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Citation

Strachan H, Cheyne H, Cameron D & Maxwell M (2021) A rapid review exploring levels of midwifery practice roles beyond the point of registration, their clinical outcomes, benefits and disadvantages in countries with comparable midwifery qualifications at point of registration to the UK.. Scottish Government Chief Nurse's Office.

Abstract
AIM: To explore roles, outcomes, benefits or disadvantages of levels of midwifery practice which exist beyond the point of registration in countries with comparable midwifery qualifications to the UK. METHOD: A rapid review of the literature searching databases CINAL, MEDLINE, Health Source and Cochrane Central, from 2005-2020, both qualitative and quantitative studies, in English. RESULTS: Forty three articles, reporting unique data from 35 studies, met the inclusion criteria. One country, The Republic of Ireland, was found to have Advanced Midwifery Practitioners registered with their regulatory body. FINDINGS: Levels of midwifery practice beyond the point of registration lacked clarity with a variety of titles, roles and scope of practice in existence. It was difficult to identify what constitutes a specialist midwifery role or extended midwifery practice and what distinguishes advanced or consultant midwife roles. There was limited evidence of outcomes, benefits or disadvantages of levels of midwifery practice beyond the point of registration, although what evidence exists was positive. Roles of midwife specialists, practitioners or midwives with extended levels of practice related to specific health conditions, interventions or client groups. Advanced or Consultant midwives dealt with greater complexity whilst still focusing on physiological pregnancy and birth. Education for advanced midwifery roles was mostly at master’s level whereas specialist’s midwifery roles extended their skills through supervised practice. There was some evidence that midwives can safely perform extended roles when compared to a doctor’s performance or the best evidence. Additionally, these extended roles may improve: women’s access, choice and experience of maternity services and midwifery leadership. Midwives benefit from greater job satisfaction but disadvantages are increased workload and lack of support or continuous professional development. CONCLUSION: Midwives can extend their roles beyond the level of practice at the point of registration, safely and effectively. However, consideration needs to be given to the rationale for extended midwifery roles to ensure they benefit the quality of maternity care for women and avoid simply transferring tasks from doctors to midwives and a resulting increased in midwives workload. Additionally, many of these extended roles could be considered advancing midwifery practice rather than advanced midwifery practice. Clarity of the conceptualisation of midwifery beyond the level of practice at the point of registration is required particularly in recognition that midwives already practice autonomously at the point of registration and may already be considered to be working at the level of a specialists. Given that these extended roles improve job satisfaction would suggest a career structure is important to attract aspiring midwives and retain experience midwives. In addition, advanced midwives could provide the leadership to influence the quality of care and advance the practice of midwifery itself.