Becoming a Midwife

Rosemary Mander, Valerie Fleming

• Publisher: Routledge
• Year: 2014
• ISBN:
  9781135107604
• Edition: 2
• Topic: Medicine
• Subtopic: Nursing

What is the reality of being a midwife in the twenty-first century? What is it like to help and support women throughout pregnancy and childbirth and into motherhood? What roles can midwives play in society?

This new edition of the popular text, Becoming a Midwife, explores what it is to be a midwife, looking at the factors that make midwifery such a special profession, as well as some of the challenges. The fully updated chapters cover a variety of settings and several different stages in a woman's pregnancy, including stories from midwives working in hospitals and in the community, as managers, supervisors and educators, and as men, women, mothers and birth activists. All chapters are narrated by contributors who introduce their own theme, recount a vignette that throws light on their understandings of midwifery and reasons for becoming (or not becoming) a midwife and any subsequent career moves. Backed up by commentaries and drawing together these insights, the editors show what it means to be a midwife today.

Suitable for those contemplating a career in midwifery and providing an opportunity for reflection for more experienced midwives, this thought-provoking book is an invaluable contribution to midwifery.

PART 1

The scope of midwifery

1

STUDYING MIDWIFERY

Kirsty Darroch and Valerie Fleming

Expectations versus reality

I consider my expectations of midwifery to have been relatively realistic. After all, I had at least some grasp of what the role of the midwife entailed, as it was largely down to the midwifery care I received during my own childbearing experiences that cemented my decision to become a midwife.

My expectations prior to commencing were simple: a caring role that would be predominantly rewarding and fulfilling while undoubtedly being both physically and emotionally demanding. I did not picture midwifery as cute fluffy babies all wrapped in pink or blue while we pranced about looking glamorous! But nor did I anticipate the often backbreaking emotional rollercoaster and almost conveyor belt-like births, liberally scattered with intervention, that were encountered all too frequently in the busy inner-city hospital setting. I merely aspired to provide women with meaningful support, empower them to birth naturally, and as recommended in Midwifery 2020 (2010), promote midwifery-led care and normality in birth.

The reality initially caused me to feel slightly disillusioned and I found myself questioning the wisdom of my career leap. I had after all anticipated a little more evidence of ‘normality’ and the ‘with-woman’ ethos of midwifery but much of what I observed was medicalisation, intervention and midwives under immense pressure from an ever-increasing workload fraught with challenges of many kinds. However, as time marched on, my confidence and competence increased and I reflected on practice and began shaping myself into the midwife I had sought to become. I made the reality work for me: I clung on during the rollercoaster ride and have stepped off feeling exhilarated, satisfied and fulfilled.

Embarking on the journey

As it was for me, the commencement of an undergraduate or pre-registration midwifery programme may be the first experience of university and hospital systems for many students (Green & Baird 2009) and as such, has the capacity to rouse mixed emotions. As a direct-entry midwifery student, I had absolutely no previous nursing or medical experience whatsoever and had only attended college many years ago as a teenager! So I can clearly recall feeling simultaneously terrified and desperately excited upon entering the classroom on day one of this life-changing journey. However, making that leap into new and previously unknown territory often instills a huge sense of achievement, which continues to drive the learner forward and maintains motivation, thus facilitating a positive learning experience.

As the International Confederation of Midwives (2010) states, the purpose of midwifery education is to create safe, effective practitioners who will provide care of the highest possible standard to women and their families. So, by necessity, midwifery is taught and thereby learned through a combination of theory (academic learning) and practice (clinical learning). As stipulated by the European Union, the balance of theory to practice must consist of ‘no less than 50 per cent practice and no less than 40 per cent theory’ (Nursing and Midwifery Council 2009) and may employ a variety of learning and teaching strategies, including simulation.

The curriculum for pre-registration midwifery education is determined by Nursing and Midwifery Council (2009) standards and midwife teachers within a university setting provide the academic theory. With many institutions offering the programme it is inevitable that there will be variances in its delivery, but the European Union Directive 2005/36/EC states clear outcomes incorporating general and specific subjects as well as issues to be covered in the clinical setting. All member states are required to adhere to this and consequently all education programmes contain some degree of similarity.

