1
Cross-Functional
Competencies for
Midwifery Practice
Competencies in this category are about the
midwife’s autonomy and accountabilities as a
health professional, the relationships with women
and other care providers, and care activities that
apply to all aspects of midwifery practice. Cross-
functional Competencies apply across each of the
other Competency categories: 2, 3, 4 and 5.

Knowledge Skills & Behaviours

• Principles and concepts of • Demonstrate behaviour that

autonomy, accountability and upholds the public trust in the
1.a
transparency profession
• Personal beliefs, biases and • Participate in self-evaluation,
Assume norms and their influence on peer review and other quality
responsibility for practice improvement activities
own decisions • Knowledge of evidence-based • Demonstrate behaviour that
and actions as practices reflects the ICM Philosophy and
an autonomous • Scope of practice of the midwife Model of Midwifery Care
practitioner and the roles and responsibilities • Balance the responsibility of the
within the of midwives midwife to provide best care with
midwifery scope • ICM Philosophy of midwifery care the autonomy of the woman to
of practice and model of midwifery care make her own decisions
• National professional standards • Explain the midwife’s role in
for midwives providing care that is based on
• National professional relevant law, ethics, and evidence
organisation for midwives • Demonstrate adherence to
• Global, national and local laws professional standards, ethical
and ethical guidelines governing standards and professional
the practice of midwives codes of conduct
• Placement of midwife within the • Analyse situations, assess risks,
health system (e.g. contextual and make informed decisions
issues in health systems related independently within scope of
to decentralised level of care, practice
scope of practice, and issues • Recognise boundaries of
related to geographies where scope of practice and consult/
there are inadequate health refer to midwife colleagues
workforce numbers) and/or registered healthcare
professionals if the needs of the
woman and/or baby are beyond
scope of practice
• Take responsibility for decisions
and actions and document

ICM Essential Competencies 9

 Knowledge Skills & Behaviours

• Strategies for managing personal • Self-management in relation to

1.b safety particularly within the time, uncertainty, change and
facility or community setting coping with stress
• Strategies for personal wellbeing • Assume responsibility for
Assume
and care-of-self-practices to personal safety in various
responsibility
maintain physical, mental and practice settings
for continuing
emotional health • Maintain up-to-date skills and
education
• Self-regulation and reflective knowledge concerning protocols,
and personal
practice guidelines and safe practice
wellbeing as a
• Continuing education • Engage in self-reflective practice
midwife
opportunities (e.g. online • Remain current in practice by
platforms, workshops, mentoring, participating in continuing
etc.) to support professional professional education
development • Identify and address limitations
• Strategies for setting and in personal knowledge, (clinical)
implementing continuous skills, behaviour and/or
learning goals experience
• Develop personal career/
development plan

• Applications and the impact • Critically analyse the use and

1.c of health care technology on impact of new health care
midwifery practice and on technologies within the scope of
maternal and newborn outcomes midwifery practice
Adapt to and
(e.g. electronic health records, • Demonstrate appropriate use
adopt new
telehealth platforms, remote of health care technologies and
and emerging
monitoring devices, AI supported platforms available for use within
technologies
technology) the scope of midwifery practice
that have
• Ethical challenges and risks • Interpret and respond to data
been proven
(e.g. principles of confidentiality generated by health care
to enhance
and data protection/security; technologies (e.g. remote
midwifery
implementation of technology monitoring devices)
practice and
that does not have a robust • Ensure consent and data
care
evidence base) when using protection when using digital
health care technology in and/or AI supported technologies
midwifery care
• Adaptation strategies where
technology fails or is interrupted

CATEGORY 1: Cross-Functional Competencies for Midwifery Practice

ICM Essential Competencies 10
 Knowledge Skills & Behaviours

• Legal and regulatory frameworks • Provide oversight to ensure that

1.d related to delegation of practice is aligned with evidence-
responsibilities of care and based clinical practice guidelines
supervision in midwifery practice • Demonstrate skills of clinical
Appropriately
• Supportive strategies to preceptorship, mentoring and
delegate and
supervise others role modelling
oversee aspects
• Roles and preparation of • Delegate, document and monitor
of care
midwives as preceptors, mentors, tasks relevant to the needs of
supervisors, and role models the woman and newborn to
other healthcare professionals
based on the boundaries of their
practice
• Collaborate and communicate
effectively with other health care
professionals

• Relevance of using research and • Integrate current critically

1.e evidence-based practice appraised evidence into practice
• Epidemiologic concepts relevant • Apply midwifery-related research
to women’s health as well as to midwifery practice
Use research to
sexual, reproductive, maternal, • Critically evaluate the reliability
inform practice
newborn and adolescent health and applicability of midwifery
• Global recommendations for related research
practice and their evidence base • Communicate the findings of
(e.g. World Health Organization relevant research to professional
guidelines) and non-midwife audiences,
including women and their
families
• Participate in the development
and updates of policies and
guidelines to implement
evidence-based practice

CATEGORY 1: Cross-Functional Competencies for Midwifery Practice

ICM Essential Competencies 11
 Knowledge Skills & Behaviours

• National/state/local laws and • Identify any gaps in national/

1.f regulations regarding midwifery state/local laws and regulations
practice for midwifery practice in relation
• National/state/local standards of to ICM’s Core Documents
Adhere to
midwifery practice (e.g. International Definition
national, state
• National/state/local professional and Scope of Practice of the
and local laws,
ethics and codes of conduct for Midwife, Philosophy and Model
regulatory
midwives of Midwifery Care, International
requirements,
• ICM’s midwifery philosophy, Code of Ethics, Bill of Rights for
and codes of
values, code of ethics Women and Midwives, Global
conduct for
Standards, Position Statements
midwifery
• Practise according to legal
practice
requirements, ICM’s midwifery
philosophy, values, standards
and ethical principles
(including capacity, privacy and
confidentiality, consent, conflict
of interest, duty of care, dignity
and privacy)
• Meet requirements for entry
and maintenance of midwifery
registration
• Protect privacy and
confidentiality of oral information
and written records
• Maintain records of care in the
manner required by the health
authorities
• Comply with all local reporting
regulations for birth and death
registration
• Recognise violations of laws,
regulations, and codes of ethics
at local and national level and
take appropriate action
• Report and document incidents
and adverse outcomes as
required while providing care

CATEGORY 1: Cross-Functional Competencies for Midwifery Practice

ICM Essential Competencies 12
 Knowledge Skills & Behaviours

• Principles, laws and codes that • Provide information to

1.g protect human rights adolescents and women about
• Human right to be treated their sexual and reproductive
equally, regardless of sex, race, health and rights
Uphold
ethnicity, nationality, class, caste, • Inform women about the scope
fundamental
religion, beliefs, gender, language, of midwifery practice and
human rights
sexual orientation, age, health or responsibility of midwives to
of individuals
marital status uphold women’s rights
when providing
• Sexual and reproductive health • Inform people seeking care
midwifery care
and rights (SRHR) across the about eligible services in
reproductive life cycle alignment with their sexual and
• Health equity, human rights and reproductive health needs and
respectful care within midwifery rights
practise • Advocate for the rights of women
• Sustainable Development Goals and families to access eligible
(SDGs) and Universal Health services, get evidence-based
Coverage (UHC) information and make their own
choices
• Treat women and girls across
the reproductive life course
with dignity and respect and
in a non-judgmental and non-
discriminatory manner

• Cultural norms and practices • Support women in developing

1.h surrounding sexuality, sexual their health literacy
practices, marriage, the • Advocate for and support women
childbearing continuum, and to be the central decision makers
Support women
parenting in their care
to make choices
• Principles of partnership and • Assist women to identify
and decisions
empowerment, including shared their needs and preferences
about care
decision making throughout the course of care
• Self-care interventions for women • Support women to make
for health and wellbeing informed decisions
• Methods of translating health • Provide information and
information to individuals, anticipatory guidance about
groups, communities sexual and reproductive health
• Sexual and reproductive health rights (SRHR) to assist women’s
and rights (SRHR) choices decision making
available to women • Collaborate with women in
• Principles of informed choice developing a comprehensive
and consent, and procedures for plan of care that respects their
obtaining women’s consent or preferences and decisions
refusing care • Support women to manage their
health within the constraints of
the health system

