Pre-registration Midwifery Education Research Articles

A qualitative study which aims to explore the factors influencing the delivery of both theory and practice of contraception and sexual health on pre-registration midwifery programmes in England

BackgroundPregnancy offers an opportunity to provide equitable access to contraception information and provision, and professional bodies advocate provision of contraception in the immediate postpartum period. This study examines the contribution...

Discursive constructions of student midwives’ professional identities: A discourse analysis

BackgroundThe construction and performance of professional identity is significant to broader socio-cultural understandings of who ‘professionals’ are and what they do. Importantly, it is also implicated in the development and enactment of policy, regulation, education, and professional practice. Professional identity is linked to self-esteem, self-efficacy, professional value, confidence and success. The salience of this in relation to midwifery practice is highly significant; aspects of autonomy, confidence, competence, responsibility, and accountability are all implicated in the provision of safe and effective care. AimTo explore how student midwives are constructed in the discourses of policy, professionalism, and learning, to provide new perspectives to inform, policy, education, and practice. MethodsAn adapted critical discourse analysis of the United Kingdom (UK) Nursing and Midwifery Council’s 2009 Standards for pre-registration midwifery education, using a three-step process: exploring discourse at the level of (1) discursive practice (2) linguistic features of the text, and (3) social practice. Findings/ DiscussionThe discourses that relate to midwifery education and practice emerge within socio-political and historical contexts. Constructions of identity are articulated through a rule-bound framework which includes competence, confidence and ‘good health and good character’. There is a requirement for midwives to ‘be’ responsible, accountable, autonomous, professional, competent, and confident. Regulatory power is reinforced through medico-legal discourses, with the status of midwifery discursively presented as inferior to medicine. ConclusionAccording to the Standards, midwives must be a lot of things in their role and function. The Standards’ discourses are authoritative, legislative and controlling, creating an ideology about professional status and agency which constructs an ‘imaginary autonomy’; becoming a midwife is more automatic (with the perception of control), than agentic. All of which has significance for the social practice of midwifery. Tweetable abstract‘How are midwives made? Discursive constructions of student midwives’ professional identities: a discourse analysis.

Pre-registration midwifery education: adapting infant feeding observed simulated clinical examinations

Digitally developed and virtually provided midwifery education has gathered momentum as a result of the COVID-19 pandemic. Preparing students for professional practice in a virtual environment creates challenges and creative opportunities for midwifery educators. Course designs and structures have been adapted to enable students to gain knowledge and experience of practicing in a virtual environment and approaches to assessment have also required adaptation. This article outlines how observed simulated clinical examinations were modified in conjunction with stakeholders from clinical practice and the breastfeeding community to ensure that they aligned with the local reality of virtual infant feeding support. Collaboration was required to ensure that the reality of student's experiences was captured in the assessment process. Challenges encountered included being sensitive to the fluidity of the clinical setting and ensuring that scenarios were relevant and created a sufficient challenge for students. Mitigating against students' concerns regarding virtual simulated clinical assessment should be incorporated into future adaptations of educational interventions and assessments.

The influence of route of entry on a Pre-Registration Midwifery education programme.

Entry to midwifery education in the United Kingdom (UK) typically requires three A-Levels. However, the commitment to widening access to university has led to a growing number of students accessing midwifery education with ‘non-traditional’ qualifications. It is not known if widening access to include such entry qualifications has an impact on degree attainment or retention of students in midwifery education. This retrospective cohort observation study looked at entry route and outcomes, in a single higher education midwifery programme. Findings identify that route of entry does not have an impact on retention of students or final degree classification awarded.

