Women and Birth
Volume 20, Issue 2 , Pages 81-84, June 2007

Bachelor of Midwifery: Reflections on the first 5 years from two Victorian universities

  • Lisa McKenna

      Affiliations

    • School of Nursing and Midwifery, Monash University, Peninsula Campus, McMahon's Road, Frankston, Victoria 3199, Australia
    • Corresponding Author InformationCorresponding author. Tel.: +61 3 9904 4352; fax: +61 3 9904 4655.
    • ,
  • Colleen Rolls

      Affiliations

    • School of Nursing and Midwifery, Australian Catholic University (Victoria), St. Patrick's Campus, 115 Victoria Parade, Fitzroy, Victoria 3065, Australia
    • Tel.: +61 3 9953 3191; fax: +61 3 9953 3355.

Received 5 March 2007; received in revised form 3 April 2007; accepted 3 April 2007.

Article Outline

Summary 

Bachelor of Midwifery programs in the state of Victoria, Australia commenced in 2002 through an affiliation of three universities in Melbourne named the ‘Werna Naloo Bachelor of Midwifery consortium’. The approach allowed for collaborative synergies in program delivery through offering online ‘consortium’ units each semester in addition to on-campus content at each university.

It is now 5 years since the first cohort of students commenced the course. During those years, members of the consortium have experienced a range of challenges and tensions. This paper provides a reflection by the course coordinators from two remaining members of the consortium, Australian Catholic University and Monash University. It explores issues confronted, regulation and registration, educational and clinical practice issues. In addition, the authors discuss course outcomes in terms of employment of graduates and their integration into the workforce, career development pathways and demand for the course. The authors conclude that the consortium has been successful and course outcomes positive with graduates successful in securing employment. Overall, the future for the Bachelor of Midwifery at both universities appears positive.

Keywords: Bachelor of Midwifery, Direct entry, Consortium, Midwifery education

 

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Introduction 

The beginning of Bachelor of Midwifery courses was a new era in the education of midwives in Australia. In 1999, Australian College of Midwives (Victorian Branch) advocated the introduction of Bachelor of Midwifery courses into Victoria for a range of reasons including addressing consumers’ demands for choice in maternity care, issues of professionalism, and changing health care needs.1 It is now 5 years since the first Bachelor of Midwifery students commenced their courses. Australian Catholic University (ACU) first introduced the Bachelor of Midwifery in 2002 and Monash University in 2003. Since that time, ACU has graduated three groups of graduates and Monash has graduated two. Bachelor of Midwifery course teams commenced with grand ideals and expectations, many of which have been realized, while others are still being sought. This paper provides some reflections by the two current course coordinators at these universities on the course 5 years after its inception.

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The Werna Naloo consortium 

The Werna Naloo consortium was conceived and developed from 2000. The indigenous title “Werna Naloo”, meaning ‘we, us, together’ was specifically chosen as the name for the grouping borrowed with permission from the Ganai Elders Language Reference Group. Initially the consortium consisted of three universities, Monash University, ACU and Victoria University.2 The goal of taking a consortium approach was seen to “pool expertise, provide support and collegiality and realize economies of scale” (p. 181).2 Each member developed ‘consortium units’ that are taught at all stages of the courses, and offered online across all of the participating universities. The size of the consortium has since been revised to a two university consortium structure with Victoria University's gradual withdrawal from 2005. However, recently other universities have expressed interest about joining the consortium.

Developing structures to support the consortium were integral to ensuring that it was successful. The complex committee structures required to manage the course across three locations have been previously described.3 Three committees were formed: Curriculum Implementation and Evaluation Committee (CIEC), Reference Committee, and Steering and Management Committee. CIEC consists of academic staff teaching midwifery units and the course coordinators from each university. The Reference Committee provides advice and involves representation from professional and industrial bodies, maternity services providers, consumers and students, while the Steering and Management Committee consists of Heads of Schools and course coordinators. These committees are held in addition to specific course committees of each university. Hence, the administration of supporting committees is both complex and time consuming.

