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This book teaches students and educators in the midwifery field how to tackle dilemmas and decision making. Combining theory and practice, and promoting critical thinking, this book provides key knowledge alongside case studies of how to approach real-life dilemmas in midwifery.Written and edited by experts in the field, this book gives midwives and student midwives the opportunity to experience a systematic approach to facing dilemmas and decision making through the use of clinical scenarios. This is done in a safe space through an annotated thinking aloud framework where students and educators can have open discussions. Student midwives and practitioners are given the opportunity to explore professional dilemmas they might not have witnessed and uncover new theories that will influence future decisions. Linked to the 2019 NMC Standards for Midwifery, this book is essential reading for all stages of the midwifery career including those supporting students, coordinating care teams and those supporting multi-cultural communities. The midwives' personal reflections explore best practice and take account of other professional perspectives, including facilitators and barriers to interdisciplinary working. Learners will be able to consider a number of factors including concepts and theories, ethics and legal accountability, to explore how they interplay in making decisions.  

Background Early postnatal discharge is increasingly common worldwide, yet the World Health Organization’s recommended 3-3-6 schedule for postnatal visits and assessments is often not adhered to by mothers and healthcare workers. The early neonatal period is critical for both mother and baby, accounting for a significant proportion of maternal and neonatal deaths, especially in developing countries. According to the recently released Midwifery Accelerator , achieving universal coverage of care provided by midwives can avert two-thirds of maternal and newborn deaths, including stillbirths. Domiciliary midwifery practice, where mothers and newborns are followed up at home after discharge, represents a promising model of midwifery continuity of care that can assist in reducing maternal and neonatal mortality. This study therefore, aims to explore the perceived factors influencing domiciliary midwifery practice among midwifery students. Methods A qualitative descriptive cross-sectional study was conducted using semi-structured interview and focus group discussion guides. Seven key informant interviews and three focus group discussions were conducted among purposively selected lecturers and 20 Bachelor of Midwifery Science students in Lira District, Uganda. Data was collected between May and July 2024, and analyzed using the socio-ecological model, thematic analysis, while NVivo software was used to organize the data. Findings Two major themes of barriers and facilitators, with 14 subthemes were identified. Multiple intertwined factors at various levels were found to influence student’s domiciliary midwifery practice. Most of these factors operated at the individual and institutional levels. Individual-level factors included poverty, cultural beliefs, and trust. At the institutional level, factors included the availability of resources, supervision, time constraints, and the working environment. Significant figure influence, attitudes, relationships, and feedback were identified at the interpersonal level. Conclusion Many of the individual and institutional factors that hinder effective domiciliary midwifery practice by students are preventable. Therefore, stakeholder engagement is crucial to address these barriers at all levels, with the ultimate goal of reducing maternal neonatal mortality during the early postnatal period.

Background: In South Africa, midwives should integrate the Ubuntu philosophy in maternity care services to promote utilisation of maternal and child healthcare services. Women expect to be treated with respect, love, dignity and mutual caring during childbirth. However, women experience obstetric violence, such as physical and verbal abuse during labour, which is associated with poor integration of the Ubuntu philosophy in maternity care units. Aim: The study aimed to explore and describe the perceived experiences of women during labour regarding the integration of Ubuntu in maternity services. Setting: The study was conducted in the six community healthcare centres that were purposively selected in Limpopo province. Methods: A qualitative, exploratory descriptive design was used. A non-probability, purposive and convenience sampling method was used to select participants. Data were generated from 24 women using individual face-to-face interviews. Trustworthiness and ethical standards were considered and adhered to. Data were analysed using thematic analysis. Results: The findings revealed three themes associated with a lack of integration of Ubuntu when rendering maternity care services, and two sub-themes emerged from themes one and two; three sub-themes emerged from sub-theme three. First theme: the personal conduct of midwives as perceived by women during labour. Attitude of midwives towards women in labour and midwives’ lack of commitment emerged as sub-themes. Second theme: interpersonal relations as perceived by women during labour. Poor midwife-woman relationship and communication, and abusive conduct by midwives emerged as sub-themes. Third theme: the support system needed by women during labour. Poor support from midwives, the use of traditional remedies versus Western medicine, and a lack of sufficient resources that deprive women of quality midwifery care services emerged as sub-themes. Verbal and physical abuse, poor midwife-women relationships, use of traditional remedies and lack of support could lead to inadequate utilisation of maternity care services by pregnant women for childbirth. Conclusion: Integrating Ubuntu principles into maternity care can improve maternal and neonatal outcomes by promoting compassionate, respectful, and patient-centered care.

