MIDIRS Essence > March 2009 > Student/Tutor feature

Student feature: my first year as a student midwife

Originally posted on Mar 2009

Two settings and one learning experience: the differences in the midwifery care provided in a hospital-based setting and in the community

My name is Sophie-Louise Finnerty and I am in my first year at De Montfort University, Leicester. Over the past month I have spent a short amount of time with a community midwife as well as with a hospital-based midwife on a midwifery-led birth centre. Time spent in both settings was rewarding and allowed me to develop skills that I thought would take me much longer to learn.

My first week was on the community and I began just by observing. I noticed that it was a gentle approach to care and that your community midwife is seen as a trustworthy and valued health professional. We had many expectant mothers and their families asking lots of questions and the midwife responded in an empathetic and understanding way, and left the women satisfied. I understood that pregnancy can be a confusing and, at times, worrying period that requires a lot of reassurance and special understanding from midwives. This is what attracted me to midwifery; I was so passionate about giving dedicated and empathetic care. The one thing that stuck out for me was the requirement for a high level of communication skills, in order to reduce language barriers and physical barriers. I gained this overall impression from all the community midwives and it has been a good place to start my midwifery training.

By the time I had got to the second week in the birth centre, I had been observing my community midwife and the skills she uses on an everyday basis; taking blood pressure was my main challenge as at the start I thought it would take me a long time to develop this skill. Within the first five minutes on the birth centre, I had completed a blood pressure, pulse and a temperature taking. I was quite nervous as I know that variations of blood pressure can make a difference in the approach to care and interventions proposed. I felt as if I was expected to know these skills although, in fact, I had only really observed them after having one day skills practice at university, which I thought was not enough. However, I did surprise myself and I feel as if this ‘hands-on’ approach allowed me to develop my skills quicker as I had mastered the technique by the end of my first shift. In terms of the midwives, I realised that their approach to care was very different between the community and the hospital environment, which does not allow for as much time with the woman and is not what the woman is used to. In the birth centre, the midwife pops in to see the woman, listens for the fetal heart beat, and pops back out to another woman. Blood pressure, temperature and pulse are also taken at regular intervals. I observed it was very easy to complete the procedures and forget to ask the women ‘how they are feeling’. This, when compared to the antenatal community appointments, was a very different approach, whereby the first question to be asked is how the women are feeling, which must make them feel quite different about their care, especially as labour can be a very confusing and emotional time.

As the labour starts to progress and medical intervention can start to occur, an established multi-disciplinary team gets involved with the woman’s care as appropriate. This can include several members of staff and possibly more than one student if the consent of the woman has been given. The involvement of doctors is necessary when deviations from the norm occur and also when a woman requests pain relief such as an epidural.

At a home birth the most number of staff present will be two midwives and possibly two student midwives. It is understandable, then, why home births are becoming more popular in some areas.

I feel that in the hospital-based setting, it was a very nervous time and I began to feel as if I was needed as a health care professional rather than as a student; however, I feel that I wouldn’t be at the level I am at the moment, if it wasn’t for the intense initial period in the hospital. In turn, my time in the community has provided a different approach to care by allowing me more time to develop my skills and still have the confidence to perform them. I feel that both experiences reflect the care experienced by women. I feel that as a student in an observatory capacity, there is an evident gap between midwifery care provided in the community and hospital-based settings and the transition between the two is not a smooth one. Something needs to be done to bridge the gap between the two settings.

In terms of the course, I will have spent 13 weeks in community by February and only one week on a midwifery-led birth centre, so it can be said that I have not had enough experience on the birth centre to gain a fair judgement about the differences in my learning experience. And, to finally note, I am a new student and therefore my arguments are based only on judgements from my experience so far.

Sophie-Louise Finnerty | Student Midwife | De Montford University

---

Your Comments

Have your say! Register now and post your comments on this article here.

Sorry, there are currently no comments for this article.