Women and Birth
Volume 20, Issue 4 , Pages 149-152, December 2007

Women's experiences of a Follow Through Journey Program with Bachelor of Midwifery students

  • Colleen Rolls

      Affiliations

    • School of Nursing & Midwifery, Australian Catholic University, St. Patrick's Campus, Fitzroy 3065, Australia
    • Corresponding Author InformationCorresponding author at: School of Nursing & Midwifery, Australian Catholic University, Locked Bag 4115, Fitzroy MDC 3065, Australia. Tel.: +61 3 9953 3191; fax: +61 3 9953 3355.
    • ,
  • Betty McGuinness

      Affiliations

    • School of Nursing & Midwifery, Australian Catholic University, Aquinas Campus, Ballarat 3353, Australia

Received 19 February 2007; received in revised form 3 September 2007; accepted 3 September 2007.

Article Outline

Summary 

The purpose of this study was to explore the experiences of women involved with Bachelor of Midwifery students enrolled at Australian Catholic University (ACU), Victoria in a Follow Through Journey Program. The study incorporated an exploratory descriptive design utilising semi-structured interviews. Seven women participated in the study. Data analysis identified four major themes. These are as follows: women and students in partnership; the student was for me; making a difference, and the system. Women were very satisfied with the Bachelor of Midwifery student Follow Through Journey Program because the outcome for them was an empowering pregnancy, birth and early parenting experience.

Keywords: Midwifery students, Education, Women's experiences, Women-centred care, Maternity care, Childbearing, Follow Through Journey

 

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Introduction 

Women-centred care is an approach in midwifery practice that implies a focus on the woman's individual needs, expectations, and aspirations within her particular social milieu.1 During their 3-year course, Bachelor of Midwifery students at Australian Catholic University (ACU) recruit and observe continuity of midwifery care with 30 women in a Follow Through Journey Program. The Follow Through Journey is defined as ‘the ongoing midwifery relationship between the student and the woman from the initial contact in early pregnancy through to the weeks immediately after the woman has given birth, across the interface between community and hospital settings’.2 For the student, the Follow Through Journey consists of observation and when appropriate, under the supervision of a qualified midwife, assisting in activities such as: health assessment, health promotion, support during the process of birthing, and follow up visits for the woman and her baby. One significant aspect of the Follow Through Journey Program at ACU is that students are allocated an experienced midwife as a mentor, to facilitate consent, provide education and support to the student and woman, along with assessment and documentation of the Follow Through Journey experience. The purpose of this study was to explore women's experiences of participating in the Follow Through Journey Program with student enrolled in the Bachelor of Midwifery course at ACU.

An evaluation of the experiences of the first cohort of Bachelor of Midwifery students at ACU found that Follow Through Journey provided opportunities for students to develop partnership skills and increase their confidence.3 The number of mandated Follow Through Journey experiences, however, was considered by students to be too many and for some, recruitment of women was difficult. Anecdotally, students enjoy this aspect of their course because of the richness of midwifery experiences encountered.

As Follow Through Journey Programs for Bachelor of Midwifery students in Australia are recent additions to midwifery and midwifery education, related research is limited. No studies were located that looked specifically at women's experiences of student involvement in their childbearing journey. Support and continuous companionship during pregnancy and birth have been studied extensively, and found to be associated with significantly less need for analgesia, instrumental and caesarean births, shorter duration of labour and an increased sense of personal control.4, 5, 6, 7, 8 Midwife characteristics such as empathy, friendliness, tenderness, calmness and trust were identified as factors supportive of woman-centred care during pregnancy and labour.9, 10, 11 An additional aspect of women's satisfaction with their birth experience was their relationship with the midwife, communication and involvement in decision making.11 A study to explore women's experiences of the Follow Through Journey Program with an emphasis on the student–woman relationship and the benefits women gained from this relationship therefore, was warranted.

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Method 

The study incorporated an exploratory descriptive design utilising feminist principles of with, and not on women, mutual respect and sharing.12 Semi-structured interviewing was utilised in this study with the aim of exploring women's experiences of the Follow Through Journey Program. These included their perceptions of the student qualities that were helpful to women, student support offered during birthing and early parenting and whether women would recommend Follow Through Journey to others, and be involved in the program again. The researchers conducted the interviews individually with one researcher undertaking four interviews and the other researcher three interviews. Interview probes encompassing the study aims were developed and used in each interview to maintain reliability. Ethics approval to conduct the study was granted by ACU National Human Research Ethics Committee. Participants were interviewed in their homes from May to September 2005. All interviews were tape-recorded and lasted 30–40min.