CATEGORY 1: Cross-Functional Competencies for Midwifery Practice

ICM Essential Competencies 13
 Knowledge Skills & Behaviours

• Role and responsibilities of • Communicate in an open, honest,

midwives and other health clear and timely manner
1.i
providers in sexual and • Respect others’ points of view
reproductive health, maternal and • Promote the expression of diverse
Demonstrate adolescent health opinions and perspectives
respectful • Principles of respectful and • Manage tensions and conflict
and effective effective communication constructively
interpersonal (including, but not limited to, • Use the preferred language of
communication listening, speaking, documenting, the woman or an interpreter
with women writing and digital skills) (including sign language) to
and families, • Cultural practices and beliefs maximise communication
health care related to childbearing and sexual • Establish ethical and culturally
professionals, and reproductive health and appropriate boundaries between
teams, and rights (SRHR) professional and non-professional
community • Principles of communication in relationships
groups challenging circumstances (e.g. • Apply principles of cultural safety,
grief and loss, emergencies) equity, diversity and inclusion
• Principles of effectively working • Demonstrate sensitivity,
and communicating in health compassion and empathy for
care teams and with community bereaved women and family
groups members
• Convey information accurately
and clearly
• Appropriately respond to the
needs of individuals
• Document all aspects of care
provided according to standard
protocols

• Definitions and boundaries of • Engage in respectful shared

inter- and intra-professional decision-making with midwife
1.j
collaboration colleagues and other healthcare
• Shared decision-making and providers
Collaborate accountability • Use national consultation and
effectively with • Principles of effectively referral guidelines
other health care working and communicating in • Establish and maintain
professionals health care teams (e.g. SBAR- collaborative relationships with
tool - Situation, Background, individuals, agencies, institutions
Assessment, Recommendation) that are part of referral networks
• The intersection between • Effectively and safely use digital
midwifery and the roles and collaboration tools to share
responsibilities of other information and ideas (e.g. SBAR-
healthcare professionals (e.g. tool)
physicians, nurses and other • Document all aspects of care
health professionals) and provided according to standard
interprofessional teams protocols
• Structures and functions of • Manage tensions and conflict
healthcare system, including constructively
consultation, referral and transfer • Respect and value other members
pathways and interprofessional of the health professional team
teamwork

CATEGORY 1: Cross-Functional Competencies for Midwifery Practice

ICM Essential Competencies 14
 Knowledge Skills & Behaviours

• Health needs of adolescents and • Conduct a comprehensive

1.k women related to reproduction assessment of sexual and
• Health needs and conditions that reproductive health and
affect (early) adolescent girls and wellbeing needs
Assess the
the impacts of “child marriage” • Assess risk factors and at-risk
health status,
• Health conditions that pose risks behaviour
screen for
during reproduction • Obtain a medical history and a
health risks,
• Health needs of adolescent comprehensive assessment of
and promote
girls and women, including health
general health
immunisation, nutrition, sexual • Order, perform, and interpret
and wellbeing of
health laboratory tests and/ or imaging
adolescent girls,
• Determinants of health screening tests
women
• Principles and fundamentals • Exhibit critical thinking and
of self-care interventions and clinical reasoning informed by
rights relevant to sexual and evidence when assessing and
reproductive health and rights promoting health and wellbeing
(SRHR) of adolescent girls and • Provide health information and
women advice tailored to individual
circumstances of adolescents,
women and families
• Collaborate with adolescent
girls and women to develop and
implement a plan of care

• Common health problems related • Maintain/promote safe and

1.l to sexuality, reproduction and hygienic conditions for women
early life and newborns
• Treatment of common health • Use universal precautions
Prevent and
problems consistently
treat common
• Strategies, including health • Provide options to adolescent
health problems
education and promotion, girls and women for coping with
within scope
to prevent and control the and treating common health
of midwifery
acquisition and transmission problems
practice
of environmental and • Use technology and interventions
communicable diseases appropriately to promote
health and prevent secondary
complications
• Recognise when consultation or
referral is indicated for managing
identified health problems,
including consultation with other
midwives
• Include women in decision-
making about consultation
and referral to other healthcare
providers and services

CATEGORY 1: Cross-Functional Competencies for Midwifery Practice

ICM Essential Competencies 15
 Knowledge Skills & Behaviours

• Complications/pathologic • Maintain up-to-date knowledge,

1.m conditions related to health life-saving skills and equipment
status, including communicable for responding to emergency
and non-communicable diseases situations
Recognise
• Emergency interventions/life- • Recognise signs, symptoms of
abnormalities
saving therapies/first level complications and situations
and
management including Basic requiring expertise beyond
complications
Life Support (BLS), Neonatal midwife scope of practice/
and provide
Life Support (NLS) training, personal competence of the
appropriate
Emergency Obstetric and midwife
treatment and
Newborn Care (EmONC) • Determine the need for
referral when
• Limits of midwife scope of immediate intervention and
necessary
practice and own experience/ respond appropriately
competence • Provide Emergency Obstetric and
• Available consultation and Newborn Care (EmONC) including
referral systems to access Basic Emergency Obstetric and
medical and other personnel to Newborn Care (BEmONC) and
collaborate in management of Comprehensive Emergency
complications Obstetric and Newborn Care
• Community/facility plans and (CEmONC)
protocols for accessing resources • Implement timely and
in timely manner appropriate intervention, inter-
professional consultation and/or
timely referral taking account of
local circumstances
• Maintain appropriate and
effective communication with
women about nature of problem,
actions taken, consultation,
referral and transfer of care if
indicated
• Provide accurate oral and
written information to other care
providers when referral is made,
e.g. SBAR communication tool
• Collaborate with other healthcare
providers in decision-making if
possible and appropriate

CATEGORY 1: Cross-Functional Competencies for Midwifery Practice

ICM Essential Competencies 16
 Knowledge Skills & Behaviours

• Normal biological, psychological, • Promote and facilitate policies

1.n social, and cultural aspects of and a work culture that protect
reproduction and early life the physiological, social and
• Practices that facilitate and those cultural processes of giving birth
Facilitate normal/
that interfere with physiological and enable continuity of care
physiological
processes, including birth setting • Utilise human and clinical care
birth processes
and overmedicalisation resources to provide personalised
in institutional
• Policies and protocols about care care for women and their
and community
of women in facility, community newborns
settings,
and home settings • Exhibit clinical reasoning
including
• Physiological and informed by evidence when
women’s homes
pathophysiological aspects promoting normal/physiological
for the management of the birth and wellbeing
childbirth process to enable • Provide health information and
quality midwifery care and timely advice tailored to individual
referral to a medical professional circumstances of women,
in case of pathologies families and the community
• Online resources for women’s • Support women to adopt healthy
and family education in various behaviours and incorporate
settings health promotion and the
• Community views about and prevention of disability, disease
utilisation of health care facilities and injury into interactions
and place(s) of birth • Provide continuity of care by
• Determinants of health and a midwife or small team of
health equity (e.g. socio- midwives known to the woman
economic, hereditary, gender)
• Fundamentals of environmental
health especially in relation to
‘’WASH’’ (Water, Sanitation and
Hygiene)
• Health promotion and disease
prevention

CATEGORY 1: Cross-Functional Competencies for Midwifery Practice

ICM Essential Competencies 17
 Knowledge Skills & Behaviours

• Basic pharmacology and • Confirm allergies, possible

1.o prescribing drug interactions and/
• Medicines and products within or contraindications and
midwifery scope of practice and clinical indication for any
Prescribe,
according to legal requirements pharmaceuticals
dispense and
(e.g. drugs for first and second • Explain the indications, benefits,
administer
level of care (EmONC) such as side-effects and risks of specific
medicines or
uterotonic drugs, antibiotics) medicines/products to the
products
• Generic or brand names of woman, and any alternatives, and
medicines, mode of action, obtain consent
indications, routes, dosages, • Document and administer
frequency, side-effects, and appropriate medications in
complications and their line with national guidelines
management and protocols for BEmONC
• Calculation of dosages for (e.g. parenteral antibiotics,
different medicines postpartum haemorrhage
• Protocol for administering (PPH) medication, parenteral
medicines (oral, parenteral - anticonvulsants, etc.), including
subcutaneous, intramuscular, clear information about dosage,
intravenous) frequency and route
• Protocol for documentation of • Store medication/products safely
medication administered • Maintain infection prevention
• Infection prevention and waste and waste management
management protocols standards
• Monitor the woman’s response
to medication/product, including
any side-effects or reactions
• Identify and provide emergency
management of life-threatening
side effects of medicines ( e.g.
use of calcium gluconate)

