The global challenge in reproductive health issues; Lesson learnt for a developed country: Japan
Recently, we are facing women‘s later age of marriage and thus older age for first birth, declining birthrate and increasing aging population, increasing technology in medical care, and advancing reproductive techniques., The field of perinatal medicine is also changing. At first, we thought there must be a practical guideline, which midwives can follow, in these changing times, in order to provide safe, comfort, and high quality care throughout the perinatal period. Consequently, The Academy of Midwifery started to develop the ―Evidence-based guidelines for midwifery care in pregnancy and childbirth‖ containing care policies for healthy low-risk women and newborns. We developed clinical questions based on midwifery care, systematic reviews and searched references. Based on a critical appraisal of each reference, we provided the evidence statement and recommendation. In 2016, the 2nd edition was produced; there are 43 clinical question: 13 in the pregnancy section and 30 in the intrapartum section. For the 2nd, we established a System for Enhancing Midwifery Competencies through collaboration among related associations. In the past midwives had no professionally approved mechanism to acquire advanced competencies. Therefore we needed to enhance midwifery competencies in a planned manner. We developed and promoted tools for enhancing midwifery competencies that included suggesting the career paths for midwives. This career path is contained in the Clinical Ladder of Competencies for Midwifery Practice (CLoCMiP). In 2015, we establish the CLoCMiPⓇ Level III certification system. The overview of the system is that it objectively evaluates that midwives have a specified level of midwifery competencies, and reviews and certifies that the CLoCMiP Level III requirements are satisfied. The CLoCMiPⓇ system was supported by the leading midwifery related organizations: Japanese Midwives Association, Japanese Nursing Association, Japan Academy of Midwifery, Japan Society of Midwifery Education, and the Japan Institute of Midwifery Evaluation. In 2016, 11,002 midwives became certified through the CLoCMiPⓇ Level III certification system. Thus 'Advanced Midwives' were born. Fidelity to the Evidence-based guidelines for midwifery care and the System of Advanced Midwife will contribute to developing our profession and assuring quality of care by all Japanese midwives.