Administering the course has also proven to be complex as not only are there home university requirements to contend with but also cross-institutional demands. Each university administers and teaches online units through the consortium to all students. This requires students enrolling at each of the universities at different times of the course. The work of the course coordinators involves approving many cross-institutional enrolments each year. However, the complexity of cross-institution study requirements is slowly being eased. Experience has helped as we now find ourselves more comfortable with the course structure and have established networks at each of the consortium universities to attend to issues that arise. Overall it can be said that a high level of trust has evolved between course coordinators to competently handle student enrolment and course progress issues.

Online learning for undergraduate midwifery education was a journey into the unknown as none of the universities had been involved in similar strategies before. Initially almost 50% of the course was offered online, that is, midwifery theory and an interdisciplinary support subject of sociology. By 2008 the online content of the course will be reduced to one third. A decision has recently been made to not have any online subjects in semester one of year one to allow students to adapt to university learning on-campus initially. The transition to university has been complicated for students in the consortium as they not only grapple with university life but units that are taught exclusively online. The change to be introduced in 2008 will enable students to be orientated to online learning and the technological aspects of the learning platforms at their home university initially before enrolling in a cross-institution subject at a host university. Enrolment in consortium units has been difficult for students in the first semester of their course because of the technical complexity of this type of learning for the novice. An additional benefit of delaying the introduction of the online units until semester two will be that cross-institution enrolment processes can be undertaken more expediently in the semester preceding the offering of online units.

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Regulatory bodies 

Australian College of Midwives Incorporated Standards for the Accreditation of Bachelor of Midwifery Programs Leading to Initial Registration as a Midwife4 were adopted by the Nurses Board of Victoria (NBV) as a foundation for accrediting Bachelor of Midwifery courses. These have been difficult to achieve in the current context of maternity services in Victoria, in particular the requirement for assisting 40 women during labour and with the process of normal birthing. A majority of students have been required to undertake additional clinical hours beyond what is prescribed in the curriculum, in some cases in significant amounts, to meet the requirements. This has resulted in increased costs in delivering the courses and questions over the continued viability of the courses by University finance managers and Heads of Schools.

In order to successfully complete the course, and meet registration requirements, students must undertake in excess of 1200 practice hours and 300 follow through journey hours totalling 1500 clinical hours over 3 years. This has further raised questions over course viability as this expectation is almost double the clinical hours that nursing students are required to undertake as part of the Bachelor of Nursing. Moreover, the combination of clinical hours has been identified as placing pressure on midwifery students and their families.

Registration of Bachelor of Midwifery graduates has also presented tensions for both the Nurses Board of Victoria and course graduates themselves. In Victoria no separate midwifery register exists. Consequently, graduates from Bachelor of Midwifery courses are registered in Division 1 of the register alongside registered nurses with restriction to practice midwifery only. Graduates see themselves working in a different discipline from nursing. Therefore, under the current structure, tensions have resulted from graduates not being nurses but being placed on a nursing register. A submission prepared by all universities offering midwifery courses in Victoria was submitted to the Nurses Board Victoria in 2004 requesting consideration of the minimum requirements for registration of midwives. To date no change has been officially announced to the Bachelor of Midwifery requirements.

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Educational issues 

Course teams at both universities have worked hard within their schools to have midwifery recognised as a distinct discipline since the commencement of the courses. Until 2006, both Monash University and ACU Bachelor of Midwifery courses were conducted within Schools of Nursing before they became Schools of Nursing and Midwifery. This has indicated acknowledgement from management of both schools that the two disciplines are distinct professions.

The viability of Bachelor of Midwifery courses at both universities has been questioned at school level at various times over the 5 years. The courses are expensive to run through the demands for clinical requirements. In order to increase viability, both schools have had to incorporate more nursing-based units into the programs. These units have been adopted where there has been clear replication of units such as in science, basic clinical care, professional practice and research. This approach is at odds with the philosophy that midwifery is a distinct discipline separate from nursing, however, necessary for cost savings and the viability of the courses at each university. The shift has necessitated increased communication between midwifery and nursing lecturers to ensure that content taught in the nursing units recognises midwifery practice. This has been a challenge resulting in midwifery lecturers needing to assist students and nursing lecturers to make necessary links to midwifery practice. It is expected that over time this need will decrease.

