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Start here: the core remediation set for midwives
Midwifery concerns have a character of their own. Care is often given over months, by one midwife, in the woman's home or a primary unit, and decisions about referral and transfer are made under time pressure. The core set reflects that: two courses written for midwives, then six that deal with the process and with showing learning.
The ethics course for midwives is about values and decisions: partnership with the woman, informed choice when she declines advice, balancing her autonomy with the safety of her and her baby, and respecting her culture and whānau. The professional standards course for midwives is about conduct and accountability: what the Code of Conduct requires in your professional relationships, your notes, your working relationships with other professionals, your scope and your behaviour. A concern about how a decision was reached points to the first; a concern about how you practised or behaved points to the second.
Add the courses on responding to a complaint, insight, reflection, remediation planning, preventing recurrence and rebuilding trust.
Core setComplete the set with these
Ethics and ethical conduct
Ethical concerns in midwifery often arise around informed choice: a woman who wanted a home birth after advice to transfer, a decision about induction or monitoring, or information given in a way that steered rather than informed. The Code of Conduct expects midwives to give impartial, honest and accurate information. Code of Rights Rights 6 and 7 add the legal floor: the information a reasonable consumer would expect, and the right to make an informed choice, including the right to refuse.
Ethical concerns also arise when something goes wrong and the woman or whānau were not told clearly. HDC guidance on open disclosure expects an acknowledgement, an explanation of what happened, an apology and information about what will change.
RecommendedStart with these
Professionalism, conduct and attitude
The Code of Conduct gives separate attention to inter-professional relationships, and many midwifery concerns come from there: friction with obstetric teams, a breakdown in communication at transfer, or criticism of another midwife's care in front of a woman. Other concerns relate to professional behaviour: unreliability on call, failing to arrange back-up, or conduct online.
Concerns about how you work with colleagues are about safety, not personality. Handover and transfer depend on trust between professionals, and a breakdown can put a mother or baby at risk.
RecommendedStart with these
Probity, honesty and financial integrity
For midwives, probity concerns most often involve maternity notes written or added to after the event, inaccurate claims for services, or undeclared commercial interests in products recommended to women. The Code of Conduct expects information to be factual and verifiable, and it says commercial benefits must never be covert.
Annual practising certificate declarations, including those about recertification, need to be accurate. Errors here become honesty issues even when the underlying practice was sound. If you realise a declaration or a claim was wrong, correcting it yourself, promptly and with an explanation, is almost always better than waiting for it to be found. Take advice on how to do that before you contact anyone.
RecommendedStart with these
Further relevantAdd if they fit the concern
Professional boundaries: women, whānau and colleagues
Continuity of care brings midwives close to women and their families over a long period, often in small communities where the midwife is also a neighbour or friend. The Code of Conduct is clear that midwives must not have sexual or emotional relationships with women in their care, their partners or their family members.
Less obvious boundary concerns include becoming a confidante beyond the professional role, social media friendships with current clients, providing care to your own family, and gifts. The Code of Rights protects consumers from exploitation, which includes any abuse of a position of trust.
RecommendedStart with these
Further relevantAdd if they fit the concern
Clinical care, referral and records
Clinical concerns about midwives often centre on recognising when care should be escalated: abnormal fetal heart patterns, signs of maternal infection or bleeding, delayed referral or transfer, or an unclear handover to an obstetric or neonatal team. Records are central because they are the main evidence of what you saw, what you advised and what the woman decided. The Code of Conduct expects clear, professional maternity notes.
Health information must generally be kept for at least 10 years from the day after the last service under the Health (Retention of Health Information) Regulations 1996.
RecommendedStart with these
Further relevantAdd if they fit the concern
Competence review, complaint and Tribunal process
The Council describes its competence reviews as educative and supportive, and that framing matters. A review is set up with Terms of Reference, carried out by a panel of experienced midwives, and may include a practical assessment such as an OSCE. The report is due within 20 working days. While a review is open you must stop mentoring and precepting, Midwifery Standards Review reviewer work and locum work.
Preparing well for a review means understanding the Terms of Reference and the competencies involved. If you are returning to practice after a programme or a break, add the return to practice and supervision courses. Our Midwifery Council competence review guide goes through each stage.
RecommendedStart with these
Further relevantAdd if they fit the concern
Match the concern to a course
The concerns that most often lead to complaints and investigations, how they are viewed, and the courses that address each one.
Delayed referral or transfer
Usually assessed through a competence review against the competencies for midwives; panels look at the information available at the time.
Informed choice not documented
Code of Rights Rights 6 and 7 and the Code of Conduct apply; without notes, it is hard to show the woman's decision was informed.
Poor communication at handover
The Code's section on inter-professional relationships expects clear, respectful communication with other professionals.
Emotional or personal relationship with a client
The Code of Conduct says midwives must not have sexual or emotional relationships with women in their care, partners or family.
