Norwegian midwives\u2019 opinion of their midwifery education \u2013 a mixed methods study

Mirjam Lukasse,Anne Marie Lilleengen,Anne Margrethe Fylkesnes,Lena Henriksen

doi:10.1186/s12909-017-0917-0

Mirjam Lukasse, Anne Marie Lilleengen + Show 2 more

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https://doi.org/10.1186/s12909-017-0917-0

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Abstract

BackgroundMidwifery education in Norway has undergone radical reforms in the past few decades. In 2004, the compulsory year of paid internship was removed from the requirement to become an authorised midwife. Since then, authorisation as a midwife depends on the successful completion of a two-year full-time academic course, consisting of 50% clinical practice and 50% theoretical education. Our objective was to examine midwives’ opinion of their Norwegian midwifery education in relation to their midwifery practice, comparing those educated with internship to those without.MethodsWe performed a mixed-methods study based on data from a nationwide cross-sectional survey. A sample of 547 midwives completed a postal questionnaire, autumn 2014. Midwives were asked how they were educated, how their education prepared them for practice (multiple choice) and to freely comment on their midwifery education. Thematic analysis and descriptive and comparative analysis was used. Data sets were analysed independently and jointly interpreted.ResultsOf our sample, 154 (28.2%) were educated through a two-year midwifery education without internship, while 393 (71.8%) had a one-year midwifery education with internship. Compared to midwives who had internship, midwives without were four times more likely to report that their education did not, or only partially prepare them for their work as a midwife. The association lost its significance when adjusted for experience as a midwife. According to the qualitative data, the primary reason for the association was insufficient clinical practice during education. Relevant clinical placement, ample practice time with good preceptorship and internship were proposed as methods to prepare for practice as a midwife. The theory–practice gap was highlighted as another hindrance to being prepared for practice.ConclusionsAcademisation of the midwifery education has resulted in newly qualified midwives feeling less prepared for practice. Midwives would have liked more time for clinical practice and simulation training of core midwifery clinical skills included in the education. Midwifery educations need to explore ways to achieve a good balance between practice and theory. Workplaces need to explore alternative ways to internship to assist new graduates to become confident midwives with a strong midwifery identity.

Highlights

Midwifery education in Norway has undergone radical reforms in the past few decades
Midwives with internship worked more often in community antenatal care, Out Patient Department (OPD) and in education and management, while those without internship were more often working on labour, postnatal or combined labour/postnatal wards at larger maternity units (Table 1)
Compared to midwives with internship those without internship more often reported that their education did not or only partially prepared for their work as a midwife (P < 0.001) (Table 2)

Summary

Introduction

Midwifery education in Norway has undergone radical reforms in the past few decades. In 2004, the compulsory year of paid internship was removed from the requirement to become an authorised midwife. Authorisation as a midwife depends on the successful completion of a two-year full-time academic course, consisting of 50% clinical practice and 50% theoretical education. The aim of midwifery education is to prepare students to enter the profession of midwifery with the required competencies to provide safe and high standard evidence based maternity care for women experiencing complex pregnancies and births while supporting normal pregnancy and birth [1, 2]. The majority of midwives in Norway work in obstetrician led maternity units. Norway has few midwifery-led units; few independent midwives and planned home-births are rare. Midwives experience a great deal of autonomy within the given structure while women-centred care has limited focus [6, 7]

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