The study aimed to explore and describe the needs of registered midwives in labour rooms in the North-West Province of South Africa with regard to clinical mentorship of student midwives to identify the strengths and gaps in the clinical mentorship programme and make recommendations to optimise clinical mentorship for student midwives in this setting. The South African healthcare system is overburdened by numerous problems, particularly in maternity services. It has been reported that nurses are not skilled enough to provide quality care to pregnant women. The onus is on nursing education institutions to produce competent midwives to improve the quality of care. Mentorship has been proven to improve competence among mentees and this strategy can be used to address this health problem in South Africa. The study employed a qualitative descriptive design and purposive sampling was used to select the participants from the level 2 hospitals in the North-West province in South Africa. Data were collected using individual telephonic interviews and 14 participants from three level 2 hospitals in the North-West province participated in the data collection process. Three main themes emerged from interviews conducted with the participants. Their needs to successfully mentor student midwives in an intrapartum setting are a positive environment for learning, teaching and mentorship; a collaborative relationship between the nursing education institutions and the health facilities where they are employed as well as positive student conduct. The sub-themes under theme 1, a positive environment for teaching, learning and mentorship, are patience, teamwork, mutual respect and human and material resources. Theme 2, a collaborative relationship between the nursing education institutions and the health facilities, had three sub-themes, namely, presence, effective communication on students' objectives, activities and progress and opportunities for self-development and empowerment. Commitment to learning (presence, patience and pre-knowledge) is the sub-theme that emerged from the theme of positive student conduct. For successful mentorship in the clinical setting, the focus should not just be on the mentees themselves and creating an environment where they can learn. There is a need to look into how the mentors, who provide learning opportunities and teach, guide and support mentees in order for them to be competent, can be assisted to enjoy mentorship.

Objective: In the United Kingdom (UK) and most countries worldwide, midwives are professionally required to undertake an initial perinatal mental health (PMH) risk assessment at every maternity contact. However, studies have found that midwives feel that they are not well-equipped to provide effective care for women with PMH needs. This study explores how the newly qualified midwives (NQMs) are prepared through pre-registration midwifery education and placements to have sufficient confidence in their knowledge, attitude, skills, and habits (KASH) for their post-registration PMH role. Methods: This explanatory sequential mixed methods study collected survey data from two independent groups: NQMs (n = 50), who qualified from 10 UK universities, and senior specialist midwives (SSMs) (n = 32). Descriptive and inferential responses were analysed using SPSS. Statistical differences between the ranged Likert scale responses of the NQMs and SSMs were analysed using the Mann-Whitney U test. The p-value of <0.05 was considered statistically significant. The semi-structured interview phase comprised of NQMs (n = 12) and SSMs (n = 8). The qualitative data were thematically analysed using NVivo. Results: The pre-registration midwifery programme significantly prepared the NQMs to have sufficient confidence in their knowledge of the related PMH role, multidisciplinary team (MDT) role, and available services (p < 0.05) and good attitude towards women with varying PMH conditions (p < 0.0005). The NQMs had sufficient confidence in their skills in using the validated tool for PMH assessment, to build rapport to facilitate disclosure, and recognise deteriorating PMH (p < 0.01). They had regular habits of discussing PMH well-being at booking and made prompt referrals (p < 0.05). The NQMs were not prepared to have sufficient knowledge of PMH medications, perinatal suicide prevention, and the impact of maternal mental health on partners (p < 0.01) including children (p < 0.05); skills in managing PMH emergencies (p < 0.05), and to regularly discuss suicidal thoughts (p < 0.01), issues of self-harm, and debrief women following pregnancy or neonatal losses and traumatic births (p < 0.05). Some aspects were either confirmed or contradicted at the interviews. Conclusions and recommendations: The pre-registration midwifery programme prepares the NQMs to some extent for their post-registration PMH role. Perceived areas for improvement suggest implications for the development of educational, practice, policy, and preceptorship to facilitate the NQMs’ sustainable confidence in their KASH.