Learning through relationships: The transformative learning experience of midwifery continuity of care for students: A qualitative study

BackgroundMidwifery curricula in Australia incorporate ‘Continuity of care experiences’ (CoCE) as an educational strategy based on an assumption that midwifery students will learn skills and knowledge about woman-centred care that they may not learn in the typical fragmented care system. However, exactly what skills and knowledge they are expected to ‘learn’ and how these can be assessed have never been specifically identified. AimTo explore midwifery students’ continuity of care learning experiences within pre-registration midwifery education. MethodsFocus groups were conducted with first, second and third year Bachelor of Midwifery students (n = 12), who were undertaking CoCE in rural and regional tertiary hospitals in NSW, Australia. FindingsThe overarching theme, ‘Learning through relationships’, was made up of three interrelated themes: Meeting women and making connections, Being known, and Understanding holistic care. DiscussionThe findings from this study contribute to understanding the educational effects of CoCE. The CoCE relationship provided safety and freedom to learn which was seen as foundational for midwifery students’ vision of their future practice and can be seen as a self-determined transformational approach to learning. ConclusionThis study adds insight into midwifery students’ experience of CoCE, and demonstrates that transformative learning occurs through developing a relationship with both the woman and the midwife. For midwifery to develop as a profession and maintain its focus on woman-centredness, it is important that this aspect of midwifery education remains embedded within midwifery program philosophies and learning outcomes.

Embedding strengths-based perspectives into pre-registration midwifery education

This article is a reflection of the process undertaken to embed the concept of strengths-based perspectives of Aboriginal and Torres Strait Islander people’s health and wellness into the pre-registration program for student midwives and nurses. In years past the subject has been taught from an exceedingly negative perspective. This was a desperate bid to encourage non-indigenous nurses and midwives to care. Following the example given by Boler in the Pedagogy of Discomfort1 it was an attempt to engage the empathy of student nurses and midwives.

Finding the Future Midwife: How the revised Standards of Proficiencies for Midwives support pre-registration midwifery programme admissions processes

Pre-registration midwifery education programmes are quietly undergoing a revolution. In 2019, the Nursing and Midwifery Council (NMC) published an ambitious set of proficiencies for the future midwife, defining a framework of skills, knowledge and behaviours that midwives are required to demonstrate at the point of qualification and subsequent entry to the register.1 The revised Proficiencies for Midwives were required to reflect the demands of contemporary maternity services and were based on the framework produced by Renfrew et al. within the Lancet midwifery series.

O102 - The MIDAC CoCE Portal: connecting pregnant women with midwifery students in Victoria, Australia

In Australia all pre-registration midwifery students are required to engage and partner with a minimum of ten women in midwifery continuity of care experiences (CoCE) throughout their course of study. Around 77,000 women give birth in Victoria each year, however two out of three students report difficulties recruiting pregnant women as CoCE partners (Newton et al., 2021). On the basis of this evidence as well as the temporary additional CoCE difficulties caused by the COVID-19 pandemic, the Midwifery Academics of Victoria (MIDAC) group developed a web portal to support students to attain CoCE requirements wherein women can learn about CoCE and register to be partnered with a midwifery student from a university that works with the maternity service providing their care. The aim of this project was to facilitate midwifery students engaging in CoCE partnerships with childbearing women in the state of Victoria, Australia. A project team was convened comprising one lead and five other midwifery academics representing all universities offering pre-registration midwifery education in Victoria, Australia, as well as Information Technology staff members and students from one of those universities. The team worked together to develop the web portal's content, design and functionality over a period of 12 months. The MIDAC CoCE web portal was launched in early 2022 with an accessible, responsive design suitable for desktop and mobile devices. QR code-enabled flyers are displayed in maternity health services enabling pregnant women to easily access the website and register their interest via a simple web form. The data is securely sent to that university's Professional Practice contact, who then pairs the woman with a suitable student. Evaluation is underway.

