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Preparing students to provide continuity of care

Continuity of midwifery care provides superior maternal and neonatal outcomes (Sandall et al., 2016). Access to continuity of care models is limited, both for women and for midwifery students who have the opportunity to gain direct experience of such models. There is also concern that placing students in a continuity of care model rather than a standard hospital model of care may reduce their learning.

New research from Professor Kathleen Baird, Ms Carolyn Hastie, Ms Paula Stanton and Emeritus Professor Jenny Gamble of the Transforming Maternity Care Collaborative focussed on the learning experiences of students who complete an extended placement in a midwifery group practice providing continuity of care at Griffith University (Baird et al., 2021). Final year midwifery students were able to elect to take part in a six-month placement in a midwifery group practice team. The research team conducted focus group interviews to explore the experiences of fifteen students who had taken part in the placement.

Students reported that their placement in the midwifery group practice was the highlight of their degree and was not as demanding as they had anticipated. Being able to develop skills in providing relationship-based care was highly valued by students and was enabled and supported by the midwives they were working with. The culture of the midwifery group practice in which students were placed provided a supportive environment were students learned to take care of themselves and their team members, and to collaborate with other members of the team. Students felt that they were valued members of the team. Returning back to the hospital shift-based system was challenging for most students. They were aware of a loss of autonomy and a faster pace of care. Some were supported well in this transition, while others were criticised for their choice to spend time in the midwifery group practice.

This research enables midwifery educators to be confident that prolonged immersive student placements in midwifery continuity of care models provides positive learning experiences. The students described feeling and acting like a “real midwife” during their placement, with six being adamant that they would apply for a position in a midwifery group practice immediately after graduation. Increased access to midwifery continuity of care models for women would provide more opportunities for midwifery students to gain experience of working in this model.

References

Baird, K., Hastie, C. R., Stanton, P., & Gamble, J. (2021). Learning to be a midwife: Midwifery students’ experiences of an extended placement within a midwifery group practice. Women and Birth, in press.

Sandall, J., Soltani, H., Gates, S., Shennan, A., & Devane, D. (2016, Apr 28). Midwife-led continuity models versus other models of care for childbearing women. Cochrane Database of Systematic Reviews, 4(11), CD004667.

How well does midwifery education prepare graduates to work in continuity of care models?

Access to continuity of midwifery care (CoMC) models in Australia is increasing but the capacity of the emerging midwifery workforce to provide this care remains largely unknown. Continuity of midwifery care has been a required component of Australian midwifery education programs since 2009 (ANMAC, 2009). This has been primarily achieved through the concept of the ‘Continuity of Care Experience’ (COCE), where midwifery students follow a woman on her journey through the pregnancy, birth, and postnatal period (ANMAC, 2014). COCE are undertaken within all models of maternity care and the requirements surrounding these experiences vary widely by educational institution (Gamble et al., 2020). Midwifery education programs are required to contain equal parts theoretical and clinical hours and those clinical hours not achieved through COCE are undertaken via clinical placements, most often within standard (or fragmented) maternity care models (ANMAC, 2014; Gamble et al., 2020).

Researchers from the Transforming Maternity Care Collaborative recently published an integrative literature review which set out to discover how well pre-registration midwifery education prepares and motivates Australian midwifery students to work in continuity of midwifery care models when they enter practice (Carter et al., 2020). The findings reveal that access and exposure to CoMC is a crucial component of midwifery education. The full text of the paper is available free via this link for a short time.

Midwifery students consistently expressed that their COCE  equipped them with increased knowledge, skills, and confidence in midwifery practice (Browne et al., 2014; Dawson et al., 2015; Fenwick et al., 2016; McKellar et al., 2014; Sidebotham et al., 2015). Their COCE enabled them to build trusting relationships with women, enabling them to recognise and provide woman-centred midwifery care (Browne et al., 2014; Dawson et al., 2015; Fenwick et al., 2016; McKellar et al., 2014; Sidebotham et al., 2015). These factors improved work satisfaction amongst midwifery students and motivated them to provide CoMC upon entry to practice (Brown et al., 2014; Evans et al., 2020; McLachlan et al., 2013; Sidebotham et al., 2015; Sidebotham & Fenwick 2019). Midwifery support played an important role in influencing students learning and future career aspirations (Carter et al., 2015; Sidebotham & Fenwick 2019). Continuity of mentorship from a midwife, who worked in, and whose midwifery philosophy aligns with continuity of care, improved students’ understanding of the role, providing opportunity for them to gain insight into what working in these models really ‘looks like’ (Carter et al., 2015; Sidebotham & Fenwick, 2019).