The objective of this study is to examine the experience of undergraduate student midwives in the neonatal unit. Clinical experience is an essential component of education for the development of competent midwives. Literature has highlighted the pivotal effects of precepting and how it contributes to student experience. Although there is a plethora of research examining undergraduate student midwives’ experience, to our knowledge this is the first study exploring their experience in the neonatal unit. Based in phenomenology, eight semi-structured interviews were conducted producing rich data. Following informed consent and ethical approval, post transcription, the data were coded using Colaizzi’s (1978) framework. Significant themes and sub-themes emerged such as course design, environmental experience, sources of stress and preceptor experience. The student experience very much depends on the preceptor, how busy the environment is and if appropriately staffed. Based on these findings there are suggested recommendations including adjusting the timing and length of the placement and how to improve the environment based on the preceptor-student relationship. Also, suggestions on how consistency and communication can be improved are proposed.

The aim of this integrative review is to synthesise the literature on creative teaching methods in midwifery education. The review question seeks to investigate the experiences of student midwives and midwifery educators of using creative methods as a learning approach. The benefits of creative teaching methods are widely acknowledged but the ways in which this may impact midwifery students’ learning processes, or how this relates to their developing professional development, is not well understood. Research focused specifically on student midwives is yet to be synthesised. An integrative review was undertaken using data comparison with reflexive thematic analysis to identify common themes. Eight electronic databases were searched with key terms in June 2022. English language studies from qualitative, quantitative, mixed-methods and wider literature were included. Twenty-two texts were included in the synthesis. Four themes were generated from the data; 1) What is the offering - More than a lecture; exploring the educator and student exchange and environment for learning; 2) Working in parallel - examining the change in teaching dynamic and collaborative partnerships; 3) Journeying towards holism - focused on student’s integration of learning processes; and 4) Stepping into the professional - engaging with how using creativity can aid students’ growing sense of themselves as professionals. This highlights improvements in levels of confidence, professional development and emotional intelligence in midwifery students. Creative teaching and learning methods enable student midwives to make meaningful connections between theoretical and practice learning environments, assisting knowledge and skills acquisition.

BackgroundPerforming midwifery care requires competence and confidence because of the profession’s emphasis on independent functioning and professional responsibility. The student midwives generally can manage to plot the symphysis fundal height measurements on charts correctly, but their real learning need is to accurately interpret what the measurements meant in relation to their patients’ due dates and overall pregnancy health. This interpretation is essential for the early detection of potential complications.AimTo explore and describe lecturers’ perceptions of student midwives’ competence and confidence in performing symphysis fundal height measurements, plotting, and interpreting the results.SettingThe study took place in KwaZulu-Natal College of Nursing, South Africa.MethodsA descriptive, qualitative design was used. Data were collected using focus group discussions from August 2023 to September 2023. Thematic analysis method was used to analyse data.ResultsFour main themes emerged namely, perceived significance of symphysis fundal height measurement, the perceived prerequisites enabling competence and confidence, the perceived challenges and barriers to competence and confidence, and the recommendations made to improve the competence and confidence of student midwives.ConclusionIt was the perception of the lecturers that improved competence and confidence of student midwives in the measurement, plotting, and interpretation of symphysis fundal height could lead to the correct interpretation and identification of high-risk pregnancies.ContributionThe findings will guide the curriculum developers and policy makers in the formulation of symphysis fundal height measurement protocols and standard operating procedures, to improve and standardise midwifery skills in this regard.