CATEGORY 1: Cross-Functional Competencies for Midwifery Practice

ICM Essential Competencies 18
 Knowledge Skills & Behaviours

• Sexual and reproductive health • Support the implementation

1.p needs of refugees, migrants, and of the Minimum Initial Service
internally displaced people Package (MISP) for reproductive
• Maternal and newborn health health in humanitarian settings
Provide
needs of refugees, migrants and • Adapt clinical skills and protocols
midwifery care
internally displaced people to address health needs arising
for women and
• Global health disparities from specific climate disasters
newborns who
and challenges for specific (e.g. managing heat exhaustion
are affected by
populations in vulnerable and exposure to extreme heat;
humanitarian
situations nutrition; and portable fluid for
crises caused
• Disaster types and phases pregnant and breastfeeding
by natural
of a disaster (mitigation, mothers)
disasters,
preparedness, response, • Work creatively with limited
climate change,
recovery), and the impact on resources that may be further
pandemics, and
sexual, reproductive, maternal, strained by climate-related
human caused
newborn and adolescent health disasters
conflicts and
and rights • Adopt a flexible, adaptable
disasters
• Principles of humanitarian approach to navigating personal
action, neutrality, and and professional challenges
impartiality during times of crisis
• National and international • Provide support for lactation, and
strategies for providing sexual, safe newborn, infant and young
reproductive, maternal, newborn child feeding in crisis settings
and adolescent health services • Provide and promote respectful
during crises maternity care in humanitarian
• Impact of climate change on settings
sexual, reproductive, maternal, • Adapt clinical skills and protocols
newborn and adolescent health to address health needs in times
and rights of disasters
• Maternal and newborn health • Recognise and address the
risks (e.g. heatstroke, famine, specific mental health needs of
dehydration, etc.) associated with women and newborns affected by
climate disasters and crises humanitarian settings and crises
• The Minimum Initial Service (e.g. anxiety due to displacement
Package (MISP) for reproductive or loss of livelihood)
health in crises situations • Coordinate and collaborate with
• Respectful maternity care in other disaster response teams
humanitarian settings • Provide sexual and reproductive
• Midwives’ role in preparedness, health services in humanitarian
response, and recovery in settings
humanitarian settings
• The role of midwives in
mitigating and responding to
climate change

CATEGORY 1: Cross-Functional Competencies for Midwifery Practice

ICM Essential Competencies 19
CATEGORY 2
Sexual and Reproductive
Health and Rights
Competencies in this category are about the midwife’s
broader role in sexual and reproductive health care,
counselling and education, including contraception,
pre-conception and comprehensive abortion care. This
care is provided to women, adolescent girls and gender
diverse people midwives serve, but also to families and
communities, as identified in the ICM International
Definition and Scope of Practice of the Midwife.

Knowledge Skills & Behaviours

• Normal biological, psychological, • Support adolescents and women

2.a social, and cultural aspects to adopt healthy behaviours and
of sexual development, incorporate health promotion and
reproduction and early life the prevention of disease and
Provide • Definitions and awareness of injury
education on intersectionality for biological • Implement strategies to help
sexual and sex, sex characteristics, gender, adolescents and women at
reproductive gender assigned at birth, gender risk for unintended pregnancy
health, identity, gender expression, and their partners to choose
contraception sexual orientation appropriate contraceptive
and family • Socio-cultural aspects of human methods and help them
planning sexuality use methods correctly and
• Safe sexual practices, respectful consistently to prevent unwanted
relationships and risk factors for pregnancies
unsafe sexual practices • Provide unbiased education,
• Screening and detection of which incorporates evidence-
communicable and non- based medicine, including
communicable diseases (e.g. prevention of STIs (condoms,
malaria, HIV/AIDS, STIs, cervical HPV vaccine), LARCs (IUCDs,
or breast cancers and mental implants), side effects and
health issues managing side effects
• Health promotion (e.g. menstrual • Provide health information and
health and hygiene, how to advice tailored to individual
preserve fertility) and disease circumstances of adolescent
prevention girls, women and their families
• Prevention of communicable and • Ensure confidential care and
non-communicable diseases (e.g. obtain parent or guardian
STIs and HIV/AIDS) consent when minors are
• Pregnancy options for HIV involved and in accordance with
positive women or couples local laws for contraceptive
services

ICM Essential Competencies 20

 • Sexual and reproductive health
2.a and rights (SRHR) across the life-
course
• National/state/local laws
(continued) and regulations regarding
contraception and family
Provide
planning
education on
• Contraception methods
sexual and
(including natural, barrier,
reproductive
injectable, hormonal,
health,
implantable; intra-uterine
contraception
contraceptive devices (IUCD),
and family
emergency contraception,
planning
sterilisation); comparative
effectiveness, medical eligibility
criteria and contraindications,
risk of pregnancy, benefits,
their possible side effects and
conditions affecting their use
(medical, social, individual
circumstances)
• Available written and pictorial
resources, along with job
aids and anatomical models,
for effective teaching about
contraception and methods and
their demonstration
• Methods to effectively convey
sexual and reproductive health
information

CATEGORY 2: Sexual and Reproductive Health and Rights

ICM Essential Competencies 21
 Knowledge Skills & Behaviours

• Female and male reproductive • Confirm effectiveness/limitations

2.b anatomy and physiology of chosen method with the
• Menstrual cycle, changes in woman
symptoms (i.e. cervical mucus • Review method effectiveness,
Provide support and basal body temperature) benefits and risks with the
on natural family • Comparative effectiveness, risks woman
planning (NFP) and benefits of NFP and barrier • Provide counselling on NFP and
(24) and barrier methods barrier methods
methods (25) • Medical eligibility criteria for use • Explain to breastfeeding women
of natural NFP in breastfeeding when to seek an alternative
and non-breastfeeding women, method of contraception
and for each barrier method • Describe and demonstrate how to
• NFP and barrier methods, use the method, encouraging the
requirements and accessories, woman to demonstrate proper use
advantages and disadvantages of of the method using a model or
each herself
• Protocol for providing • Maintain infection prevention and
instructions/support for use of waste management standards
NFP and barrier methods
• Use of job aids and anatomic
models for demonstration of
methods
• Infection prevention and waste
management protocols
• Self-care instructions for the
woman (e.g. monitoring basal
temperature)

CATEGORY 2: Sexual and Reproductive Health and Rights

ICM Essential Competencies 22
 Knowledge Skills & Behaviours

• Female reproductive anatomy • Confirm the woman meets

2.c and physiology eligibility and obtain consent for
• Anatomy of the upper arm, the contraceptive method
including nerves and blood • Review method effectiveness,
Administer vessels benefits, risks side-effects,
contraceptives • Menstrual cycle, effect on the complications and their
within scope of menstrual cycle of different management with the woman
practice contraceptive methods • Describe how to use the method
• Contraception methods using job aids and demonstrate
(including natural, barrier, using an anatomical model
injectable, hormonal, • Verbally inform the woman of
implantable; intra-uterine the steps of the procedure, what
contraceptive devices (IUCD), to expect and ask for informed
emergency contraception, consent
sterilisation); comparative • Provide pain management as per
effectiveness, medical eligibility protocol
criteria and contraindications, • Prepare all supplies for the
risks (e.g. of pregnancy), benefits, procedure, check the integrity of
their possible side effects and the packaging and the expiration
conditions affecting their use dates of methods dispensed on
(medical, social, individual site
circumstances) • Provide contraceptives in
• Local protocols for each alignment with local laws and
contraceptive method protocols
• Use of job aids and models for • Counsel and refer the woman or
demonstration partner for sterilisation procedure
• Management of side-effects and to another provider
complications • Respond to side-effects and
• Emergency referral protocols complications and refer to other
• Infection prevention and waste professionals when necessary
management protocols • Provide counselling and follow-
• Self-care instructions for the up, support and answer any
woman questions relevant to the
concerns and complication during
contraceptive uses to prevent
unmet family planning needs
• Maintain infection prevention and
waste management standards
• Removal of intrauterine
contraceptive device and
contraception implant

