Tuesday, January 29, 2013

What clinical experiences makes a good student midwife?

Midwifery education in Australia is about to undergo a review as the Nursing and Midwifery Board look at the standards underpinning midwifery education. One of the potential controversies that is likely to be debated during the consultation process, is the clinical requirements that students are expected to achieve.

Follow-through (continuity of care) experiences
At the moment, student midwives are required to obtain 20 follow-through, or continuity of care experiences during their education. During the continuity experience, the student follows a woman through her pregnancy, birth, and up to six weeks after the baby is born.  Students feel that this experience is an incomparable learning experience, and gives the student a sense of the whole context that a woman comes from, which is invaluable, whatever model of practice the student goes on to work in as a midwife.Students also find it easier to obtain experiences and skills such as perineal repair and vaginal examination when they are working with women they know well, as opposed to complete strangers. 

The problem that students are finding is that these experiences are very time-consuming, expensive and being on call means they are not free to work during their time off.  These requirements, along with all the other clinical requirements, are creating huge workloads for student midwives.

There are some midwifery educators who want to drop the number of continuity requirements because of workload issues, whilst others see the continuity experience as a non-negotiable elements of midwifery education, especially as the Australian maternity system is so fragmented.

Need to focus on normal midwifery
Having spent 11 years as an educator in New Zealand, as well as one year teaching in Australia, I whole heartedly support the continuity experience as one that not only provides clinical skills, but also re-enforces an understanding of childbirth as a holistic process, and not a fragmented one which is encouraged by the other clinical requirements such as 100 antenatal visits, 100 post natal visits,  and so on. I believe the continuity experience should not be a luxury or add-on, but the essential core of midiwfery education. However, my personal feeling (and not necessarily that of the Australian College of Midwives) is that student midwives in Australia have too big a clinical workload.

If any requirements are reduced, it should be those that focus on the technical, medical skills that are quickly picked up in hospital, such as working with women with epidural, or providing care for women who have had cesarean section - midwives pick up those skills quick enough once they are registered  because of the high epidural and cesarean rates in Australian hospitals.

Holistic midwifery
During their education program,  students must be given the opportunity to learn about supporting normal birth, and develop a full understanding the role of midwife. They may not go on to work in a continuity scheme as a midwife, but they will understand how midwifery is provided in that context so they can support their sisters who do work in these models of care. But more important, they have a framework on which they can base their understanding of childbirth, and guide their interactions with women and families, especially when they work in fragmented hospital systems.

If you are interested in reading more, here are some references that the Australian College of Midwives is currently collating:  http://www.midwives.org.au/scripts/cgiip.exe/WService=MIDW/ccms.r?PageId=10175

Are you a student midwife - what do you think about your clinical experience? How does it prepare you for practice as a midwife? What would you change, if anything?  Are you a pregnant woman? Have you had experience of working with a student midwife? What did you enjoy about having a student midwife?

Image: 'Soheyl'
Found on flickrcc.net


Anonymous said...

Whilst I was a student (in NZ), my richest learning came from the continuity placements. However, they were exhausting on top of full time study, meeting course requirements with DEM days and juggling a family as a single mum.
To gain the full advantage of continuity, anything less than 15 weeks sees fragmented care, as you either haven't seen the woman antenatally or don't get to attend her discharge visit. But it's exhausting. So I ended up taking one weekend a month off.
I love continuity, however now work in a hospital and enjoy working in partnership modelling with the same ideals.
I think it's a hard road educating the student, while preventing burnout.

Interesting blog post Sarah!

Sarah Stewart said...

I agree, anonymous, I take my hat off to student midwives these days - I don't know how they do it. One thing I think we should lobby for is that students receive some sort of funding so that the financial pressures they face are lifted while they meet their clinical requirements.

Claire said...

Really interesting to read about student midwifery in Australia as opposed to the UK. I'm currently going through the application process to begin studying midwifery in the UK. One of the girls on the StudentMidwife.net forum posted a link to a slideshow you put online about midwifery and social media and from there I found your twitter and then this blog! Its very difficult to get into midwifery here in Scotland at the moment, only 80 uni places this year over the 3 remaining universities than run the course! x

Sarah Stewart said...

Wow! That's a very small number, Claire, and will only increase midwifery shortages in the long run. Good luck with getting a place...let me know how you get on :)

Claire said...

Thanks :) I've just sat and hopefully passed entry tests and will find out within the next two weeks if I have an interview. I will do! Love reading your blog by the way!

Rhiannon said...


I have just begun my bachelor of nursing/midwifery this year and am really worried about the new requirements. I had a friend who completed the course two years ago who didn't need to follow as many women (I can't remember what the exact number was, but it was less than 20). She found it difficult enough then, having to occasionally leave her part-time job mid-shift to attend a labour (didn't make the bosses very happy at all).

I agree with the idea of it but I think the sheer number is going to pose a problem when my cohort is trying to graduate at the end of 2016. At my university we don't even begin our first midwifery subject until the second half of the first year, so essentially we have 3.5 years to get in these requirements. On top of that, I still need to complete all the weeks of clinical placement in nursing, with a total of 52 weeks of placement for both degrees combined. I know that the single bachelor of midwifery is starting to appear, but its not nearly as common and accessible as the nursing/midwifery combined degrees.

While I'm still very excited and feel very privileged to be doing this course, I worry a little for the future and how I'm going to support myself financially and meet the requirements. Anyway that's just my two cents worth on the matter.

Sarah Stewart said...

Hi Rhiannon, sorry its taken so long to respond to your comment. The reality is that the dual degrees pack 6 years into 4 years which is why they are so hard going. My advice, speaking as an educator and not as an ACM member of staff) is that if you want to be a midwife, to do a midwifery degree. Good luck with your studies...you'll get there in the end and it will be worth it!

Unknown said...

Wow, like Claire said, It's really interesting to hear about how you train midwives in Australia. We don't do continuity placements like that, but are just put with a mentor in each clinical practice. It sounds really interesting (and hard.) I just started my training this year and am amazed I even got in. My uni only has 37 places and around a 1000 applicants.