BackgroundUbuntu, a philosophy of human dignity, moral high ground, compassion, interconnectedness and community, significantly enhances ethical and caring practices in nursing and midwifery.AimThis study explored student midwives’ experiences in applying Ubuntu principles in midwifery services in Vhembe District, Limpopo province.SettingThe study was conducted at the Vhembe District in Limpopo province, focusing on Level 4 student midwives learning at two tertiary nursing education institutions.MethodsThis study used a qualitative, exploratory and descriptive approach. The study was conducted in three selected hospitals of Vhembe District, which were purposively selected. Thirty Level 4 student midwives from two tertiary nursing education institutions were purposefully selected from three district hospitals. Data were collected through face-to-face, semi-structured interviews, and thematically analysed using Tesch’s eight-step approach. Credibility, transferability, dependability and confirmability ensured trustworthiness. Ethical principles were rigorously followed throughout the research process.ResultsThe findings revealed both positive and negative experiences. Student midwives reported patient support, mutual respect and collegiality, alongside discrimination and abuse. These contrasting accounts point to a disconnect between Ubuntu principles and actual clinical practice, highlighting the gap between ethical ideals and the lived realities of midwifery care.ConclusionWhile some areas of clinical practice support Ubuntu values, there are significant gaps. Student midwives are exposed to positive and negative experiences in the practice of Ubuntu in midwifery services. The study recommends Ubuntu principles in midwifery practice and education to promote human-oriented and ethical care.ContributionThe study advocates for the consistent affirmation of Ubuntu in midwifery practice and education to promote ethical integrity and enhance the quality of maternal care.

Background Despite concerted efforts by policy developers, health professionals and lay groups, breastfeeding rates in Ireland remain one of the lowest in world, with 63.6% of mothers initiating breastfeeding at birth, dropping to 37.6% of mothers breastfeeding exclusively on hospital discharge. Nipple trauma and difficulties with baby latching are major contributors to the introduction of formula and discontinuation of breastfeeding. Research shows laid-back breastfeeding (LBBF) significantly reduces breast problems such as sore and cracked nipples, engorgement, and mastitis as well as facilitating a better latch. Although the benefits of LBBF are well documented, this position does not seem to be routinely suggested to mothers as an option when establishing breastfeeding. This study aims to determine midwives’ and student midwives’ knowledge, attitudes, and practices of using laid-back breastfeeding in Ireland. Method A cross-sectional descriptive survey distributed to midwives and student midwives in three maternity hospitals in Ireland and two online midwifery groups based in the Republic of Ireland, during June, July, and August 2021. Results Two hundred and fifty-three valid responses were received from nine maternity units. Most participants (81.4%) were aware of laid-back breastfeeding. However, only 6.8% of respondents cited it as the position they most frequently use. Over one-third (38.34%) had never used this position with mothers. Those more likely to suggest LBBF had personal experience of it, were lactation consultants or working towards qualification, or had participated in specific education about LBBF. Barriers included lack of education, confidence, time, and experience. Further issues related to work culture, a tendency to continue using more familiar positions and concerns about mothers’ anatomy and mothers’ unfamiliarity with LBBF. Conclusion Although there was a high level of awareness of laid-back breastfeeding among midwives and student midwives, there are challenges preventing its use in practice. Education specifically related to using LBBF in practice is required to overcome the barriers identified. A greater understanding of mothers’ and babies’ intrinsic feeding capacities may give midwives more confidence to recommend this method as a first choice, potentially leading to more successful breastfeeding establishment and maintenance.