Some midwifery students reported challenges in the achievement of their COCE. The most common concern was that of the impact on their work/ life balance and, to some extent, their finances (Brown et al., 2014, Carter et al., 2015; Dawson et al., 2015; Fenwick et al., 2016; McLachlan et al., 2013; Sidebotham & Fenwick 2019). It was evident from this research that existing methods of education program delivery and institutional structures often presented students with challenges, detracting from the value of their learning experiences. This was not the case however, when students’ clinical experiences took place within an established CoMC model (Sidebotham & Fenwick, 2019). When academic institutions actively support CoMC by prioritising and embedding it within program delivery, the challenges associated with CoMC are minimised (Sidebotham & Fenwick, 2019). These findings are in alignment with work by Gamble et al. (2020), who suggest that CoMC should become the core principle around which midwifery education programs are designed and delivered.

This integrative review found that while most midwifery students wished to work in continuity of midwifery care, not all felt able or capable to do so upon completion of their education. With motivation high, it is important to identify, expand, and promote factors that increase new midwives’ preparedness to work in CoMC. With little evidence as to how well theoretical and non-CoMC clinical learning prepares students to work in CoMC, further research is required to identify educational factors that enable and inhibit midwives from working this way upon entry to practice. Such research could be used to inform and implement a consistent approach to midwifery education internationally.

References

ANMAC (2009). Midwife accreditation standards 2009. 

ANMAC. (2014). Midwife accreditation standards 2014. 

Browne, J., Haora, P. J., Taylor, J., & Davis, D. L. (2014). “Continuity of care” experiences in midwifery education: Perspectives from diverse stakeholders. Nurse Education in Practice, 14, 573-578.

Carter, J., Dietsch, E., & Sidebotham, M. (2020). The impact of pre-registration education on the motivation and preparation of midwifery students to work in continuity of midwifery care: An integrative review. Nurse Education in Practice, 48, 102859.

Dawson, K., Newton, M., Forster, D., & McLachlan, H. (2015). Exploring midwifery students׳ views and experiences of caseload midwifery: A cross-sectional survey conducted in Victoria, Australia. Midwifery, 31, e7-e15. doi:10.1016/j.midw.2014.09.007

Evans, J., Taylor, J., Browne, J., Ferguson, S., Atchan, M., Maher, P., Homer, C. & Davis, D. (2020). The future in their hands: Graduating student midwives’ plans, job satisfaction and the desire to work in midwifery continuity of care. Women and Birth, 33(1), e59-e66.

Fenwick, J., Gamble, J. & Sidebotham, M. (2016). Being a young midwifery student: A qualitative exploration. Midwifery, 39, 27-34.

Gamble, J., Sidebotham, M., Gilkison, A., Davis, D., & Sweet, L. (2020). Acknowledging the primacy of continuity of care experiences in midwifery education. Women and Birth, 33(2), 111-118.

McKellar, L., Charlick, S., Warland, J. & Birbeck, D. (2014). Access, boundaries and confidence: The ABC of facilitating continuity of care experience in midwifery education. Women and Birth, 27(4), e61-e66.

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.

Sidebotham, M., Fenwick, J., Carter, A. & Gamble, J. (2015). Using the five senses of success framework to understand the experiences of midwifery students enrolled in an undergraduate degree program. Midwifery, 31(1), 201-207.

Sidebotham, M. &Fenwick, J. (2019). Midwifery students’ experiences of working within a midwifery caseload model. Midwifery, 74, 21-28.