Rather than focus wholly on the curriculum and format of midwifery education, we now consider some of the more salient points throughout the journey. Along the route there are numerous experiences that are immeasurably valuable both on a personal level and also as an overall positive aspect of midwifery training. For example, the overwhelming awe and wonder when I first assisted a woman to give birth to her baby and the immense privilege of being a guest at what is undoubtedly one of a woman’s or couple’s most intimate moments will remain two of my abiding memories.

Other than relating my own reasons for becoming a midwife and points along the ensuing journey, several positive curriculum-based areas are also worth touching upon. One such aspect is a midwifery student’s supernumerary status. Often regarded as a ‘bonus’ in the clinical setting where staff shortages abound, this can afford the student the luxury of spending more meaningful time with women in their care who may well be at an emotionally vulnerable stage. As there are fewer demands on the student’s time, in some instances rapport and trust may be built readily, whereas, hampered by time constraints and staff shortages, qualified midwives in busy hospitals can sometimes do little more than nod to ‘luxuries’ such as relationship building whilst carrying out safe, efficient and effective care. As a result, women generally find care provided by students to be beneficial. Snow (2010) studied women’s perceptions of care provided by midwifery students, and observed that participants found emotional support was provided through the student’s continuous presence, positive and helpful attitude, facilitation of maternal trust and the sharing of a sense of ‘mutual newness’. The same study also considers the value of midwifery students acting as ‘companions’ and raises it as a gentle reminder to all midwives of the true meaning of with woman.

Another positive aspect for me was a caseloading assignment undertaken during the second year of my studies, which was both rewarding and daunting in equal measure! Simply put, this means the student (with predominantly indirect mentor supervision) was responsible for booking up to three women for maternity care and ultimately following them throughout their entire pregnancy and childbearing continuum; thus antenatal, intra-partum and postnatal periods. My particular mentor had great faith in my abilities (she had mentored me on previous occasions) and was more than happy to let me take the lead, knowing that I would work within my own limitations and would approach her or another member of the team if I had any concerns. Her belief in me boosted my confidence and allowed the realisation to dawn that in fact, I knew more than I gave myself credit for. Student caseloading is not a new phenomenon. Bournemouth University pioneered it in 1996, claiming holistic, woman-centred care as central to their pre-registration midwifery education and integral to this was caseloading. Current United Kingdom Standards for Pre-registration Midwifery Education (NMC 2009) also state that students should be afforded the opportunity to practise continuity of care through caseloading, and indeed Lewis et al. (2008) describe it as pivotal in promoting women’s choice and control. So, upon concluding my assignment, I was somewhat amazed to discover that I had indeed considered, planned and provided safe and effective midwifery care to these women and was rewarded by very positive feedback from them as well as my mentor, and a great sense of satisfaction.

Academically, problem-based learning (PBL) is thought to improve students’ knowledge of ‘real life’ situations by using problem-solving activities and learning to work within teams. PBL was advocated almost two decades ago by the World Health Organization (1993) and is still a popular teaching tool today. Initially, due to ignorance of the benefits on my part, I dismissed PBL as lecturers shirking their teaching duties and delighting in seeing us spend our days off chained to the library desk! However, as time wore on, I found these frequent exercises to be hugely beneficial to me in many ways and understood their relevance in our education. They required us to research, read and ultimately give presentations on topics that we had until then known very little about, which generally worked out well unless someone on the team didn’t fully share the workload. By pushing me out of my comfort zone, PBL forced me to face one of my biggest personal fears – standing in front of a roomful of people and speaking to them without sounding completely idiotic. Not only did I conquer my fear, but I consistently received extremely complimentary feedback from my lecturers by the latter period of my studies.

So what of the difficulties encountered during midwifery training? I experienced the odd horrendous shift or two; the essay that I just couldn’t make any headway with; or the feeling that my brain may have exploded if I crammed any more into it. However, one recurring theme throughout much of the literature points to students’ lack of self-belief or self-confidence in their own skills and abilities; feeling insufficiently prepared for practice; lacking emotional strength and experiencing fear or anxiety that they will not meet the expectations of other midwives and therefore not be successful as an autonomous, accountable practitioner. Much research is available providing more detail on this subject; however, the focus of this chapter is more the educational journey and experience of becoming a midwife and the preparedness that results: confidence (or the lack of) is but one component within the structure. It is however worth touching on. Skirton et al. (2011) found confidence in the newly qualified midwife to be a significant feature in their study and claim that while newly qualified midwives are often able to cope with many challenging clinical situations in a safe manner, they frequently report a lack of confidence in their own abilities. The feelings of one newly qualified midwife in particular can be empathised with. Initially, when discussing her newfound responsibility, she alluded to concerns that she lacked ability, which in turn negatively impacted on her confidence. However, upon exploration of these feelings she concluded that rather than any lack of competence or knowledge, ergo ability, it was more likely to be simply a lack of confidence, which should grow through time and with experience.