The individuals who have undertaken the Bachelor of Midwifery have also provided lecturers with many new challenges not previously encountered in other courses. Many students have themselves been through the childbearing process. Often, their experiences have attracted them to become midwives. In the initial weeks of the first semester each year, midwifery lecturers have needed to spend time helping many of these women work through issues associated with their own birthing experiences, often very negative ones. This has included helping them to remove themselves as the subject of the experience and encouraging them to focus on other womens’ experiences. It is a necessary exercise so the student can appreciate the experiences of women that they are encountering and not promote personal agendas.

Many students who have enrolled in the Bachelor of Midwifery to date are mature age. A large number have completed previous degrees so come from a wide range of backgrounds such as law, accounting, architecture, business, science and medicine, just to name a few. Each one brings with them different life experiences and expectations. However, both universities are experiencing a consistent increase in school leaver demand. Whilst these students maybe bereft of such diverse life experiences they enter the course with a passion to help women birth and parent within a caring environment. The recruitment of school leavers is considered a crucial one in a context where there is a growing shortage of midwives, an average age of 41.4 and a large part-time workforce in Victoria.5 Issues between mature aged and school leaver students have arisen with a negative attitude promulgated on the young adults because of their perceived minimal life experiences. Of concern has been the negativity projected on students in the clinical arena by midwives not supportive of Bachelor of Midwifery programs. Educationally, the students have required additional on-campus support because of online learning and clinical issues arising from episodes of horizontal violence.

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Clinical practice 

The two universities currently use different models for midwifery practice experience. ACU uses a block approach for placements where students attend clinical for 5 days per week for 4 weeks, while Monash University students attend clinical placements 2 days per week over the entire semester in the same hospital throughout their course. Each model has its benefits and limitations. Students from ACU have the benefit of seeing the same clientele throughout their confinement period while Monash students will usually see women for 2 days out of their total confinement. On the other hand, Monash students are always in the same hospital and develop some socialisation within the maternity unit to which they are attached. An evaluative study of the benefits and limitations of each model is currently being planned.

Clinical placements for both groups of students have been conducted largely in maternity units of large public hospitals. Midwifery units of some private hospitals have not been willing to host students as yet although this is beginning to change, while indemnity issues have meant that students have not been able to work with independent midwives. This has limited the scope of midwifery practice and models of care that students have been able to experience during their courses. As the Bachelor of Midwifery is underpinned by a woman-centred approach to care, and a variety of models for the delivery of midwifery care, classroom theory is often contradictory to what students are reporting that they have experienced in clinical practice. Many students have voiced experiencing tensions between women's rights to choose their models for midwifery care, witnessing approaches to care that are far removed from women-centred, and opportunities for women to make informed decisions about their childbearing experience. This situation, however, is not limited to the Bachelor of Midwifery. In their study, Leap et al.6 found that midwifery course coordinators were concerned that students did not have sufficient opportunities to experience different models of care.

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Employment and integration into the workforce 

Bachelor of Midwifery graduates from the two courses have generally experienced little difficulty in securing employment in hospitals throughout Australia that initially were reluctant to employ direct-entry graduates. These, however, are usually medium to large metropolitan hospitals and most graduates are accessing supported Graduate Midwifery Programs. Anecdotal evidence from some hospitals suggests that these graduates are an asset, and bring a refreshing woman-centred approach to midwifery care. While the Bachelor of Midwifery prepares midwives who can work in midwife-led models of care, many graduates are employed in obstetric-led models of care. The degree of influence that these graduates have on changing models available to women will be unclear for some time. In the present context regional and rural hospitals have expressed an inability to employ midwives who are not nurses as many small maternity units have periods where there are no midwifery clients, necessitating reallocating staff to general ward areas. However, this situation may well be overcome as the shortage of midwives in these areas becomes dire and alternate models for midwifery care evolve to maintain midwifery service delivery.

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Career development pathways 

One of the current challenges around the Bachelor of Midwifery centres on the potential for career development and further study options. Graduates from the course can articulate into Master of Midwifery (or similar) programs in some universities. However, at ACU graduates cannot enter research masters programs. A lack of opportunities for specialisation is an area requiring significant development. Currently, neonatal intensive care and maternal and child health courses require nursing qualifications for entry. While these seem to be obvious choices for Bachelor of Midwifery graduates, they are unable to apply as they do not meet the nursing requirement. It is argued that nursing courses contain an essential paediatric component however, the reality is that this is an area that many nursing courses are reducing.