CATEGORY 2: Sexual and Reproductive Health and Rights

ICM Essential Competencies 23
 Knowledge Skills & Behaviours

• Anatomy and physiology related • Identify and assist in reducing

2.d to sexual development and barriers related to accessing and
reproduction using sexual and reproductive
• Socio-cultural aspects of human health services
Provide sexuality • Assess health and risk factors
pre-conception • Health and nutrition for before conception
care pregnancy • Perform screening procedures for
• Pre-conception health screening sexually transmitted and other
and risk factors identification infections, HIV, cervical cancer
• Screening of women and their • Provide counselling about
partners for genetic history, nutritional supplements such
cancer of reproductive organs as iron and folic acid, dietary
and other health problems interventions, exercise, updating
such as diabetes, hypertension, immunisations as needed,
thyroid conditions, and modifying risk behaviours, and
chronic infections that impact prevention of sexually transmitted
conception and pregnancy infections, family planning and
• Screening and detection of methods of contraception
communicable and non- • Provide counselling on
communicable diseases (e.g. preconception care for women
malaria, HIV/AIDS, STIs, cervical with complex medical diseases,
or breast cancers and mental and/or history of previous
health issues terminations, miscarriages,
• Pregnancy options for HIV pregnancy loss and concealed
positive women or couples pregnancies
• Healthy Timing and Spacing of • Provide information and support
Pregnancies (HTSP) biological, emotional and social
• Planning pregnancy aspects for planning pregnancy

CATEGORY 2: Sexual and Reproductive Health and Rights

ICM Essential Competencies 24
 Knowledge Skills & Behaviours

• WHO guidelines on the care for • Provide information to all women

2.e gender-based violence (GBV) about sources of help regardless
survivors of whether there is disclosure
• Signs and symptoms from about violence
Care for girls individual history and • Inquire routinely about safety at
and women examination suggestive of risk home, at work, etc.
who experience for gender-based violence (GBV) • Create safe opportunities for
physical and female genital mutilation (FGM), the woman to disclose abuse/
sexual violence intimate partner violence (IPV) or violence
and abuse sexual violence • Recognise potential signs of
• Socio-cultural, behavioural, and abuse from physical appearance,
economic conditions that often emotional effect, and related risk
accompany violence and abuse behaviours such as substance
• Resources in community to abuse
counsel, manage and support • Provide special support for
individuals with sexual problems, adolescent girls and victims of
risk of GBV, FGM, IPV or sexual gender-based violence including
violence rape
• Impact of violence and • Ensure evidence is collected
abuse on the physical, social, in case the woman wants to
psychological, spiritual and prosecute
cultural wellbeing of women who • Ensure access to emergency
disclose violence contraceptives and PEP (post-
• Gender inequality and how this exposure prophylaxis)
influences gender-based violence
• Principles of confidentiality,
privacy and data security
• Signs of safe sexual practices
and risk factors for unsafe sexual
practices and for signs of GBV,
FGM, IPV or sexual violence
• Type and timing of testing and
treatment for sexual assault
survivors
• Legal responsibilities and duty of
care for midwives in identifying,
referring or reporting needs of
GBV, FGM, IPV or sexual violence
survivors

CATEGORY 2: Sexual and Reproductive Health and Rights

ICM Essential Competencies 25
 Knowledge Skills & Behaviours

• Complexity of decision-making • Confirm pregnancy and determine

2.f about unintended or mistimed gestational age; refer for
pregnancies ultrasound if unknown gestation
• Emergency contraception and/or symptoms of ectopic
Provide • Legal options for induced pregnancy
comprehensive abortion; eligibility and • Recognise the woman’s right
abortion care availability of medication and to decide for herself to have an
within local laws surgical abortion services abortion
• Abortion methods (including • Provide information and counsel
cervical preparation, medication the woman about options to
abortion, vacuum aspiration, maintain or end the pregnancy
dilatation and evacuation), and respect the ultimate decision
comparative effectiveness, • Recognise the emotional,
medical eligibility criteria and psychological and social support
contraindications, benefits and which may be needed by the
risks for each method woman and respond appropriately
• Medications used to induce • Provide supportive antenatal care
abortion; properties, effects and if woman decides to continue the
side effects pregnancy (e.g. refer to agencies,
• Risks of unsafe abortion and social services for support
• Contraception methods and assistance when needed)
appropriate for the post-abortion • Provide information about
period abortion methods (including
• Care and support (physical and cervical preparation, medication
psychological) needed during and abortion, vacuum aspiration,
after abortion dilatation and evacuation), their
• Management of side-effects and effectiveness, benefits, risks,
complications side-effects, complications and
• Emergency referral protocols their management, and when to
• Self-care instructions (e.g. seek help
monitoring vaginal discharge) • Provide information about laws
and regulations, eligibility, and
access to abortion services
• Identify from obstetric,
medical and social history,
contraindications to medication
or aspiration methods
• Verbally inform the woman of the
steps for using the self-managed/
administered medication abortion
method and what to expect
• Confirm the woman’s eligibility
and consent for the method,
including for emergency
contraception and post-abortion
family planning and contraceptive
method

CATEGORY 2: Sexual and Reproductive Health and Rights

ICM Essential Competencies 26
 • Provide abortion methods
2.f according to scope of practice
or refer for abortion procedure or
any further treatment that may
(continued) be required
• Manage complications and
Provide
implement referral when required
comprehensive
• Provide pre- and post-abortion
abortion care
care (e.g. confirm expulsion of
within local laws
products of conception from
history, ultrasound or levels of
HCG; remove retained products
of conception and implement
referral when required)
• Provide the woman (and where
appropriate her partner) with
education concerning her future
health, including contraception
and planning for future
pregnancy
• Assess psychological response to
abortion and refer when required
• Prescribe, dispense and
administer medicines or
products according to local
protocols
• Provide pain management

CATEGORY 2: Sexual and Reproductive Health and Rights

ICM Essential Competencies 27
CATEGORY 3

Antenatal Care
Competencies in this category are about health
assessment of the woman and fetus, promotion of
health and wellbeing, detection of complications
during pregnancy, and care of women with an
unexpected pregnancy.

Knowledge Skills & Behaviours

• Basic anatomy and physiology • Confirm pregnancy and estimate

related to reproduction and gestational age from history,
3.a embryology physical exam, laboratory test
• Reproductive cycle and stages of and/or ultrasound
Determine health development • Obtain a comprehensive health
status of women • Physiology of menstrual and history (including emotional/
and assess ovulatory cycle mental health assessment)
pregnancy • Signs and symptoms of pregnancy • Determine if the pregnancy is
• Risk factors associated with planned and address any related
pregnancy (e.g. ectopic pregnancy, concerns
anaemia, STIs, genetic factors, • Perform a complete physical
lifestyle and environmental risks, examination
etc.) • Explain the use of laboratory
• Maternal mental health risks and tests, ultrasound diagnostic tests
early diagnosis or procedures that are indicated
• Components of a comprehensive by the woman’s history and
health history including psycho- examination, including risks and
social responses to pregnancy benefits
• Components of complete physical • Obtain samples for laboratory
exam tests (e.g. venepuncture, finger
• Screening tests and normal puncture, urine samples, and
parameters vaginal swabs)
• Collecting laboratory specimens • Determine whether there are
(including how to prepare the indications for additional
woman) and performing indicated assessment/examination and
tests, including ultrasound refer if abnormalities or variations
examinations from normal are detected
• Health conditions including • Provide information about
infections and genetic conditions conditions that may be detected
detected by screening blood and by screening (e.g. non-invasive
biologic samples prenatal test (NIPT)) and support
• Clinical indications and conditions ethical thinking and decision
for abdominal and pelvic/vaginal making
ultrasound examinations • Discuss findings and potential
• Standards for Rhesus (Rh) implications with the woman and
testing and administration of Rh- mutually determine plan of care
immunoglobulin