Licqurish and Seibold (2007) carried out a study using grounded theory and gathered data from eight final-year Australian midwifery students using in-depth interviews to ascertain the impact of the mentor/preceptor on the students’ learning and development. Although there were limitations due to a small sample size and little feedback from mentors, the findings – specifically those relating to confidence – are nonetheless very insightful. It was found that midwife mentors who were considered ‘helpful’ benefited the student by being supportive, allowing hands-on practice and mistakes, shared their knowledge, were motivated and encouraged the students to take responsibility, make decisions and develop new skills. Students cited being given opportunities for responsibility for care and hands-on learning as key factors in developing their confidence and competence. The flip side to this was the ‘unhelpful’ preceptor who was generally unsupportive, took over care, failed to provide learning opportunities – particularly hands-on learning – for the student and were inconsistent with advice and practice and therefore poor role models. These partnerships left students feeling that they learned very little and as a result seriously lacked confidence: one student claims her mentor ‘crushed’ her confidence to the point where she felt unable to continue.

Prevost (2011), a final-year midwifery student, concluded in her appraisal of mentorship provision that if the quality of clinical education is compromised – whether through mentor apathy at having to teach, lack of incentive, time constraints, demands of the job or lack of commitment – the effectiveness of the clinical education becomes dubious. She surmises that if factors such as these continue to affect the quality of mentorship, so the quality of future midwives may suffer. I consider myself to have been extremely fortunate with most mentors allocated to me. One in particular stands out as having been a godsend when it came to the matter of my confidence. She knew I possessed all the qualities and attributes of a good midwife – she believed in me when I didn’t believe in myself – and so she pushed me out of my comfort zone at times, allowed me innumerable questions and doubts and empowered me to go out there feeling sure of myself and safe. I therefore strongly agree with Evans and Choucri (2012) who found excellent mentorship in the clinical area as being key in enabling this transition from student to newly qualified midwife to be smooth.

Conflicting demands

Whilst anecdotal, an article written by Pallett (2009) manages to encapsulate some of the myriad facets to midwifery training. As a final-year midwifery student she observes that it is often any combination of terrifying, hilarious or exhausting and frequently very rewarding. She goes on to make reference to the juggling of assignments and academic deadlines – of which it seems there are a never-ending stream – and the struggle we often encounter in retaining a semblance of ‘normality’ in the non-midwifery side of our lives. A difficult task indeed with partners, children and families often making sacrifices to enable us to keep going and be there to talk us round in our darker hours.

There are undoubtedly instances throughout every midwife’s training where she doubts whether or not she will ever survive long enough to become a fully-fledged midwife. Much of this can be attributed to the somewhat demanding aca...

Table of contents

• Cover Page
• Half Title page
• Title Page
• Copyright Page
• Contents
• List of Contributors
• Abbreviations
• Introduction Choosing midwifery and being a midwife
• The scope of midwifery
• 1 Studying Midwifery
• 2 Midwifery Care in the Community During The Woman's Pregnancy
• 3 Midwifery Care with the Woman in Labour in an Institution
• 4 Midwifery Care of the Mother and Baby at Home
• The midwife and the wider environment
• 5 Midwives and Perinatal Mental Health
• 6 The Supervisor of Midwives and the Manager
• 7 The Academic Midwife
• 8 The Midwife as a Researcher
• 9 The Global Midwife
• 10 The Independent and Non-NHS Midwife
• 11 A Male Midwife's Perspective
• 12 Do Women Care If Their Midwife Has Had Children? A reflection on changing my mind
• 13 The Midwife Who Is an Author
• 14 On not Becoming a Midwife The role of the birth activist
• 15 The Ex-Midwife
• 16 Conclusion
• Glossary
• Index