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Participants 

Purposive sampling was utilised with women who had been involved in the Follow Through Journey Program during the preceding 3–6 months and who were linked to midwifery students from any of the 3-year levels. Women were asked during recruitment into the Follow Through Journey Program whether they would be available for research and or evaluation projects. Seven women identifying a willingness to participate in further research were invited to participate and chose to do so. The age of women ranged from 22 to 40 years. Four women were primigravida and three were multigravida. The women's birth outcomes included six vaginal births, one caesarean birth for foetal distress, two of the women were induced and two women had epidural anaesthesia. The women were interviewed when their babies were aged from 3 to 5 months.

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Data analysis 

Interviews were audio-taped and later transcribed. Transcripts were analysed by the method described by Richards,13 where initial reading opened up the data. Further reading and analysis generated ideas. Interesting aspects of the text were noted and as described by Richards these data were interrogated. Interrogation involved asking questions of the conditions, consequences and interactions involved in the data and recording this information in memos. A process of drawing what was seen in the data then occurred and finally, themes were constructed by the researchers.

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Results 

Data analysis identified four major themes arising from this research: women and students in partnership, the student was for me, making a difference and the system. Excerpts from women's interview transcripts are included in the results. Transcripts have been identified numerically to maintain confidentiality.

Women and students in partnership 

The women perceived the students in this study to be with women. This was indicated by data identifying that the women made connections with their student, were supported, felt comfortable, empowered, developed trust and a strong woman–student partnership bond was established. One woman has described the student being with woman in that (the student) “…never made it feel it was part of her study. …It was a relationship”. Another woman claimed that the student brought to the relationship strength and support. This was because they were able to talk in a “…womanly way”. Whilst another woman reported that the benefit to her of the partnership was the student being in tune with her wishes and ways. Still another recalled: “I trusted the student very much and developed a strong bond with her”. For one woman the student was:

She is just so um --- understanding, I suppose. I think at times I was afraid of expressing feelings and thoughts to other women because --- um … I think people can be very judgemental of new mothers and pregnant women and I just felt that she [the student] was very understanding and so very, very strong (Transcript 2).

The student–woman relationship continued during the first few weeks of the baby's life with students visiting women. One woman reported that the student visited frequently although she was “…respectful of giving us our space”. The woman valued the visits because they were educational and “just really nice”.

One woman claimed that her relationship with the student, especially after the baby was born, had the potential to prevent depression. She elaborated:

One day she just turned up with a bunch of flowers .. and we just chatted; it was so nice. … [It] was really easy for me to tell her how wonderful and brilliant .. just the support you need … I know it gets you through… you know I have never had postnatal depression but you can just feel it creeping in sometimes, when you are by yourself and you don’t have the support (Transcript 5).

The student–woman relationship contributed to the positive birth and early parenting experiences for the women in this study. A ‘with woman’ philosophy of care underpinned the student–woman partnership.

The student was for me 

Analysis of data revealed all the women regarded themselves as the main focus of the student's attention. This was something that the women wanted and believed they did not get in the maternity care system they had chosen to use for their pregnancy and birth. One of the ways in which the student was described as being for them was expressed by one woman as “having one person all to oneself” and by another woman as “having someone there just for me was fantastic”.

The theme identified intuitive behaviour from the student as an important aspect of being for them. One woman described how she valued the student's intuitive way of being with her because it was helpful in identifying her needs:

She was very intuitive … I think for me it seems to go without saying, she was very intuitive … sorry I just associate this fact with her … she actually helped me to know what I wanted as well … (and) … its great to have someone who you can go to who you trust and I trusted the student very much, and developed a strong bond with her as well (Transcript 7).

Keeping the focus on the women's individual needs is described by one woman who, when asked about her sense of control in pregnancy and birth, talked about the affirming language the student maintained in the birth room when a midwife said:

You are not in labour and I’m not getting excited yet the woman said … the student was very strong about, you know, what's going on … you’re the one who's feeling this, and yes you probably are in labour (Transcript 2).

Having a student made a difference 

Making a difference was exhibited in the data by the birth support role that students carried out. The women believed the students exhibited perceptive knowledge about the care they wanted during labour and birth. This was birth support care that the women considered they did not have the right to demand and sometimes midwives were perceived as not providing.

Some women believed that students made a difference to their labour and birth by being a “go between”, translators, protectors, and as a “tower of strength”. From the women's perspective, student strength was explained as “…that constant encouragement” and an approach which included a great deal of “softness”. Student encouragement and strength, one woman said, helped her through her labour, through the “…hardest bit…”. This woman also claimed encouragement and strength were “…great for the pain relief as well”.

Some women claimed students acted as negotiators or as protectors in hospital settings. This can be demonstrated by the following quote describing how, the student negotiated the woman's labour care with hospital midwives:

She vocalised a lot to the midwives at the hospital. It certainly appeared to me that she totally knew my rights. I really did not know it is OK to say no. (She) … helped me a lot with her confidence (Transcript 3).