Monash University has offered an honours program for Bachelor of Midwifery students to articulate into in the third year of their course. During their fourth year, students undertake a clinical research project while undertaking their graduate year. However, this course is currently being wound down. Hospitals around Melbourne are not eager to provide places in graduate programs for students undertaking research programs at the same time. Hence, demand has dropped and those students who have commenced their honours program, have been encouraged to revert back to the original course. Currently, no honours program exists at ACU for Bachelor of Midwifery graduates.

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Growing demand for the course 

Each year, demand for entry into the Bachelor of Midwifery is growing as more people become aware of its existence. This is positive in light of the predicted shortages, from the ageing and part-time status of the midwifery workforce. However, only a small number of the available applicants can be offered places at either university. The numbers of students that can be accommodated are constrained by a number of factors. The most pressing of these relates to the availability of clinical places and the large clinical practice requirements imposed by the regulating authority. Under present circumstances, there is extensive competition for clinical places. Hospitals have been receptive in attempting to meet the needs of many universities. This response has meant that there are often small numbers of students from each university allocated at a large number of clinical venues.

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Future developments 

Overall, the future for the Bachelor of Midwifery at both universities appears positive. Both courses have experienced challenges and will continue to do so. As demand for the course increases, it is likely that numbers of places will grow. However, clinical placements will need to be available to accommodate increasing student numbers. From a professional viewpoint this is necessary to meet future workforce requirements.5 It appears timely to seek out new opportunities for providing clinical experience for our students, such as in the private health sector where many women are choosing to birth in a different model of care.

Recently, the Nurses Board of Victoria has adopted the revised ACMI Standards for Course Accreditation of Bachelor of Midwifery Programs Leading to Initial Registration as a Midwife.7 These have revised the requirement for births from 40 to either 40 normal or 30 normal plus 20 other (forceps, caesarean sections, vacuum extractions) providing students with the opportunity to not only focus on normal birth. Given the high incidence of instrumental and caesarean birth in Victoria this requirement also has the potential to make registration requirements easier to achieve.

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Conclusion 

The first 5 years of the Bachelor of Midwifery within the Werna Naloo consortium have provided many challenges for course coordinators and students alike. Graduates from the courses have been readily accepted into the midwifery workforce with pleasing feedback. The consortium partners have been able to share their similar experiences and present a united front in seeking to deal with issues arising. Undoubtedly, the next 5 years will present new challenges and opportunities; however the future for the Bachelor of Midwifery in Victoria appears positive.

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References 

  1. Australian College of Midwives Incorporated (Victorian Branch) . Reforming midwifery: a discussion paper on the introduction of Bachelor of Midwifery programs in Victoria. Melbourne: ACMI; 1999;
  2. Cutts D, David P, McIntyre M, Siebold C, Hopkins F, Miller M, et al. ‘We Us Together’: the birth of a midwifery education consortium. J Adv Nurs. 2003;41:170–186
  3. Rolls C, Siebold C. The challenge of implementing an undergraduate midwifery course within a three university consortium. Contemp Nurse. 2005;18:273–278
  4. Australian College of Midwives Incorporated. Standards for accreditation of three year Bachelor of Midwifery courses. Available at: www.acmi.org.au [accessed May 2, 2004].
  5. Australian Health Workforce Advisory Committee. The Midwifery Workforce in Australia 2002–2012. Sydney: AHWAC; 2002;
  6. Leap N, Barclay L, Sheehan A. Results of the Australian Midwifery Action Project Education Survey Paper 2: barriers to effective midwifery education as identified by midwifery course coordinators. Aust Midwifery. 2003;16:6–11
  7. Australian College of Midwives Incorporated . Standards for the Accreditation of Bachelor of Midwifery Programs leading to initial registration as a midwife. Canberra: ACMI; 2006;

PII: S1871-5192(07)00027-3

doi:10.1016/j.wombi.2007.04.002

Women and Birth
Volume 20, Issue 2 , Pages 81-84, June 2007

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