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Midwifery students and birthing women: a valuable relationship

Women value midwifery students and midwifery students value women. One Australian university has begun to collect routine, ongoing, web-based feedback from all women who complete a continuity of care experience (CCE) with a midwifery student. Analysis of the first 12 months of data found that women value CCE with student midwives and midwifery students are providing above and beyond the minimum requirements for care. Continuity of midwifery care (CMC) has long been recognised as the cornerstone of quality midwifery care but how does this manifest in pre-registration midwifery programs?

CCE was introduced to Australian pre-registration midwifery programs as a way to provide students “experience in woman-centred care” (ANMAC, 2015, p. 24). Currently Australian midwifery students must support a minimum of 10 women within a CCE including a minimum of four antenatal visits, attendance at the majority of women’s labour and births as well as a minimum of two postnatal visits (ANMAC, 2015). The number of CCE students are required to undertake has been reviewed periodically by accreditation board ANMAC since 2010 and has reduced from a total of 30 in 2010 to the current 10 (Teirney et al., 2018). Some midwifery students and accredited midwifery education providers have previously argued that they have found complexities when managing clinical placements, CCE experiences, assessment, course requirements, employment and family responsibilities (Gray et al., 2013; McLaughlan et al., 2013). It was thought that reducing the number of total CCE would provide a higher quality of CCE experiences for students and women (ANMAC, 2014).

Although minimum requirements of a Bachelor of Midwifery (BMid) program at one Australian university are double the number (20) of minimum CCE and a minimum of five antenatal visits, all labour and births, and three postnatal visits (to six weeks postpartum), a recent study has shown that midwifery students at this university provide women even more support than this (Tickle et al., 2020). Students in this program completed a mean average of 5.83 antenatal visits, attended 92.6 percent of women’s labour and births and a provided a mean average of six postnatal contacts. The authors state that the midwifery program in this study is flexible in its design to privilege the CCE (Tickle et al., 2020). This may have allowed students to prioritise women’s care where necessary.

From previous statements made regarding the reduction of CCE requirements with intention to increase the quality of a CCE, you may be mistaken for believing that although student attendance in this study was high, the quality of the experience for women was lacking, however this is untrue. The study, where 57 percent of women provided feedback, found that the majority of women were satisfied with the student in the antenatal period (86.6 percent), labour and birth (86.4 percent) and postnatally (79 percent) (Tickle et al., 2020). Women were more satisfied when their CCE student attended their labour and birth (Tickle et al., 2020). Additionally, there was a positive correlation between a woman’s level of satisfaction and respect (measured on standardised scales) and the number of antenatal visits and postnatal contacts midwifery students had with women (Tickle et al., 2020). Nearly all women would recommend a midwifery student (97.6 percent) (Tickle et al., 2020). It could be argued that in order for the original purpose of the introduction of CCE by ANMAC (to provide experience in woman-centred care) to be fully realised, women should remain at the centre of a CCE. Women clearly value their midwifery student providing CCE and therefore the authors recommend midwifery standards be revised to increase both the total number and minimum requirements of CCE  for pre-registration midwifery students (Tickle et al., 2020).

Providing all women the opportunity to feedback their experiences gives women a voice and exemplifies respectful, woman-centred, professional practice. Feedback from women affords students and faculty a unique perspective for reflection, practice and program review and revision to help ensure women remain at the centre of learning and teaching in midwifery.

For women to receive continuity of midwifery care the midwifery workforce requires midwives to work within continuity models (Gamble et al., 2020). Midwifery students placed in CMC models are more likely to want to work in these models after graduation (Carter et al, 2015; Cummins et al., 2017). Over one third (34.7 percent) of women in the Tickle et al. (2020) study received a midwifery continuity primary model of care meaning that many students are being exposed to CMC models which may contribute to a growing CMC workforce.

CCE is important for women, students and the future midwifery workforce. Increasing pre-registration midwifery program standards to include a larger number of CCE, increased minimum requirements, routine feedback from women and maintaining quality is both feasible and optimal. In the same way women’s satisfaction with a midwifery student providing CCE echoes current research with midwives providing CMC (Sandall et al., 2016), it is possible clinical outcomes for women receiving a CCE will follow the same trajectory.

References

Australian Nursing and Midwifery Accreditation Council. (2014). Midwife accreditation standards. ANMAC. https://www.anmac.org.au/sites/default/files/documents/ANMAC_Midwife_Accreditation_Standards_2014.pdf

Carter, A., Wilkes, E., Gamble, J., Sidebotham, & Creedy, D.K. (2015). Midwifery students׳ experiences of an innovative clinical placement model embedded within midwifery continuity of care in Australia, Midwifery, 31(8), 765. https://doi.org/10.1016/j.midw.2015.04.006

Cummins, A.M., Denney-Wilson, E., & Homer, C.S.E. (2017). The mentoring experiences of new graduate midwives working within midwifery continuity of care models in Australia. Nurse Education in Practice, 24, 106-111. https://doi.org/10.1016/j.nepr.2016.01.003

Gamble, J., Sidebotham, M., Gilkison, A., David, D. & Sweet, L. (2020). Acknowledging the primacy of continuity of care experiences in midwifery education. Women and Birth, 33(2), 111-118. https://doi.org/10.1016/j.wombi.2019.09.002

Gray, J., Leap, N., Sheehy, A. & Homer, C.S. (2013). Students’ perceptions of the follow-through experience in 3 year bachelor of midwifery programmes in Australia. Midwifery, 29(4), 400-406. https://doi.org/10.1016/j.midw.2012.07.015

McLachlan, H.L., Newton, M., Nightingale, H., Morrow, J., Kruger, G. (2013). Exploring the ‘follow-through experience’: a statewide survey of midwifery students and academics conducted in Victoria, Australia. Midwifery, 29(9), 1064-1072. https://doi.org/10.1016/j.midw.2012.12.017

Sandall, J., Soltani, H., Gates, S., Shennan, A., & Devane, D. (2016). Midwife-led continuity models versus other models of care for childbearing women. Cochrane Database of Systematic Reviews, 4. https://doi.org/ 10.1002/14651858.CD004667.pub5

Tickle N., Gamble J. & Creedy DK. (2020) Women’s reports of satisfaction and respect with continuity of midwifery care experiences by students: Findings from a routine, online survey. Women & Birth, in press. doi.org/10.1016/j.wombi.2020.11.004

Tierney, O., Sweet, L., Houston, D. & Ebert, L. (2018). A historical account of the governance of midwifery education Australia and the evolution of the continuity of care experience. Women and Birth, 31(210-215). https://doi.org/10.1016/j.wombi.2017.09.009