“One of those things the student is left to do”. Student midwives' experience of infant feeding education. A phenomenological study

Aim/ObjectiveTo explore final year student midwives’ experiences of breastfeeding education and clinical experience during their three year pre-registration midwifery degree course. BackgroundDespite an increasing research base about what helps or hinders breastfeeding, there is a dramatic drop in breastfeeding prevalence within the first six weeks of birth. Breastfeeding support and education have been identified as influencing factors associated with breastfeeding prevalence, yet there is a paucity of evidence exploring infant feeding education for pre-registration student midwives. DesignQualitative data was gathered using semi-structured interviews with seventeen final year midwifery students in a Higher Education Institution in the North of England. MethodsInterviews were audio recorded, transcribed verbatim, and analysed using thematic analysis. ResultsThree core themes were identified: The Mentor-Student Relationship, Midwives and student midwives’ attitudes towards breastfeeding and Theory-Practice Disassociation. University-based input provided them with underpinning knowledge but provided little opportunity to develop skills. Attitudes towards breastfeeding were predominantly negative, and these negative descriptions were frequently linked by students to time constraints and workload pressures. The relationship between students and mentors had a direct impact on students’ development of breastfeeding support skills and confidence: students who had mentors who were enthusiastic about their role in facilitating learning in clinical practice were confident in supporting women with infant feeding. However, many students described the hospital environment as too busy for infant feeding skills teaching and guidance. ConclusionsAlthough few participants were dissatisfied with how their pre-registration midwifery education prepared them for clinical practice in general, the majority would have liked more opportunities to support women with infant feeding in complex and challenging cases, both in University and in clinical practice. There is a need for midwifery students to be provided with a variety of educational experiences such as theoretical classroom-based learning, simulation-based learning, peer learning, clinical care practice and direct service user engagement. These learning experiences need to include artificial feeding and breastfeeding.

Prepared and motivated to work in midwifery continuity of care? A descriptive analysis of midwifery students’ perspectives

BackgroundInternationally, midwifery education and maternity services are evolving to promote midwifery continuity of care. It is unclear whether current Australian midwifery education programs are graduating a midwifery workforce prepared and motivated to work in this way. AimTo discover how well midwifery students in Australia feel they have been prepared and motivated to work in midwifery continuity of care when they enter practice. MethodsA pragmatist approach was used. Participants were final year midwifery students at one Australian university participating in the Midwifery Student Evaluation of Practice (MidSTEP) project over three consecutive years. Descriptive analysis of selected scaled and free text responses was undertaken to ascertain how students’ clinical practice experiences had influenced their learning, development and career aspirations. ResultsExposure to midwifery continuity of care had profound impact on students’ learning, enabling them to provide woman-centred midwifery care whilst increasing confidence and preparedness for practice. The majority were motivated to work in midwifery continuity of care upon graduation. A small minority of participants felt unprepared to work in midwifery continuity of care, attributing this to their family commitments, a sense of needing more experience or unsupportive workplace cultures. SummaryMidwifery continuity of care experiences are highly valued by midwifery students and positively influence confidence, preparation and motivation for beginning practice. It is necessary to review education standards to ensure quality, consistency, and adequacy of these experiences throughout pre-registration midwifery education. This will assist in generating a midwifery workforce prepared and motivated to deliver the goals of maternity service reform.

Women’s reports of satisfaction and respect with continuity of care experiences by students: Findings from a routine, online survey

BackgroundPre-registration midwifery students in Australia undertake a minimum of ten continuity of care experiences with childbearing women. However, women are rarely asked to formally evaluate this care by students. AimTo evaluate data from a routine, web-based survey of women about having a midwifery student provide a continuity of care experience. MethodsAll women (n=886) recruited by a midwifery student for a continuity of care experience during a 12 month period received an email inviting them to complete an online survey. The survey included personal details, experiences of care, and two scales on Respect and Satisfaction. ResultsA response rate of 57% (n=501) was achieved. On average students attended six antenatal visits (mean=5.83) and had six postnatal contacts with women. Most students attended labour and birth (92.6% n=464). Most women rated overall satisfaction with care by their student as ‘better than they had hoped’. Positive correlations were found between number of antenatal visits and postnatal contact with students on both levels of satisfaction and respect felt by women. Women felt more satisfied when their midwifery student attended labour and birth. ConclusionsThe online survey was feasible and provided valid and reliable feedback from women about their student during a continuity of care experience. Women valued having an ongoing relationship with a student during pregnancy, labour and birth, and postpartum. Pre-registration midwifery education programs should continue to privilege relationship-based care and national standards should support the effective integration of continuity of care experiences.

