Graduating midwifery students’ preferred model of practice and first job decisions: A qualitative study

Published:August 16, 2020DOI:https://doi.org/10.1016/j.wombi.2020.07.005

      Abstract

      Objectives

      To explore and describe the preferred model of practice and first job decisions of final stage midwifery students from three Western Australian universities.

      Design

      Qualitative descriptive.

      Setting

      Three Western Australian (WA) universities offering courses leading to registration as a midwife.

      Participants

      Twenty-seven midwifery students from undergraduate and postgraduate (pre-registration) courses.

      Methods

      Data were collected from recorded interviews and focus groups. Thematic analysis of interview transcripts was used to identify commonalities. Data saturation guided when recruitment ceased and final sample size was achieved.

      Findings

      Participants’ preferred model of maternity care was influenced by learning about and witnessing both autonomous midwifery practice and collaborative care during their studies. The greatest influence was clinical experience, with most preferring a continuity of midwifery model (CoM) but first consolidating their practice in a public hospital. Most students reported that they would not choose a private hospital as their first option. Work/life balance was also considered, with some accepting that family commitments and a need to work close to home may prevent them from choosing a CoM model.

      Conclusion and implications

      Although many Australian midwifery students start their midwifery course with preconceived ideology of their eventual workplace, the influences of their educators, clinical placement environment, preceptors and continuity of care experience relationships with women helped determine their final direction. To provide students with the experiences to become woman-centred autonomous practitioners it is important for universities and all maternity care providers to carefully consider their responsibility in how they influence midwifery students in education and practice.