Notes written after the event
Late entries must be clearly dated and marked; undisclosed changes can turn a clinical concern into a probity one.
Missed signs of maternal infection
Treated as a competence matter; a review panel may use practical assessment.
Breach of a woman's confidentiality
The Code allows disclosure only in limited situations such as imminent serious harm or legal requirement.
Culturally unsafe care
Respect for culture and whānau is part of the Code of Rights and midwifery competence.
Which midwives these courses suit
Concerns reach midwives in every setting, and the right mix of courses depends on where you practise.
- Lead maternity carer (LMC) midwives in continuity-of-care practice, where concerns usually involve referral timing, informed choice and documentation across a long episode of care.
- Employed core midwives in hospital and primary units, where handover, teamwork, workload and escalation feature more often.
- New graduates and midwives in their first years, who may want structured learning on documentation, consent and when to consult.
- Midwives returning to practice after a break, conditions or a competence programme, who need to rebuild confidence and show current knowledge.
- Internationally qualified midwives adjusting to the partnership model, the Code of Rights and cultural safety in Aotearoa.
Whatever your setting, choose courses for the issue raised rather than for your role alone, and say in your reflection how the learning applies to the way you actually practise.
Who handles a concern about a midwife
The HDC first
Complaints that a midwife's care affected a woman or baby go to the Health and Disability Commissioner first. The HDC can refer the matter back to be resolved with the help of the Health and Disability Advocacy Service, make recommendations, or investigate and form an opinion. Its report goes to the Council.
The Midwifery Council
The Council receives complaints and notifications from women, whānau, colleagues and employers, and from the HDC. It decides whether the matter is about competence, health or conduct.
The competence route
A competence review by a panel of midwives can lead to a competence programme, conditions on your scope, an examination or assessment, supervision, or in serious cases suspension.
The health route
Concerns about a midwife's health follow the HPCA Act health process, which focuses on whether you can practise safely.
Professional Conduct Committee and the HPDT
Conduct concerns can be referred to a PCC, which may recommend action, refer the matter to conciliation, take no further steps, or lay a charge before the Health Practitioners Disciplinary Tribunal. The Tribunal decides charges and penalties.
Interim action and what stays the same
If there is a risk of serious harm, the Council can suspend or impose conditions while a review or investigation is open. Otherwise you usually keep practising, apart from the activities you must pause during a competence review, and keep your caseload, back-up and documentation running as normal.
What the Midwifery Council and a review panel are assessing
- Insight: do you understand the clinical issue and its impact on the woman, baby and whānau?
- Remediation: what have you learned and changed in assessment, referral or documentation?
- Risk of repetition: what is different now: back-up arrangements, consultation habits, workload?
- Candour: did you explain what happened openly to the woman and her whānau?
- Records: do your notes show what you assessed, advised and discussed, and the woman's decisions?
- Verifiable evidence: certificates, reflection, feedback from colleagues and any review findings.
How a certificated course helps a midwife's response
A competence review panel is looking at whether your practice meets the competencies. Evidence that you have already identified a gap and worked on it shows engagement with the process. A certificate shows what you studied and that you passed an assessment; the reflective account shows how the learning connects to the woman's care and to your current practice.
Because LMC midwives often work alone, structured study can also give you a framework for thinking through what happened when there was no team debrief.
Courses do not guarantee any outcome and do not replace a competence programme, conditions or Tribunal order unless the Council, the Tribunal or your supervisor accepts them.
Five steps for midwives
- Take advice. The New Zealand College of Midwives and MERAS support midwives through complaints and reviews; your indemnity insurer and a lawyer can advise on a PCC.
- Choose by concern. Read the complaint or Terms of Reference and match each issue to a concern group.
- Complete privately. Study when your caseload allows; access is immediate.
- Write the reflection. Link the learning to the Code of Conduct and to the specific care in question.
- Provide it through your adviser. If they agree, include it with your response or bring it to the review.
Insight, reflection and remediation for midwives
Reflection is already part of a midwife's professional life through the Midwifery Standards Review and recertification. Reflection after a concern goes deeper into one episode of care: what you noticed, what you missed, what the woman experienced, and what you now do. Insight is not defined in law, but panels and committees look for it. Remediation is the plan and the evidence that the plan has been carried out.
Statements made for a competence review or programme are protected from use against you in other proceedings, but private reflective notes have no general legal privilege. Keep women and babies de-identified.
Support for midwives
- 1737 Need to talk?: free call or text 1737 at any time (1737.org.nz).
- Your college and union for practical and professional support.
- A trusted midwife colleague who can cover your caseload and talk through the clinical issues.
- Your GP if the stress is affecting your health or sleep.
Start your midwifery remediation set
Begin with the midwives' ethics and professional standards courses, then add courses for the concern raised.
Questions
Which courses should a midwife take before a competence review?
