The need to manage expectations

Interviewees suggested there was a mismatch between what students, and their teachers and midwives, expected in terms of competence at the point of registration and the role that qualifiers should be able to fulfil. It is also suggested that this mismatch between expectations, and a mismatch between student’s expectations of being a midwife and the reality of practice experienced upon qualification, was a concern for a small number of new midwives. This theme is raised again in Chapter Seven, which focuses on the experiences of midwives over the first year in practice.

As previously suggested, the aims of pre-registration midwifery education include preparing midwives to:

 take on a lead role in providing care for normal pregnancy, to detect deviations and to refer appropriately, as outlined in Changing Childbirth (Department of Health, 1993)

 be agents of change and knowledgeable doers, equipped for research-based practice and to be able to challenge conventional practices

 be continuous learners with skills of reflection, and able to recognise and address their own learning needs.

The (re)introduction of pre-registration midwifery education following closely on the heels of Project 2000, has provided an unprecedented opportunity for midwifery educators to outline a new curriculum to truly change the course of midwifery practice. The move of more and more providers of midwifery education in with institutions of higher education provided the licence for providers to enhance the theoretical underpinnings of midwifery education programmes by including subjects such as sociology and psychology as foundation elements of programmes. The focus of midwifery programmes is on health, education, and promoting health, and pregnancy and childbirth are seen as altered physiological states and normal activities (Mountford et al, 1995). In addition, the publication of Changing Childbirth by the Expert Maternity Group in 1993, gave further credence to the notion of the midwife as the lead professional in the provision of care for normal pregnancy and childbirth.

It is suggested however, that in reality the wheels of progress turned a lot more slowly in the development of midwifery practice and only two of the thirty nine new midwives in this study cohort found themselves practising in situations consistent with the new ways of working outlined in Changing Childbirth and reflected in curriculum statements.

In terms of becoming competent, it is suggested that the role undertaken by students at registration had not yet evolved in line with that espoused in curriculum documents and promoted over the duration of the programme. This was a source of frustration for a small number of students, who suggested that the role that they would undertake at registration would not be the same as that promoted on the programme.

It is also suggested that a similar number of new midwives felt under pressure to revert to conventional ways of doing things, rather than challenging practice. This is also reflected in concerns that a small number of participants had about not being able to provide care for women with complications or who are ill and concerns about fitting in within the practice situation.

However, it is suggested that most of the study midwives accepted and were able to cope with the realities of midwifery practice. Some new midwives reported that they would be happy to practise in the hospital situation initially and gain more experience so that they could move in the longer-term into community or team-based positions, which they anticipated would enable them to practise more along the lines of Changing Childbirth. Other new midwives suggested that they would use the interim period as an opportunity to learn more about other aspects of midwifery practice.

6.6 Conclusion

The analysis of the views expressed by students about the final stages of their preparation for the midwifery role and those of assessors, teachers and midwives working with them suggests that becoming competent involves a distinct and

sudden transition from the passive student status to the active practitioner role. It is suggested that transition is a significant event in the lives of students and the careers of midwives and that this time is an anxious but exciting time from students. Further, it is suggested that the final stages of learning in preparation for that transition to the role of the midwife involves consolidating practice, becoming reasonably confident, taking on accountability and responsibility, and providing individualised care.

Consolidation is a vital element of development in the final stages of preparation for the role of the midwife. The focus of consolidation is on further developing knowledge and practice through experience and with reduced support, as opposed to learning new things. Through consolidation students build confidence, develop coping skills and learn to be autonomous. Consolidation is more likely to occur where students are allocated a specific period at the end of the programme and where they have previously covered the full range of learning. In addition, consolidation is more likely to occur where practice allocations provide a degree of continuity for the student and where learning is explicitly student-centred over the final stages of programmes. The experience of transition from student to midwife can also be enhanced by ensuring that students have realistic expectations of the role they are likely to fulfil upon registration, the competence expected of them, and the type of support that they will have.