Elsevier

Midwifery

Volume 86, July 2020, 102691
Midwifery

Evaluation of a student-led midwifery group practice: A woman's perspective

https://doi.org/10.1016/j.midw.2020.102691Get rights and content

Highlights

  • Women value continuity of care with student-led midwifery models of care.

  • Women value students’ learning experiences in a continuity of care model.

  • Women value being informed throughout the course of pregnancy by student midwives.

  • Women feel continually supported by student midwives’ experience and expertise.

  • Women feel included in decision-making processes with student-led midwifery models.

Abstract

Background

 .

Objective

To evaluate women's experiences of a student-led midwifery group practice.

Design

A mixed methods design was used to examine women's experiences and level of satisfaction about a student-led midwifery model of care. An on-line survey elucidated women's levels of satisfaction and experiences with the student-led midwifery group practice. The online survey was sent to all women (n = 25) who were receiving care from third year Bachelor of Midwifery students in 2018 via email up to 6 weeks postnatally. The online survey was distributed in the first instance to obtain baseline information about the importance of this student-led midwifery group practice and so the survey information was linked to the in-depth interview in the analysis for the purpose of identifying if the women were primiparous or multiparous. Women (n = 9) were invited to participate in an in-depth interview by self-opting on the survey and this extra data provided a richer understanding about the level of satisfaction about woman-centred care led by midwifery students.

Retrospective data were also collected from the Maternity database - E-Maternity about birth outcomes.

Setting

A tertiary teaching public hospital in New South Wales (NSW).

Participants

Fifteen women participated in an online survey. Five primiparous and four multiparous women opted to be involved in the in-depth interviews on the online survey.

Measurements and findings

Analysis in SPSS provided descriptive statistics including frequencies and percentages of data including birth outcomes. Simple correlations enabled associations to be established between levels of satisfaction, individualised care, quality of care, benefits and anxiety during pregnancy. The overarching themes from the qualitative findings identified the students’ presence for the women as the most important component of the women's journey. The four main themes that emerged from the study included: familiarity of the caregiver, staying informed on the journey, feeling supported and reassured by their expertise, and control and decisions over birth events.

Key conclusions

For a variety of reasons, women valued the presence of the students throughout their childbearing journey, including valuing the woman's private space during labour and her time with her partner. This combination of pedagogical approaches provides an alternative to the current placement approach, which includes working shifts in all areas of maternity. This approach will better support midwifery students to achieve the skills necessary to provide a continuity of care experience (CoCE) amongst a small team by a student-led midwifery group practice that is supported by a registered midwife in the antenatal clinic. The midwifery student is able to develop a relationship with the woman as a component of the CoCE under the guidance of a registered midwife and this is an important underpinning of the philosophy of woman-centred care.

Implications for practice

This model of care provides evidence that women do value the students’ support and presence throughout their experience and that the benefits of this model should be offered to all women as a normal component of their midwifery care.

Introduction

The introduction of student-led midwifery group practice is a timely initiative to the midwifery profession, directing us towards the vision of the profession. This vision extends from a large body of evidence that shows that midwives as primary carers are an essential element in reducing high maternal and neonatal mortality rates in all settings in all countries (UNFPA, ICM, WHO, 2014) and that quality midwifery education was a key aspect in reaching this vision (Luyben et al., 2017). This CoCE initiative encompasses the forming of a unique and nuanced relationship between the woman and the midwifery student to enhance better outcomes for both the woman, her baby and significant others including her family and community members. There is limited evidence exploring women's experiences of student-led midwifery group practices. Preparation of midwifery students to enter the profession as safe and competent practitioners is an essential requirement of the profession (Nursing and Midwifery Board of Australia, 2018) and midwifery group practice is one way of developing the skills necessary to build a relationship with the woman.

At one NSW tertiary hospital, the Women's and Children's Health Network (services department) has a high quota of midwifery students and it became increasingly difficult to place all students at a given time into the antenatal clinic, making it difficult to achieve the university mandatory clinical requirements of CoCE's due to the overburdening of the number of midwifery students to each midwife's capacity to support the student. The student-led midwifery group practice piloted their first antenatal clinic in 2015. This initiative was signed off by the Head of Department for Women's and Children's Health as a new model of care. The four Bachelor of Midwifery students study at two universities and are allocated to spend time in a caseload midwifery antenatal clinic that has evolved into a midwifery student-led midwifery group practice. The students follow through approximately 40 women throughout their final year, meeting the requirement of the 10 CoCE women for the Bachelor of Midwifery program. This alternative was posed to support midwifery students and also provides another opportunity to provide care for low risk women and their families. This study focused on data that were collected in 2018.