Another woman perceived the student negotiator and or protector role to be related to strength. The following quote illustrates this woman's viewpoint on student strength and what it meant for her during labour.

…she was very strong, …when I asked her a question there was no fluffing around, especially when I was in actual birth. … you want someone who is going to be direct … because you need to lean on them at this time … I think strength was definitely a (student) quality (Transcript 4).

Making a difference for all the women was the birth support role performed by the students. A role that involved negotiating birth plans with midwives as well as providing encouraging and supportive labour and birth care for the women.

Students bridge the system 

Women in the study perceived the care they would receive in the hospital settings would not be what they desired for their labour and birth. Some women were fearful that their birth plan would not be respected in the labour ward environment. The role of the student in bridging the system and negating this fear is described by one of the woman:

… towards the end I became so glad that I had someone there who was going to be like a go between for me, as I was scared that things would happen in hospital that I wouldn’t be happy with (Transcript 1)…

Another woman described how the student worked within the system to protect her from unwanted intrusions into her privacy during labour by being a gatekeeper. The woman identified how the student performed this task by:

… became so important during my labour. There were things happening in labour, when I went to hospital that were very upsetting … people coming in, so lots of new faces. There was a trainee standing around like a stunned mullet, staring and not being communicative with me at all, not telling me who she was. It was just like having strangers walking in off the street through the most personal, probably the most powerful experience ever of my life … and the student --- I asked her to tell her (the trainee) to go away, and she did.… it was great to have her there, so strong …to ward them off kind of thing (Transcript 6).

Some women in this study talked of midwives in hospital being too busy, and being reluctant to interrupt them, and of medical staff who disregarded them. One woman said that midwives in the hospital could not give her their full attention due to other women's demands, although she regarded the midwives, whom she knew reasonably well, as “…open and available…” and respectful of her partnership with the student. The same woman claimed that medical staff did not listen to her requests or at least her requests were not taken into account, yet she stated they listened to the student.

This study clearly elucidated that the women wanted supportive and caring pregnancy and birth experiences which was more than the hospital system offered. As one woman pointed out she really knew what she wanted, and the presence of the student provided the vehicle through which her desires were achieved. It was the student's presence and focus upon women, which empowered the women in this study.

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Discussion 

This study was confined to stories of seven women purposively invited to be part of the research as they were involved in the Follow Through Journey Program at ACU National, Victoria. The study identified how the relationship between student and woman enabled the woman's birth plan to be implemented during labour and birth. According to these women, student strength was displayed through a relationship where trust and respect enabled woman to be empowered and thus retain control, albeit with student support during birthing. Students made a difference because of their woman-centred approach, their strength, support and encouragement.

From the women's stories the researchers identified a number of interrelated issues about the health care system including fear of loss of control and powerlessness. Fears existed due to a perceived disparity separating women from the labour and birth experience they desired and what they would be likely to experience. It was evident that women in this study had been triumphant being in control during pregnancy, yet on entering the hospital to give birth became vulnerable, powerless and isolated in a system that was foreign to them. The study identified how students as birth support persons were instrumental in assisting these women to fulfil their birth plans.

The study found that the women participants benefited from support and a consistent, continuing relationship during the childbearing continuum. Van Zandt et al.5 in the United States identified that student nurses in a Birth Companions Program educated to be doulas, showed an association of lower epidural use with increased complementary doula interventions. That students made a difference for women during childbearing, with their presence and actions, highlights their capability of adopting a women-centred approach in their course. Potentially Follow Through Journey could be developed into a formalised program in Victoria allowing students to achieve required practice experiences mandated by the state government regulatory body.

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Conclusion 

Limitations of the study include the small sample size, purposive sample of women and the positive birth experiences of all the women participants. It could be argued that women volunteering to participate in a research project such as this, 3–5 months after the birth of their baby will only report positive outcomes and as such further exploration of this area is warranted.

Overall, women in this study were very satisfied with the Bachelor of Midwifery student Follow Through Journey Program at ACU, because the outcome for them was an empowering pregnancy, birth and early parenting experience. Additionally, for the midwifery students, acknowledgement that they do practise in a woman-centred way has occurred in this small study. The Follow Through Journey Program provided benefits to women throughout the childbearing continuum.

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Acknowledgements 

This project was funded by Australian Catholic University, Faculty of Health Sciences, Dean's Initiative Fund. We would like to thank the women who participated in the Follow Through Journey with students and as research participants.

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References 

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PII: S1871-5192(07)00095-9

doi:10.1016/j.wombi.2007.09.001

Women and Birth
Volume 20, Issue 4 , Pages 149-152, December 2007

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