A study to evaluate the introduction of the Newborn Infant Physical Examination knowledge and skills into an undergraduate pre-registration midwifery education programme

Newborn Infant Physical Examination is recommended between six to 72 h from birth and the midwife is ideally placed to undertake this screening examination. In the United Kingdom only a small percentage of midwives are competent to undertake this screening, and is usually taught once qualified. The aim of this qualitative study was to explore the experiences of student midwives in relation to the impact and effectiveness of introducing the theory of Newborn Infant Physical Examination into an undergraduate midwifery curriculum and the opportunity to apply the skills in practice. Two focus groups with final year student midwives (n = 11) were undertaken. The transcribed interviews were reviewed by the researchers and thematically analysed. Three themes emerged: i) timing of the theoretical content, ii) applying theory to practice iii) holistic care. Recommendations include the importance of incorporating the theoretical elements into the programme even if students do not have the opportunity to become competent in the required skills. Most students favoured the theory elements to be threaded throughout the three year programme rather than having a single dedicated module. Students identified that when midwives completed the newborn examination, holistic care was improved.

Pre-registration midwifery education: is ‘cleverness’ the ‘7th C’?

Pre-registration midwifery education is vocational, requiring the teaching of specific skills and knowledge in preparation for a career as a midwife. In addition to being competent and confident in practice, student midwives are also expected to possess six fundamental values in order to deliver care of the highest quality: care, compassion, competence, communication, courage and commitment—known as the ‘6Cs’. This article will outline how the University of Northampton's midwifery team and colleagues in Library and Learning Services collaborate to support student midwives in their academic journey to develop sound academic skills, thereby nurturing the 7th C: ‘cleverness’. Thanks to this partnership, students are aided to pass the programme of study with a BSc (Hons) degree and enter the workforce as a committed lifelong learner.

Is the incorporation of the newborn examination in the pre-registration curriculum acceptable in clinical practice? A qualitative study.

The objectives of this qualitative study were to describe the experiences of currently practicing newborn examiner midwives who had accessed their training post registration; explore their views on the inclusion of newborn examination in the pre-registration curriculum and invite them to identify strategies to achieve practical implementation of the inclusion of the newborn examination in pre-registration in the practice setting. Data were collected through semi-structured interviews and analysed using Thematic Analysis with an inductive approach. Three main themes were identified; experiences of the role, views of the newborn examination being incorporated into the pre-registration midwifery curriculum and practical considerations. The findings from this study show that currently practicing newborn examiner midwives accept the need for inclusion of the newborn examination in pre-registration midwifery education in order to sustain the best service for mothers and babies. The findings also indicate a need for ongoing interprofessional learning, support and investment to maximise efficiency of the service.

Early-career midwives' experiences of perineal assessment and repair after normal vaginal birth

Background It falls within the midwife's scope of practice to assess and repair first- and second-degree perineal trauma. Failure to accurately do so can lead to significant maternal morbidities. Evidence suggests that this can be a source of anxiety for midwives. Aims To explore early-career midwives' experiences of performing perineal assessment and repair after normal vaginal birth. Methods A qualitative semi-structured interview study analysed via interpretative phenomenological analysis. Six purposively-selected midwives, qualified for fewer than 5 years, were interviewed. Findings The study identified two superordinate themes. ‘Working and learning in an imperfect environment’ highlighted inadequacies in pre-registration midwifery education in preparing midwives for suturing, and a lack of support for developing their clinical skills once qualified. ‘Knowing myself, understanding my women’, highlighted midwives' understanding of suturing in terms of professional identity, responsibility for women's wellbeing and promotion of continuity. Conclusions Midwives often experience their pre-registration training as poor preparation for suturing in practice. Once qualified, preceptorship programmes can be variable and support for skills development is often lacking. Time constraints and structural hierarchies can inhibit the ability of midwives to articulate and advance their learning needs.