ICM Essential Competencies 28

 Knowledge Skills & Behaviours

• Placental physiology, embryology, • Use tools and technologies

3.b fetal growth and development, within scope of practice to
and indicators of fetal wellbeing assess fetal wellbeing (e.g. pinard
(including multiple pregnancies) stethoscope, doppler ultrasound,
Assess fetal
• Fetal movement patterns cardiotocography (CTG), (AI-
wellbeing
• Complications and referral assisted) ultrasound scan)
policies • Assess fetal size, amniotic fluid
• Evidence-based guidelines volume, fetal position, activity,
for use of technologies within and heart rate through physical
scope of practice to assess examination of the maternal
fetal wellbeing (e.g. pinard abdomen (including multiple
stethoscope, doppler ultrasound, pregnancies) or ultrasound if
cardiotocography (CTG), (AI- available and/or indicated
assisted) ultrasound scan) • Determine whether there are
indications for additional
assessment/examination
and refer if abnormalities or
variations from normal are
detected
• Assess fetal movements and
educate women on normal
patterns of movement and when
to seek help

CATEGORY 3: Antenatal Care

ICM Essential Competencies 29
 Knowledge Skills & Behaviours

• Anatomical and physiological • Use tools and technologies within

3.c changes with advancing scope of practice to monitor and
pregnancy assess progression of pregnancy
• Nutritional requirements of • Perform abdominal palpation and
Monitor
pregnancy measure fundal height
and assess
• Common physiological responses • Provide information regarding
progression of
to pregnancy and symptoms of physiological (normal) progress
pregnancy
mental health distress of pregnancy to the woman, her
• Evidence informed antenatal care partner, family members, or other
policies and guidelines, including support persons, including those
frequency of antenatal visits related to fetal movements
• Pregnancy related complications • Use evidence-based information
and high-risk pregnancies to suggest measures to cope
• Referral policies for pregnancy with common discomforts of
related complications and high- pregnancy
risk pregnancies • Provide evidence-based
information (including written,
digital and/or pictorial) about
danger signs, (e.g. vaginal
bleeding, signs of preterm labour,
prelabour rupture of membranes,
changed fetal movements),
emergency preparedness, and
when and where to seek help
• Identify early onset of pregnancy-
related complications and
intervene, consult and refer as
appropriate
• Provide emergency services in
first and second level of care and
refer when appropriate (EmONC)
• Review findings and revise
plan of care with the woman as
pregnancy progresses
• Refer when required

CATEGORY 3: Antenatal Care

ICM Essential Competencies 30
 Knowledge Skills & Behaviours

• Impact of adverse social, • Provide emotional support to

3.d environmental, and economic women to encourage change in
conditions on maternal-fetal health behaviour
health • Provide information to the
Promote and
• Effects of inadequate nutrition woman and family about impact
support health
and heavy physical work on mother and fetus of risk
behaviours
• Effects of tobacco use and conditions
that improve
exposure to second-hand smoke, • Counsel women about and offer
wellbeing
use of alcohol, vaping, chewed referral to appropriate persons or
tobaccos and addictive drugs agencies for assistance
• Effects of prescribed medications • Respect women’s decisions
on fetus about participating in treatments
• Community resources for income and programmes
support, food access, and • Make recommendations and
programmes to minimize risks of identify resources for smoking
substance abuse reduction/cessation in pregnancy
• Strategies to prevent or reduce • Refer to relevant organisations to
risks of mother-to-child disease provide additional support and
transmission including newborn care
and infant feeding options for HIV
infection
• Effects of gender-based violence,
emotional abuse, and physical
neglect
• Referral agencies for additional
support

CATEGORY 3: Antenatal Care

ICM Essential Competencies 31
 Knowledge Skills & Behaviours

• Needs of women and families for • Participate in—and refer women

3.e different information at different and support persons to—
times in their respective life childbirth education programmes
cycles • Convey information accurately
Provide
• Methods of providing information and clearly and respond to needs
anticipatory
to women and groups of women
guidance
• Methods of eliciting maternal • Inform and prepare the woman,
related to
feelings and expectations for self, partner, and family to recognise
pregnancy, birth,
newborn, and family labour onset, when to seek care,
breastfeeding,
• Physiology of lactation and and progress of labour
parenthood, and
breastfeeding • Provide information on sexuality
change in the
• Preparing for parenthood, and intimate relationships after
family
emphasising the emotional, birth and during postpartum
psychological, social and including contraception needs
financial changes • Encourage breastfeeding for
newborn and infant health
• Provide information about care of
newborns and who to refer to in
case of concerns or problems
• Identify needs or problems
requiring further expertise
or referral such as perinatal
mental health problems and
dysfunctional relationships
• Provide guidance for women with
known fetal complexities within
the multidisciplinary team

CATEGORY 3: Antenatal Care

ICM Essential Competencies 32
 Knowledge Skills & Behaviours

• Complications of early pregnancy • Deliver life-saving skills to

3.f such as threatened or actual manage complications and
miscarriage, and ectopic stabilise in emergencies before
pregnancy timely referral for treatment as
Detect, stabilise,
• Fetal compromise, growth necessary
manage, and
restriction, malposition, preterm • Counsel and continue to care for
refer women
labour women with complications as
with complicated
• Diseases and medications part of the team
pregnancies
before pregnancy and their effect • Implement critical care
on pregnancy and foetus (e.g. activities to support vital body
diabetes, neurological diseases functions (e.g. intravenous (IV)
such as migraine, epilepsy, fluids, magnesium sulphate,
autoimmune diseases, blood antihaemorrhagics)
diseases, etc.) • Prepare the blood transfusion
• Signs and symptoms of maternal procedure and mobilise blood
pathologic conditions such donors if necessary
as pre-eclampsia, gestational • Stabilise and transfer to higher
diabetes, hypertensive disorders level facility if needed
and other systemic illnesses
• Signs of acute emergencies such
as haemorrhage, seizure, and
sepsis
• Provide emergency services in
first and second level of care and
refer when appropriate (EmONC)
• Signs and symptoms of perinatal
mental health conditions

CATEGORY 3: Antenatal Care

ICM Essential Competencies 33
 Knowledge Skills & Behaviours

• Evidence about birth outcomes in • Inform and discuss available

3.g different birthplace settings options, preferences and
• Availability of options in specific contingency plans with each
location, limitations of climate, woman and partner, support the
Assist the
geography, means of transport, right of choice and respect their
woman and her
and resources available in decision
family to plan for
facilities • Inform women about her right to
birth
• Local policies and guidelines be accompanied during labour
• Women’s rights and respectful and birth by a person of her
maternity care principles choice
• Birth planning • Support the woman in developing
a birth plan
• Provide information about
preparing birth site if in
community or home and discuss
preparation for travel to identified
facility if transfer required
• Share evidence-based knowledge
around place of birth options
and outcomes and promote the
availability of a full range of birth
settings
• Support women to make
informed choices regarding place
and position for birth
• Provide respectful care and
uphold women’s rights

CATEGORY 3: Antenatal Care

ICM Essential Competencies 34
CATEGORY 4
Care During
Labour and Birth
Competencies in this category are about
assessment and care of women during labour that
facilitate physiological processes and a safe birth,
the immediate care of the newborn, detection of
complications in mother or newborn, stabilisation
of emergencies, and referral as needed.