      Keywords

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      References

        • ANMAC
        Midwife Accreditation Standards 2014.
        Australian Nursing and Midwifery Council, Canberra2014
        • Page L.
        Research on midwifery continuity of care shows many advantages.
        Br. J. Midwifery. 2013; 21: 690
        • Sandall J.
        • et al.
        Midwife-led continuity models versus other models of care for childbearing women.
        Cochrane Database Systematic Rev. 2016; 4https://doi.org/10.1002/14651858.CD004667.pub5
        • Tracy S.K.
        • et al.
        Caseload midwifery compared to standard or private obstetric care for first time mothers in a public teaching hospital in Australia: a cross sectional study of cost and birth outcomes.
        BMC Pregnancy and Childbirth. 2014; 14: 46
        • COAG Health Council
        Woman-centred care.
        in: D.o. Health Strategic Directions for Australian Maternity Services. Creative Common Licence, Canberra2019
        • Eddy A.
        Midwifery as primary healthcare.
        in: Pairman S. Tracy S.K. Dahlen H.G. Dixon L. Midwifery Preparation for Practice. Elsevier, Sydney2019
        • Guilliland K.
        • Tracy S.K.
        Contemporary Australian and New Zealand midwifery and maternity services.
        in: Pairman S. Tracy S.K. Dahlen H.G. Dixon L. Midwifery Preparation for Practice. Elsevier, Sydney2019
        • Department of Health
        Nursing and Midwifery Workforce 2015.
        A.I.o.H.a. Welfare, Canberra2016
        • Hames K.
        National Maternity Services Plan.
        in: D.o.Health The Australian Health Ministers’ Conference: Canberra. 2010
        • Henderson A.
        • et al.
        Nursing students’ perceptions of learning in practice environments: A review.
        Nurse Educ. Today. 2012; 32: 299-302
        • Hamilton V.
        • Baird K.
        • Fenwick J.
        Nurturing autonomy in student midwives within a student led antenatal clinic.
        Women Birth: J. Austr. Coll. Midwives. 2019; (Online ahead of print)https://doi.org/10.1016/j.wombi.2019.12.001
        • Griffiths M.
        • et al.
        Midwifery student evaluation of practice: The MidSTEP tool – Perceptions of clinical learning experiences.
        Women Birth: J. Austr. Coll. Midwives. 2019; 19https://doi.org/10.1016/j.wombi.2019.09.010
        • West R.
        • et al.
        Culturally capable and culturally safe: Caseload care for Indigenous women by Indigenous midwifery students.
        Women Birth. 2016; 29: 524-530
        • Gamble J.
        • et al.
        Acknowledging the primacy of continuity of care experiences in midwifery education.
        Women Birth. 2020; 33: 111-118
        • Carter A.G.
        • et al.
        Midwifery students’ experiences of an innovative clinical placement model embedded within midwifery continuity of care in Australia.
        Midwifery. 2015; 31: 765-771
        • Griffiths M.
        • et al.
        Midwives transition to practice: Expectations and experiences.
        Nurse Educ. Pract. 2019; 41: 102641https://doi.org/10.1016/j.nepr.2019.102641
        • Kuliukas L.
        • et al.
        Midwifery students’: Developing an understanding of being ‘with woman’––A qualitative study.
        Midwifery. 2020; 84: 102658https://doi.org/10.1016/j.midw.2020.102658
        • Sidebotham M.
        • et al.
        Using the five senses of success framework to understand the experiences of midwifery students enroled in an undergraduate degree program.
        Midwifery. 2015; 31: 201-207
        • Evans J.
        • et al.
        The future in their hands: Graduating student midwives’ plans, job satisfaction and the desire to work in midwifery continuity of care.
        Women Birth. 2020; 33: e59-e66
        • Bloxsome D.
        • Bayes S.
        • Ireson D.
        I love being a midwife it's who I am”: A Glaserian grounded theory study of why midwives stay in midwifery.
        J. Clinical Nurs. 2020; 29: 208-220
        • Geraghty S.
        • Speelman C.
        • Bayes S.
        Fighting a losing battle: Midwives experiences of workplace stress.
        Women Birth. 2019; 32: pe297-pe306
        • World Health Organization UNICEF
        Strengthening quality midwifery education for Universal Health Coverage 2030: Framework for action.
        WHO, Geneva2019
        • Department of Health (WA)
        Having A Baby. 2020.
        Department of Health WA, Perth, WA2020 (Available from: https://healthywa.wa.gov.au/Healthy-living/Having-a-baby.)
        • DoH(WA)
        Having A Baby in Private Care.
        Department of Health Western Australia, Perth, WA2020
        • Roberts C.
        • Tracy S.
        • Peat B.
        Rates for obstetric intervention among private and public patients in Australia: Population based descriptive study.
        BMJ. 2000; 321
        • Dahlen H.G.
        • Tracy S.
        • Tracy M.
        • Bisits A.
        • Brown C.
        • Thornton C.
        Rates of obstetric intervention among low-risk women giving birth in private and public hospitals in NSW: A population-based descriptive study.
        BMJ. 2012; 2
        • Nursing and Midwifery Board of Australia
        Midwife Standards for Practice.
        2018
        • Harding T.
        • Whitehead D.
        • et al.
        Analysing data in qualitative research.
        in: Schneider Z. Nursing and Midwifery Research: Methods and Appraisal for Evidence-based Practice. Elsevier, Chatswood, NSW2014: 127-142
        • Schneider Z.
        • et al.
        Nursing and Midwifery Research: Methods and Appraisal for Evidence-based Practice.
