Advanced intrapartum midwifery practice: a scoping review

There is no international consensus on advanced midwifery practice in intrapartum care.

Evidence suggests that advanced practice midwives improve maternal and neonatal clinical outcomes, access to care, resource efficiency and staff satisfaction. However, specific literature on advanced midwifery skills in intrapartum care is lacking.

To map advanced midwifery skills in intrapartum care.

A scoping review was conducted using electronic databases including Medline, Scopus, CINAHL, Cochrane Library, Google from inception to April 2022, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews.

A systematic search of the literature identified 6932 studies, and 17 met inclusion criteria. The advanced intrapartum skills identified relate to perineal care, instrumental vaginal birth, breech vaginal birth, perineal repair, cesarean section, emergencies procedures, intrapartum ultrasound, counseling and mediation, labour techniques, advanced clinical assessment, intangible skills, external cephalic version.

Two main trends emerge: the skills practiced in midwifery-led units are oriented to promote and respect the physiology of childbirth and, in more under-resourced contexts, the development of midwifery follows an overlapping path with that of medical skills. The advancement of intrapartum practice involves the exercise of technological and emotional skills. The practice of counseling skills contributes to the professional development of the whole team.

This review suggests the need to develop advanced skills in the area of birth physiology through the promotion of organisational models such as midwifery-led units. It is important to focus on how advanced profiles can be implemented and how advancement in practice affects maternal and neonatal outcomes.