Knowledge Skills & Behaviours

• Anatomy of maternal pelvis and • Provide care for a woman in

4.a fetus; mechanisms of labour for the birth setting of her choice,
different fetal presentations following evidence-based practice
• Physiological onset and • Obtain relevant obstetric and
Promote normal/ progression of labour medical history
physiological • Evidence informed intrapartum • Perform and interpret focused
labour and birth care policies and guidelines, physical examination of the
including avoidance of routine woman and fetus
interventions in normal labour • Order and interpret laboratory
and birth tests if needed
• Physical, emotional and • Use tools and technologies for
psychological support in labour intermittent or continuous (if
• Cultural norms related to labour required because of labour status)
and birth monitoring of fetal wellbeing
• Signs and behaviours of labour (e.g. pinard stethoscope, doppler
progress; factors that impede ultrasound, CTG monitoring)
labour progress • Assess the woman’s physical and
• Tools for monitoring progress of behavioural responses to labour
labour (e.g. partograph) • Provide information, support, and
• Methods of assessing fetus encouragement to the woman
during labour and support persons throughout
• Pain management labour and birth
• Provide respectful one-to-one care
and facilitate shared decision
making with women
• Offer a companion of choice for
all women throughout labour and
childbirth
• Encourage freedom of movement
and birthing positions

ICM Essential Competencies 35

 • Provide nourishment and fluids
4.a • Offer and support the woman
to use strategies for coping
with labour pain, e.g. controlled
(continued) breathing, water immersion,
Promote normal/ relaxation, massage,
physiological acupressure, position changes,
labour and birth movement and pharmacologic
modalities when needed
• Regularly assess parameters of
maternal-fetal status, and e.g.
vital signs, contractions, cervical
changes and fetal descent
• Use labour progress graphic
display (e.g. partograph) to record
findings and assist in detecting
complications
• Augment uterine contractility
judiciously using non-
pharmacological or
pharmacological agents to
prevent non-progressive labour
• Prevent unnecessary routine
interventions, (e.g. amniotomy,
CTG monitoring, directed closed
glottis pushing, episiotomy)

CATEGORY 4: Care During Labour and Birth

ICM Essential Competencies 36
 Knowledge Skills & Behaviours

• Physiology and process of safe, • Support the woman to give birth

4.b spontaneous vaginal birth. in her position of choice
• Evidence about conduct of • Offer a companion of choice for
third stage, including use of all women throughout labour and
Manage a safe, uterotonics childbirth
spontaneous • Scoring systems to assess • Ensure clean environment,
vaginal birth, maternal status (e.g. Modified presence of clean necessary
prevent and Early Obstetric Warning Scores supplies and source of warmth
manage (MEOWS) and newborn charts • Coach the woman about pushing
complications (Newborn Early Warning Scores to control expulsion of presenting
(NEWS)) part, avoid routine episiotomy
• Pathology and signs of • Undertake appropriate
complications and their manoeuvres, use maternal
immediate treatment (e.g. position to facilitate vertex,
prolonged/obstructed labour, occipito-posterior, occipito-
shoulder dystocia, excessive transverse or breech birth
bleeding, fetal compromise, • Assist vaginal birth via vacuum
eclampsia, placental separation, extraction, noting local
retained placenta) regulations
• Management of emergencies • Expedite birth in presence of fetal
as covered in emergency skills distress
training programmes such as • Provide optimal cord clamping
BEmONC , Helping Mothers depending on condition of
Survive (HMS), Helping Babies newborn
Survive (HBS) • Manage nuchal cord
• Appearance of normal placenta, • Assess immediate condition of
membranes and umbilical cord newborn
• Types of perineal and vaginal • Provide skin to skin contact and
trauma requiring repair and warm environment
suturing techniques • Deliver placenta and membranes
and inspect for completeness
• Assess uterine tone, maintain
firm contraction, and estimate
and record maternal blood loss;
manage excessive blood loss
including administration of
uterotonic drugs and manual
removal of the placenta noting
local policies, guidelines and
regulatory authorities
• Inspect vaginal and perineal
areas for trauma, and repair as
needed, following local policies
and protocols
• Educate women on danger signs
after birth
• Refer to specialist for continuing
treatment of any complications
as needed

CATEGORY 4: Care During Labour and Birth

ICM Essential Competencies 37
 Knowledge Skills & Behaviours

• Anatomical and physiological • Promote family-centred care

transition to extra-uterine including birth companion in
4.c environment delivery room and involvement
• Scoring systems to assess of mother and families in care of
Provide care of newborn status including small and sick newborn care
the newborn assessment of newborns with • Use standardised method to
immediately different skin colours (APGAR assess newborn condition in the
after birth scores and Newborn Early first minutes of life (APGAR scores
Warning Scores (NEWS)) and NEWS) and refer if needed
• Pathology in the newborn • Start breastfeeding immediately
and signs indicating need after birth
for immediate actions • Distinguish normal variation
to assist transition (e.g. in newborn appearance and
infectious diseases, congenital behaviour from those indicating
abnormalities, hypoglycaemia, pathologic conditions
jaundice, etc.) • Provide actions to establish
• Interventions to establish and support breathing and
breathing and circulation as oxygenation (e.g. neonatal
covered in Essential Newborn resuscitation with bag and mask),
Care programmes (e.g. HBS, continuous positive airway
BEmONC/CEmONC) pressure (CPAP), refer to specialist
• Appearance and behaviour of for continuing treatment as
healthy newborns needed
• Needs of small for gestational • Provide a safe, warm environment
age, low and high birth weight for initiating early breastfeeding
newborns and attachment (bonding,
• Preterm guidelines and continuous skin-to-skin) in the
(Immediate) Kangaroo Mother first hour of life
Care (IKMC and KMC) for preterm • Practise zero separation of
and low birth weight newborns mother and baby in birthing room,
• Family-centred model of care operating theatre and post-natal
wards
• Initiate IKMC and KMC for preterm
and low birth weight babies
• Conduct a complete physical
examination of newborn in
presence of mother/family;
explain findings and expected
changes e.g. colour of extremities,
moulding of head. Refer to
specialist for abnormal findings
• Institute newborn prophylaxis
e.g. ophthalmic infection and
haemorrhagic disease, according
to local policies and guidelines
• Promote care by mother, frequent
feeding and close observation
• Involve partner/support persons
in providing newborn care and
pay attention to parent-newborn
interaction
• Support mother-baby dyad during
transfers or referrals

CATEGORY 4: Care During Labour and Birth

ICM Essential Competencies 38
CATEGORY 5
Ongoing Care of
Women and Newborns
Competencies in this category address the
continuing health assessment of women
and newborns, health education, support for
breastfeeding, detection of complications,
stabilisation and referral in emergencies, and
provision of family planning services.

Knowledge Skills & Behaviours

• Physiological changes following • Review history of pregnancy,

birth, uterine involution, onset labour, and birth of women
5.a of lactation, healing of perineal- • Conduct a focused physical
vaginal tissues exam to assess breast changes
Provide • Common discomforts of the and involution of the uterus.
postnatal care postnatal period and comfort Monitor blood loss and other body
for the healthy measures functions and act when signs are
woman • Need for rest, support, and abnormal
nutrition to support lactation • Assess breastfeeding technique
• Psychological responses to and provide ongoing support
mothering role, addition of • Promote bonding between mother
newborn to the family and newborn
• Postnatal family planning • Assess maternal mental health
• Maternal mental health and feelings about motherhood
and demands of newborn care
• Assess social circumstances and
possible need for support
• Provide perinatal and maternal
mental health care
• Provide pain control strategies if
needed for uterine contractions,
and perineal trauma
• Provide information about self-
care that enables mother to meet
needs of newborn, e.g. adequate
food, nutritional supplements,
usual activities, rest periods and
household help
• Provide respectful counselling
about sexuality and intimate
relationships, safe sex,
contraception methods
appropriate for the immediate
postnatal period, and pregnancy
spacing
• Provide contraception in postnatal
period