        4th ed. Mosby Elsevier, Sydney2013
        • Nowell L.S.
        • et al.
        Thematic analysis: striving to meet the trustworthiness criteria.
        Int. J. Qualitative Methods. 2017; 16 (p 1609406917733847)
        • Annells M.
        • Whitehead D.
        Analysing data in qualitative research.
        in: Schneider Z. Whitehead D. Elliott D. Nursing and Midwifery Research Methods and Appraisal for Evidence Based Practice. Elsevier, Sydney2007
        • Gray J.
        • et al.
        Students’ perceptions of the follow-through experience in 3 year bachelor of midwifery programmes in Australia.
        Midwifery. 2013; 29: 400-406
        • Browne J.
        • et al.
        “Continuity of care” experiences in midwifery education: Perspectives from diverse stakeholders.
        Nurse Educ. Pract. 2014; 14: 573-578
        • Davis D.
        • et al.
        The self reported confidence of newly graduated midwives before and after their first year of practice in Sydney, Australia.
        Women Birth: J. Austr. Coll. Midwives. 2012; 25: pe1
        • Axcell C.
        Six months qualified.
        Br. J. Midwifery. 2019; 27: 534
        • Tracy S.K.
        • et al.
        Caseload midwifery care versus standard maternity care for women of any risk: [email protected], a randomised controlled trial.
        Lancet. 2013; 382: 1723-1732
        • Collins C.T.
        • et al.
        An evaluation of the satisfaction of midwives’ working in midwifery group practice.
        Midwifery. 2010; 26: 435-441
        • Warmelink J.C.
        • et al.
        An explorative study of factors contributing to the job satisfaction of primary care midwives.
        Midwifery. 2015; 31: 482-488
        • Yoshida Y.
        • Sandall J.
        Occupational burnout and work factors in community and hospital midwives: A survey analysis.
        Midwifery. 2013; 29: 921-926
        • Cummins A.M.
        • Denney-Wilson E.
        • Homer C.S.E.
        The mentoring experiences of new graduate midwives working in midwifery continuity of care models in Australia.
        Nurse Educ. Pract. 2017; 24: 106-111
        • Bradshaw C.
        • Murphy Tighe S.
        • Doody O.
        Midwifery students’ experiences of their clinical internship: A qualitative descriptive study.
        Nurse Educ. Today. 2018; 68: 213-217
        • Hauck Y.
        • Bayes S.
        • Robertson J.M.
        Addressing the workplace needs of Western Australian midwives: a Delphi study.
        Aust. Health Rev. 2012; 36: 176-183
        • Bradfield Z.
        • et al.
        Midwives ‘with woman’ in the private obstetric model: Where divergent philosophies meet.
        Women Birth. 2018; 32: 157-167
        • Lutomski J.E.
        • et al.
        Private health care coverage and increased risk of obstetric intervention.
        BMC Preg. Childbirth. 2014; 14: 13
        • Hutchinson M.J.
        • Peirce A.A.
        Western Australia's Mothers and Babies, 2015: 33rd Annual Report of the Western Australian Midwives’ Notification System, 2019.
        Department of Health, Western Australia2019
        • Bradfield Z.
        • et al.
        Emissaries in a foreign land: Western Australian midwives’ experiences of being ‘with woman’ during labour and birth in the private obstetric model.
        Women Birth. 2018; 31: S16
        • Beecroft P.C.
        • et al.
        New graduate nurses’ perceptions of mentoring: six-year programme evaluation.
        J. Adv. Nurs. 2006; 55: 736-747
        • Lennox S.
        • Skinner J.
        • Foureur M.
        Mentorship, preceptorship and clinical supervision: Three key processes for supporting midwives.
        N. Z. College Midwives J. 2008; 39: 7-12
        • Coates R.
        • et al.
        A postgraduate optimum birth module to increase midwives’ readiness to work in midwifery-led settings: A mixed-methods evaluation.
        Birth. 2019; 46: 533-539
        • Hodnett E.D.
        • et al.
        Continuous support for women during childbirth.
        Cochrane Database Systematic Rev. 2011; 2: CD003766
        • Hauck Y.
        • Lewis Kuliukas L.L.
        • Butt J.
        • Wood J.
        Graduate midwives’ perception of their preparation and support in using evidence to advocate for women's choice: A Western Australian study. vol.16. Elsevier Ltd Nurse Education in Practice, 2016–01, Scotland2015: 305-311
        • Thompson S.M.
        • et al.
        Creating guardians of physiologic birth: The development of an educational initiative for student midwives in the Netherlands.
        J. Midwifery Women's Health. 2019; 64: 641
        • Browne J.
        • Taylor J.
        ‘It's a good thing…’: Women's views on their continuity experiences with midwifery students from one Australian region.
        Midwifery. 2014; 30: e108-e114
        • Tickle N.
        • et al.
        Women's experiences of having a Bachelor of Midwifery student provide continuity of care.
        Women Birth. 2016; 29: 245-251
        • Fenwick J.
        • et al.
        The emotional and professional wellbeing of Australian midwives: A comparison between those providing continuity of midwifery care and those not providing continuity.
        Women Birth. 2018; 31: 38-43
        • Homer C.S.
        Models of maternity care: Evidence for midwifery continuity of care.
        Med. J. Austr. 2016; 205: 370-374
        • Dawson K.
        • et al.
        Exploring midwifery students’ views and experiences of caseload midwifery: A cross-sectional survey conducted in Victoria, Australia.
        Midwifery. 2015; 31: e7