What are the essential competencies required of a midwife at the point of registration?

OBJECTIVE: to identify the essential competencies required of a midwife at the point of registration. DESIGN: qualitative, descriptive, extended case study and depth interviews. SETTING: pre-registration midwifery education in England. PARTICIPANTS: 39 qualifying midwives, their assessors, midwives and midwife teachers across six higher education institutions, and 20 experienced midwives at two sites. FINDINGS: essential competencies were identified relating to (1) being a safe practitioner; (2) having the right attitude; and (3) being an effective communicator. In order to be a safe practitioner, it was proposed that a midwife must have a reasonable degree of self-sufficiency, use up-to-date knowledge in practice, and have self and professional awareness. It was suggested that having the right attitude involves being motivated, being committed to midwifery and being caring and kind. Participants highlighted the importance of effective communication so that midwives can relate to and work in partnership with women and provide truly informed choice. Essential communication skills include active listening, providing appropriate information and flexibility. KEY CONCLUSIONS: the most important requirement at registration is that a midwife is safe and will practise safely. However, this capability to be safe is further mediated by attitudes and communication skills. IMPLICATIONS FOR PRACTICE: models of midwifery competence should always include personal attributes and effective communication in addition to the competencies required to be able to practise safely, and there should be an explicit focus in curriculum content, skills training and assessment on attitudes and communication.