ICM Essential Competencies 39

 Knowledge Skills & Behaviours

• Appearance and behaviour of • Examine newborn at interval

5.b newborns in early life; cardio- determined by local policy
respiratory changes related to and guidelines to monitor
adapting to extra-uterine life and document growth and
Provide care • Concepts of Kangaroo Mother developmental behaviour
to healthy Care (KMC) • Distinguish normal variation
newborns • Growth and development in in newborn appearance and
initial weeks and months of life behaviour from those indicating
(early child development (ECD), or pathologic conditions
the first 1000 days of life) • Provide respectful Early Essential
• Protocols for screening for Newborn Care, identify danger
metabolic conditions, infectious signs of newborn and provide
conditions, and congenital care and referral as needed
abnormalities • Provide Kangaroo Mother Care
• Protocols/guidelines for (KMC) as required
immunisations in infancy • Administer immunisations, carry
• Evidence-based information out screening test as indicated
about infant circumcision; family • Provide information to parents
values, beliefs, and cultural about a safe environment for
norms newborns, frequent feeding
to prevent jaundice, care of
umbilical cord, routine eye care,
voiding and stooling, close
physical contact, and safe
sleeping practices

CATEGORY 5: Ongoing Care of Women and Newborns

ICM Essential Competencies 40
 Knowledge Skills & Behaviours

• Physiology of lactation • Promote early initiation and

5.c • Nutritional needs of newborns, exclusive breastfeeding during
including low birth weight first 6 months, and continued
newborns breastfeeding alongside
Promote • Social, psychological, and complementary foods for two
and support cultural aspects of breastfeeding years or longer, while being
breastfeeding • Indications and sensitive to the woman’s
contraindications to use of drugs individual needs and respecting
and substances during lactation the woman’s goals regarding
• Awareness of lactation aids newborn feeding
• Breastfeeding-friendly • Provide information about
regulations and policies (UNICEF, newbornneeds, frequency and
BFHI, WHO International Code duration of feedings, and weight
of Marketing of Breast-milk gain
Substitutes) • Provide support and information
about breastfeeding for a
minimum of six months,
including combining with paid
employment, maintaining milk
supply, and storing breast milk
• Identify and manage
breastfeeding problems (e.g.
mastitis, low milk supply,
engorgement, poor latch)
• Provide information to women
breastfeeding multiple newborns
• Provide support to non-
breastfeeding women
• Provide support to women with
HIV/STIs for breastfeeding and
newborn feeding
• Refer women to breastfeeding
support as indicated
• Advocate for breastfeeding in
family and community

CATEGORY 5: Ongoing Care of Women and Newborns

ICM Essential Competencies 41
 Knowledge Skills & Behaviours

• Signs and symptoms of: • Provide information to the

5.d woman and family about signs
• conditions in postnatal peri-
of wellbeing and normal healing,
od that may respond to early
potential complications and
intervention (e.g. sub-involu-
Detect, treat, when to seek help
tion, anaemia, urinary reten-
and stabilise • Assess the woman during
tion, and localised infection)
postnatal postnatal period to detect signs
• complications that need
complications in and symptoms of complications
referral to more specialised
women and refer • Counsel for mood disorders,
provider or facility (e.g. hae-
as necessary distinguish postnatal depression
matoma, thrombophlebitis,
from transient anxiety about
sepsis, obstetric fistula, and
caring for newborn, assess
incontinence)
availability of help and support
• life-threatening complica-
at home, and provide emotional
tions requiring immediate re-
support
sponse and specialised care
• Provide counselling and follow-
(haemorrhage, amniotic fluid
up care for women and family
embolus, seizure and stroke)
members who experience
• Signs and symptoms of post- stillbirth, neonatal death, serious
natal depression, anxiety and newborn illness and congenital
psychosis conditions
• Mourning process following • Provide first level measures
perinatal death to treat or stabilise identified
• Referral policies conditions
• Provide emergency services in
first and second level care and
refer when appropriate (EmONC)
• Arrange referral and/or transfer
as needed

CATEGORY 5: Ongoing Care of Women and Newborns

ICM Essential Competencies 42
 Knowledge Skills & Behaviours

• Healthy newborn, expected • Provide information to the

5.e weight gain and behaviour woman and family about
• Congenital anomalies, genetic potential complications and
conditions and pathological when to seek help
Detect, stabilise, jaundice • Assess newborn health and
and manage • Needs of pre-term and low birth development during postnatal
health problems weight newborns, needs of large period to detect signs and
in newbornsand for gestational age and high birth symptoms of complications (e.g.
refer if weight newborns respiratory distress, neonatal
necessary • Symptoms and treatment of encephalopathy)
withdrawal from maternal drug • Provide first line measures
use to treat or stabilise identified
• Vertical transmission of conditions
infections such as HIV, hepatitis • Prevent vertical transmission of
B and C infections such as HIV, hepatitis
• Signs and symptoms of B and C
common health problems and • Provide emergency services in
complications; their immediate first and second level care and
and ongoing treatment refer when appropriate (EmONC)
• Arrange referral and/or transfer
as needed

CATEGORY 5: Ongoing Care of Women and Newborns

ICM Essential Competencies 43
Recommended Reading
• International Confederation of Midwives, 2024. International Definition and Scope of Practice of the
Midwife: https://internationalmidwives.org/resources/international-definition-of-the-midwife/

• International Confederation of Midwives, 2014. Philosophy and Model of Midwifery Care: https://inter-
nationalmidwives.org/resources/philosophy-and-model-of-midwifery-care/

• International Confederation of Midwives, 2014.International Code of Ethics for Midwives: https://in-

ternationalmidwives.org/resources/international-code-of-ethics-for-midwives/

• World Health Organization, 2022. Guideline on self-care interventions for health and well-being:
https://www.who.int/publications/i/item/9789240052192

• World Health Organization, 2022. Global Competency and Outcomes Framework for Universal Health
Coverage: https://iris.who.int/bitstream/handle/10665/352711/9789240034662-%20eng.pdf?se-
quence=1

• World Health Organization, 2021. WHO labour care guide: user’s manual: https://www.who.int/publi-
cations/i/item/9789240017566

• World Health Organization, 2016. WHO Recommendations on Antenatal Care for a Positive Pregnancy
Experience: https://www.who.int/publications/i/item/9789241549912

• World Health Organization, 2022. Family planning and comprehensive abortion care toolkit for the
primary health care workforce. Volume 1: https://www.who.int/publications/i/item/9789240063884

• World Health Organization, 2022. WHO recommendations on maternal and newborn care for a posi-
tive postnatal experience: https://www.who.int/publications/i/item/9789240045989

• World Health Organization, 2015. Medical Eligibility Criteria for Contraceptive Use, 5th ed: https://
www.who.int/publications/i/item/9789241549158

• World Health Organization, 2016. Selected Practice Recommendations for Contraceptive Use, 3rd ed:
https://www.who.int/publications/i/item/9789241565400

• World Health Organization, 2016. WHO recommendations on antenatal care for a positive pregnancy
experience: https://www.who.int/publications/i/item/WHO-RHR-18.02

• World Health Organization, 2017. Managing Complications in Pregnancy and Childbirth: A Guide for
Midwives and Doctors. 2nd ed: https://www.who.int/publications/i/item/9789241565493

• World Health Organization, 2017. Quality of Care in Contraceptive Information and Services, based on
Human Rights Standards: A Checklist for Health Care Providers: https://www.who.int/publications/i/
item/9789241512091

• World Health Organization Department of Reproductive Health and Research (WHO/RHR) and Johns
Hopkins Bloomberg School of Public Health/Center for Communication Programs (CCP), 2022.
Knowledge for Health Project. Family Planning: A Global Handbook for Providers: https://www.who.
int/publications/i/item/9780999203705

• World Health Organization, 2018. WHO recommendations: intrapartum care for a positive childbirth
experience: https://www.who.int/publications/i/item/9789241550215

• World Health Organization, 2022. Launch of Essential Childbirth Care Course of the Interprofession-

ICM Essential Competencies 44

 al Midwifery Education Toolkit: https://www.qualityofcarenetwork.org/sites/default/files/2022-09/
Launch%20of%20the%20Essential%20Childbirth%20Care%20Course%20-%2027%20April%202022.
pdf

• WHO, UNICEF, UNFPA, AMDD, 2009. Monitoring emergency obstetric care: a handbook: https://books.
google.be/books?hl=nl&lr=&id=oig4bwOXXeIC&oi=fnd&pg=PP2&ots=tzc1mE1wKb&sig=btg74Y-
iMa1TwBq26AupTuu0HfYo&redir_esc=y#v=onepage&q&f=false