An evaluation of the midwifery Pre-Qualifying Skills Passport in Wales

Background Standards for pre-registration midwifery education are being reviewed by the Nursing and Midwifery Council. In Wales a pre-qualifying skills passport (PQSP) has been in use for almost 5 years, and is designed to give midwives a chance to acquire key skills before they qualify. Aim This article presents the findings from a recent review of the Welsh PQSP. Methods Questionnaires were sent out to mentors, newly qualified midwives, midwifery lecturers and midwifery managers. Completed questionnaires were received from 167 users. Findings The PQSP helped mentors and students to know what is expected of newly qualified midwives, led to improved opportunities for vital skills acquisition and was easy to use in busy practice settings. It integrated knowledge with skills and it helped to learn skills step-by-step. There was also interest in adding further skills to the PQSP. Conclusions These findings are a positive foundation for future education standards and could be developed as a continuing professional development tool for a midwife's entire career.

Students in practice: The role of the student support midwife

The Nursing and Midwifery Council's Standards for pre-registration midwifery education state that the balance between clinical practice and theory for pre-registration midwifery education should be no less than 50% practice and no less than 40% theory. Time spent in clinical practice should enable students to achieve the required standards to be competent and confident at the point of registration. In September 2020 ‘future proof’ standards of proficiency for registered midwives will ensure student midwives are adequately prepared to deal with the increasingly complex demands of their chosen profession. In the interim, the model of support with students being supervised by sign-off mentors will remain in place. This article will discuss how one Trust has introduced the enhanced role of student support midwife to coordinate student placements.

'Living the rural experience-preparation for practice': The future proofing of sustainable rural midwifery practice through midwifery education.

Rural practice presents unique challenges and skill requirements for midwives. New Zealand and Scotland face similar challenges in sustaining a rural midwifery workforce. This paper draws from an international multi-centre study exploring rural midwifery to focus on the education needs of student midwives within pre-registration midwifery programmes in order to determine appropriate preparation for rural practice. The mixed-methods study was conducted with 222 midwives working in rural areas in New Zealand (n = 145) and Scotland (n = 77). Midwives' views were gathered through an anonymous online survey and online discussion forums. Descriptive analysis was used for quantitative data and thematic analysis was conducted with qualitative data. 'Future proofing rural midwifery practice' using education was identified as the overarching central theme in ensuring the sustainability of rural midwives, with two associated principle themes emerging (i) 'preparation for rural practice' and (ii) 'living the experience and seeing the reality'. The majority of participants agreed that pre-registration midwifery programmes should include a rural placement for students and rural-specific education with educational input from rural midwives. This study provides insight into how best to prepare midwives for rural practice within pre-registration midwifery education, in order to meet the needs of midwives and families in the rural context.

Embedding evidence-based practice within the pre-registration midwifery curriculum

Clinical midwifery skills and understanding are continually changing in line with research evidence and service innovations. Evidence-based midwifery practice is essential to ensuring that the care provided to childbearing women is safe, effective and of the best quality to meet their individual needs. To deliver woman-centred care, evidence from research should be considered in conjunction with clinical experience and women's own preferences. One of the challenges for Higher Education Institutions that offer pre-registration midwifery education is to incorporate evidence-based practice across the curriculum so that student midwives see it as an integral part of their role, rather than as a separate concept. Midwifery students need the knowledge and skills to identify areas of practice in need of investigation, an understanding of how each stage of the research process works, and the skills to critique research studies to ensure that their practice is evidence-based.

Beyond Brexit: Cross-border collaborations in pre-registration midwifery education

In June 2016, the UK voted to leave the European Union (EU), which will have wide ranging social, legal and constitutional implications. Although the International Confederation of Midwives has established international standards for midwifery education, education and practice are regulated through an EU directive that includes the recognition of professional qualifications that is necessary for midwives to practise anywhere within the EU. While there is uncertainty around the future political landscape post-Brexit, it is important that pre-existing professional links are protected and strengthened, providing a platform for international collaboration for professional discourse, dissemination of research findings and sharing of best practice. At the University of Northampton, this is happening through partnership with The Florence Network, which connects nurses and midwives.