Section snippets

Literature review

The concept of woman-centred care is an integral component to this CoCE relationship as the midwife focuses on each woman's individual needs encompassing her physical, psychosocial, emotional, intellectual, spiritual and cultural needs. A component of the National Maternity Services Plan 2010 to 2015 (Australian Health Ministers Advisory Council, 2011) was to provide quality evidence-based care to women close to where they live. This plan included a five-year national initiative of continuity

Aim of the study

This study aimed to evaluate women's experiences of a student-led midwifery group practice.

Methods

This research was an exploratory mixed methods study that explored women's experiences and level of satisfaction about a student-led midwifery model of care. The four students in this model of care worked as a team, with two students working primarily as a pair. This enabled the students to work as primary and back-up caregivers for the women. However, the women could have met all of the midwifery students providing antenatal care. This study was approved by the local Health District Human

Participant characteristics

The participants who completed the surveys were aged between 20 and 40 with a mean of 30 (seeTable 3).

The majority of women's responses were positive about the student-led midwifery group practice clinic. The most positive responses (strongly agree, always and relaxed) were scored 1 as compared to the other end of responses (disagree, never and highly anxious) that were scored 4 to 5. The total number of women who responded to the survey and their responses are displayed in Table 4. Women

Discussion

This mixed methods study measured and explored women's satisfaction levels and experiences of all risk primiparous and multiparous women who completed their childbearing journey with a team of four Bachelor of Midwifery students from two different universities in their third year in a public hospital within a student-led midwifery group practice model that underpinned a CoCE model of care. Both the quantitative and qualitative findings resonate the benefits and satisfaction with the quality of

Limitations

The small sample size of the quantitative study component and the nature of the qualitative design of this mixed methodological design may not be generalizable to other populations. Women in this study were interviewed within 6 weeks of the postnatal period, reducing the risk of recall bias.

Conclusion

This study has measured and explored women's experiences of a student-led midwifery group practice model of care that underpins a CoCE philosophy. This study has offered more substantive findings about the importance and appropriate trajectory for students into midwifery group practice models of care. The data from this study highlight the importance of woman-centred care for women during their childbearing journey.

Contributor

Sandra Lyness Clinical Midwifery Educator - Nepean Blue Mountains Local Health District

Ethical approval

Obtained from the Nepean Blue Mountains Local Health District HREC on 17 Dec, 2017 – HREC/17/Nepean/134 and Reciprocal Approval from Western Sydney University HREC on 19 Dec, 2017 – RH125.

Funding sources

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

CRediT authorship contribution statement

Virginia Stulz: Conceptualization, Formal analysis, Investigation, Methodology, Validation, Writing - original draft, Writing - review & editing. Dr Rakime Elmir: Writing - review & editing. Heather Reilly: Formal analysis, Writing - review & editing.

Declaration of Competing Interest

None declared.

Acknowledgement

We would like to acknowledge Sandra Lyness, the Clinical Midwifery Educator - Nepean Blue Mountains Local Health District in her assistance with recruitment of women.

References (35)

  • N. Tickle et al.

    Women’s experiences of having a bachelor of midwifery student provide continuity of care

    Women Birth

    (2016)
  • O. Tierney et al.

    A historical account of the governance of midwifery education in Australia and the evolution of the continuity of care experience

    Women Birth

    (2018)
  • S.K. Tracy et al.

    Caseload midwifery care versus standard maternity care for women of any risk: M@NGO, a randomised controlled trial

    Lancet

    (2013)
  • R. West et al.

    Culturally capable and culturally safe: caseload care for Indigenous women by Indigenous midwifery students

    Women Birth

    (2016)
  • J. Allen et al.

    The impact of caseload midwifery, compared with standard care, on women’s perceptions of antenatal care quality: survey results from the m@ngo randomized controlled trial for women of any risk

    Birth

    (2019)
  • The National Maternity Services Plan 2010

    (2011)
  • Australia's mothers and babies 2016—in brief

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