• United Nations, ND. Sustainable Development Goals: https://sdgs.un.org/goals

• Women’s Refugee Commission, ND. Minimum Initial Service Package (MISP) for Reproductive Health
in Crisis Situations: https://www.unhcr.org/sites/default/files/legacy-pdf/4e8d6b3b14.pdf

• Inter-Agency Working Group on Reproductive Health Crisis, 2022. Approaching Implementation of

Respectful Maternity Care in Humanitarian Settings: https://iawg.net/resources/approaching-imple-
mentation-of-respectful-maternity-care-in-humanitarian-settings

• United Nations Population Fund, 2022. Minimum Initial Service Package (MISP) for SRH in Crisis
Situations: https://www.unfpa.org/resources/minimum-initial-service-package-misp-srh-crisis-sit-
uations

• Inter-Agency Working Group on Reproductive Health Crisis, 2023. Basic Emergency Obstetric and
Newborn Care (BEmONC) in Crisis Settings, Select Signal Functions: https://iawg.net/resources/ba-
sic-emergency-obstetric-and-newborn-care-bemonc-in-crisis-settings-select-signal-functions

• Barrowclough J, Kool B, Crowther C. Fetal malposition in labour and health outcomes for women
and their newborn infants: A retrospective cohort study. PloS One. 2022 Oct 19;17(10):e0276406. Doi:
10.1371/journal.pone.0276406. PMID: 36260647; PMCID: PMC9581354.

ICM Essential Competencies 45

Endnotes / References
(1) International Confederation of Midwives. (2023). ICM International Definition and Scope of Practice
of the Midwife [online]. Available from: https://internationalmidwives.org/resources/international-
definition-of-the-midwife/

(2) Butler et al. (2017). Update of the International Confederation of Midwives’ Essential Competencies
for Basic Midwifery Practice. Draft Final Report. Internal ICM Report. Unpublished, p. 2.

(3) Introduction – WHO guideline on self-care interventions for health and well-being, 2022 revision –
NCBI Bookshelf (nih.gov) https://www.who.int/publications/i/item/WHO-SRH-21.21

(4) WHO Global Competency and Outcomes Framework for Universal Health Coverage; https://iris.who.
int/bitstream/handle/10665/352711/9789240034662- eng.pdf?sequence=1

(5) WHO labour care guide: user’s manual. Geneva: World Health Organization; 2020. Licence: CC BY-NC-
SA 3.0 IGO (https://www.who.int/publications/i/item/9789240017566)

(6) World Health Organization. (2016). WHO Recommendations: Antenatal Care for a Positive Pregnancy
Experience. Geneva: World Health Organization.

(7) Family planning and comprehensive abortion care toolkit for the primary health care workforce.
Volume 1. Competencies. Geneva: World Health Organization; 2022. Licence: CC BY-NC-SA 3.0 IGO.

(8) WHO recommendations on maternal and newborn care for a positive postnatal experience.
Geneva: World Health Organization; 2022. Licence: CC BY-NC-SA 3.0 IGO (https://www.who.int/
publications/i/item/9789240045989)

(9) World Health Organization. (2015). Medical Eligibility Criteria for Contraceptive Use. 5th ed. Geneva:
World Health Organization.

(10) World Health Organization (https://srhr.dspace express.com/server/api/core/bitstreams/c4511841-

27cd-4779-bd3c-5bb740c84961/content)
https://www.who.int/health-topics/water-sanitation-and-hygiene-wash#tab=tab_1

(11) World Health Organization. (2017). Quality of Care in Contraceptive Information and Services, based
on Human Rights Standards: A Checklist for Health Care Providers. Geneva: World Health Organization.

(12) Noncommunicable diseases (NCDs), also known as chronic diseases, tend to be of long duration
and are the result of a combination of genetic, physiological, environmental and behavioural factors.
https://www.who.int/news-room/fact-sheets/detail/noncommunicable-disease World Health
Organization. (2017).

(13) World Health Organization Department of Reproductive Health and Research (WHO/RHR) and
Johns Hopkins Bloomberg School of Public Health/Center for Communication Programs (CCP). (2018).
Knowledge for Health Project. Family Planning: A Global Handbook for Providers.

(14) WHO recommendations: Intrapartum care for a positive childbirth experience. Geneva: World
Health Organization; 2018. Licence: CC BY-NC-SA 3.0 IGO. (https://www.who.int/publications/i/
item/9789241550215

ICM Essential Competencies 46

(15) World Health Organization (2022). Essential Childbirth Care Course of the Interprofessional
Midwifery Education Toolkit (https://www.qualityofcarenetwork.org/sites/default/files/2022-09/
Launch%20of%20the%20Essential%20Childbirth%20Care%20Course%20-%2027%20April%202022.pdf
https://www.who.int/tools/essential-newborn-care-training-course; Helping Babies Survive (aap.org)

(16) WHO, UNICEF, UNFPA, AMDD. Monitoring emergency obstetric care: a

handbook. Geneva: World Health Organization; 2009. https://books.google.be/
books?hl=nl&lr=&id=oig4bwOXXeIC&oi=fnd&pg=PP2&ots=tzc1mE1wKb&sig=btg74YiMa1TwBq26
AupTuu0HfYo&redir_esc=y#v=onepage&q&f=false

(17) International Confederation of Midwives. ICM Position Statements [online]. Available from: https://
internationalmidwives.org/resources/?search=position+statements (retrieved May 12, 2024)

(18) Michelle M Butler, Judith Fullerton, Cheryl Aman (with the support of BMW students Melanie
Dowler, Tobi Reid, and Caitlin Frame). Update of the International Confederation of Midwives’ Essential
Competencies for Basic Midwifery Practice: Final (DRAFT) Report. Vancouver: UBC Midwifery Program.
April 2017.

(19) Michelle Butler, Judith Fullerton, Mary Barger, Carol Nelson, Camilla Schneck, Marianne
Nieuwenhuijze, Rita Borg-Xuereb (ICM Board Member), Rafat Jan (ICM Board Member), Atf Gherissi,
Lorena Binfa, Mizuki Takegata, Caroline Homer. Update of the International Confederation of Midwives’
Essential Competencies for Basic Midwifery Practice: Final (DRAFT) Report. Vancouver: UBC Midwifery
Program. April 2017.

(20) Jim Campbell (Director and Executive Director of the Global Health Workforce Alliance), Fran
McConville (WHO – Maternal & Child Health Committee), Gloria Metcalfe (Jhpiego MNH consultant),
Gerard Visser (Chair FIGO Safe Motherhood Committee), Petra ten Hoope-Bender (UNFPA), Sarah Williams
(Save the Children), Joeri Vermeulen (Secretary European Midwifery Association), Kimberley Pekin
(NARM & MANA), Joy Lawn (Paediatrician), Sarah Moxon (Neonatal Nurse). Update of the International
Confederation of Midwives’ Essential Competencies for Basic Midwifery Practice: Final (DRAFT) Report.
Vancouver: UBC Midwifery Program. April 2017.

(21) Carolyn Levy, Blank Design and Project Management, Vancouver, Canada.

(22) Karyn Kaufman, retired Professor and Head of Midwifery, McMaster University, Hamilton, Canada;
Professor Emeritus, McMaster University

(23) Adapted from the UK Network of Professors of Midwifery and Maternal and Newborn Health, Position
Statement: Use of sexed language in relation to women’s reproductive health, May 2023.

(24) Natural Family Planning include fertility awareness-based (FAB) methods, lactational amenorrhoea method
(LAM) and coitus interruptus/withdrawal. FAB methods “involve identification of the fertile days of the menstrual
cycle, whether by observing fertility signs such as cervical secretions and basal body temperature (i.e. symptoms-
based methods) or by monitoring cycle days (calendar-based methods).

(25) Barrier methods: e.g. male and female condoms, spermicide, sponge, diaphragm, cervical cap

ICM Essential Competencies 47