Developing confidence

The analysis of interviews suggests that confidence is both a product of development over the first part of the year and a precursor to further development, suggesting that the development of confidence has a vital and pivotal part to play in development beyond registration. In terms of confidence as a precursor to further development, it is suggested that a midwife needs to

build confidence in order to feel that she can take on responsibility and for her to fulfil the role of the midwife fully:

… I’m trusting my thinking. Running a ward, things are coming rather than having to checklist all the time … It's more that I'm more confident in knowing what I'm doing (new midwife).

… I look at her now and she's very different to how she was when she first came initially, and she's now performing better and I would say because she's more confident ….so she's obviously developed and she's feeling confident within the team (experienced midwife)

Experienced midwives gave examples of how confidence is required for an individual to be able to perform and of how lack of confidence can obstruct an individual from functioning as a midwife, such as:

Well initially when I first started as preceptor to her, she didn't have very much confidence at all. She was using me a lot of the time as a mentor ... still in the student mode, not really wanting to take responsibility, and I had to really confidence build her a great deal really and initially in the first six weeks I was a bit concerned about her. I found that she was not sure of what she was doing and needed an awful lot of guidance, but to her credit she's done really, really well (experienced midwife).

I must admit we just felt they were disastrous, … the transition from being a student to now a midwife … well the point is they were functioning as senior student midwives rather than staff midwives (experienced midwife).

Other examples were given of new midwives who felt that as they became more confident, they were able to use their knowledge more in discussions with women and with other professionals.

It is suggested that most midwives in the study experienced a drop in confidence when they first qualified.

My confidence is just slowly improving, because I think you get to a certain stage as a student when you feel you're on top of everything, and the moment you qualify then it all falls down again really and I think you start again, building it up in a different fashion really, to be independent. (new midwife)

While midwives working with them stated three participants were confident at registration, the general view was that participants’ confidence dropped initially at registration. Interviewees suggested that following the initial drop in confidence, it then took most participants three to six months to build confidence again to a level where they felt comfortable in practice. In interviews, participants appeared to be much more confident over their second six months in practice. However, a very small number of new midwives were still lacking in confidence beyond the six-month stage. The findings suggest that for these midwives, confidence did improve over the year but not as much as for other new midwives.

Unfortunately (she) sometimes is (her own) worst enemy and it's very difficult to assess her in some things because she's very anxious, that's her personality … she's extremely anxious … but she's very good, very conscientious, her practice is quite good and she's very thorough… her anxiety levels have definitely fallen, she has improved (supervisor of midwives).

In addition, midwives and supervisors suggested that a very small number of participants may have been over-confident at the point of registration - in the sense that they appeared more confident than generally would be expected. It was suggested that to be over-confident could be dangerous as over-confident midwives might take on something beyond their capability. However, it was also suggested that by the end of the first few months this very small number of new

midwives had adjusted to a more appropriate level of confidence - ‘the right level of confidence’.

Consistent with the findings previously outlined on consolidating practice, it is suggested that the experience of being a midwife and taking on responsibility is very important in building confidence. Through this experience, midwives learn that they ‘can do it’ and that they can cope with the range of experiences that they are likely to experience on a daily basis. It was suggested that confidence also develops through familiarity with the practice area itself, suggesting that some degree of continuity in practice placements will help in the development of confidence. The importance of support networks was also identified, suggesting that new midwives may feel more confident if they know that there is someone available that they can turn to for advice or support. It was also suggested that new midwives should focus on consolidating practice first and become ‘comfortable’ with that before thinking of taking on new responsibilities and new areas of practice. Linking in with the theme on coping, building confidence was also linked by one interviewee with developing the ability to predict how situations would unfold and developing a feel for practice.

(I feel) much more confident, not only with the way that I deliver care but just with talking with mums and making assessments, and being able to predict how things will develop, not being caught out so often with the multips who come in and sneeze and deliver. Just being able to assess more accurately really how things are going to go (new midwife).

The analysis suggests that there are both intrinsic and extrinsic factors involved in developing confidence beyond the point of registration. Intrinsic factors relate to feelings that new midwives have about their own ability to fulfil the role of the midwife. This also relates to how realistic new midwives’ perceptions are of what should be expected of them upon qualifying, which was highlighted by a small number of participants who had difficulties with confidence and who (unrealistically it is suggested) felt they should have been much more capable at the point of registration. Two such midwives had difficulty building confidence

and three midwives were assessed as over-confident. It was suggested that other intrinsic factors involved in confidence development over the year included the level of confidence at registration, individual coping skills and perceived gaps in skills.

A number of extrinsic factors involved in the development of confidence beyond registration were also identified relating to:

 the opportunities that midwives had to consolidate practice  the amount of experience midwives had of making decisions  the mix of normal and abnormal cases

 the stability of the practice environment  the mix of routine and non-routine  familiarity with the unit

 the number of hours worked per week  whether the environment was supportive.