Read the Terms of Reference first, then choose courses that match the competencies named. The ethics and professional standards courses for midwives, documentation and handover are common starting points, plus insight and reflection. Your college or union adviser can help you prioritise.
Is a Midwifery Council competence review a disciplinary process?
No. The Council describes competence reviews as educative and supportive. They assess whether your practice meets the competencies, and the outcome is aimed at supporting safe practice, for example a competence programme or supervision. Conduct concerns follow a separate route through a Professional Conduct Committee.
What must I stop doing while my competence review is open?
According to the Council's guide, while you are under review you must stop mentoring and precepting, Midwifery Standards Review reviewer work and locum work. You can generally continue your own practice unless conditions or suspension have been imposed. Check your notice for anything specific to you.
How long does the Midwifery Council review panel take to report?
The Council's guide says the report is due within 20 working days of the review. The Council then decides on any outcome. Keep studying and documenting your learning during this time, so you can show what you have done if asked.
Can midwives use the nurses' ethics course instead?
The nurses' course covers some shared ground, but the midwives' ethics and professional standards courses are written around the Midwifery Council's Code of Conduct and continuity-of-care practice. If you are registered as both a nurse and a midwife, choose the course that matches the role in which the concern arose.
A woman complained to the HDC after a home birth transfer. Where do I begin?
Talk to your college or union adviser and indemnity insurer first, then write a factual response with your notes. Useful courses include Responding to a Complaint, handover, documentation, consent and the midwives' ethics course. Your reflection should cover the woman's experience as well as the clinical decisions.
What outcomes can follow a competence review for a midwife?
Outcomes include a competence programme, conditions on your scope, an examination or assessment, supervision and, in serious cases, suspension. Many reviews lead to a supportive programme. Our courses can sit alongside a programme, but count towards it only if the Council or your supervisor accepts them.
How do the midwives' ethics and professional standards courses differ?
The ethics course covers values and decisions: partnership, informed choice, autonomy and safety, culture and whānau. The professional standards course covers conduct: the Code of Conduct's professional relationships, inter-professional relationships, professional behaviour, notes and scope. Choose by the concern; many need both.
I am an LMC midwife working alone. How do I show I have learned from an event?
Combine structured courses with a written reflection, a case review with a trusted colleague, and changes you can point to, such as a new consultation habit or updated back-up plan. Ask colleagues for written feedback. The preventing recurrence course helps you plan changes that can be checked.
Can a midwife be referred to the HPDT?
Yes. A Professional Conduct Committee or the HDC's Director of Proceedings can lay a charge before the Health Practitioners Disciplinary Tribunal, which hears matters for all regulated health professions. Penalties can include censure, conditions, suspension or cancellation. Get legal advice early if a PCC is involved.
How should a midwife reflect on a poor outcome that was not her fault?
Be honest about what you could and could not have known, describe your reasoning, and identify anything you would now do differently, even small things. Acknowledge the impact on the woman and whānau. A reflection that shows openness is stronger than one that only defends the decision.
Will the Midwifery Council see my course results?
Only if you choose to share them. We do not send anything to the Council, the HDC or an employer. Your adviser can help you decide whether to include certificates and a reflection in your response or at the review.
Are there remediation courses on maternal sepsis and deterioration?
Yes. The sepsis and deteriorating patient course covers recognising and escalating deterioration, which is relevant to maternity care. For concerns about escalation, combine it with handover, documentation and clinical competence, and reflect on how you now act on early warning signs.
Which concern groups come up most for LMC midwives?
We do not hold figures on this, so we will not guess. What we can say is that continuity-of-care practice puts particular weight on referral and transfer decisions, informed choice over a long pregnancy, and notes that show what was discussed. For an LMC midwife, the documentation, handover, consent and clinical competence courses together cover much of that ground, alongside the core set and the two midwifery courses.
Can a midwife ask for a support person at the review?
The HPCA Act gives practitioners under competence review the right to be heard and to have a support person. Check your notice and the Council's guide, and talk to your college or union about who to bring.
Official sources
Checked October 2026. Rules and processes change, so confirm the current position with the official source. This page is general information, not legal advice.
- Midwifery Council: Code of Conduct
- Midwifery Council: Your competence review
- HDC: Code of Health and Disability Services Consumers' Rights
- HDC: Guidance on open disclosure policies
- HDC: Complaint process
- Health Practitioners Disciplinary Tribunal: About us
- Privacy Commissioner: Retention of health information
- 1737 Need to talk?
How these courses are built
Official sources only
Every legal and regulatory point comes from primary sources: the HPCA Act 2003, the responsible authorities' standards and the Code of Health and Disability Services Consumers' Rights. Anything we cannot confirm is left out.
Original, edition by edition
Lessons, scenarios and assessment questions are written by us for each edition separately, then checked for accuracy, teaching quality and fair assessment before publication.
Reviewed when rules change
When a code, standard or law changes, the affected courses are reviewed and updated. Reported errors in legal or regulatory facts are corrected first.