Books by Carolyn R Hastie
Women and Birth, Jan 1, 2006
Birth territory and midwifery guardianship: theory for practice, education and research. Edinburgh: Books for Midwives, Jul 14, 2008
Across time and cultures, women's knowledge has included great wisdom about birth. That know... more Across time and cultures, women's knowledge has included great wisdom about birth. That knowledge has been virtually lost in the Western world. In Western science only that which can be seen, weighed and counted is considered real. Any other sort of knowledge is discounted and excluded. Writing about the role of the midwife guardian, who creates and maintains spiritually and emotionally safe birth spaces, has felt like reclaiming something very valuable. This chapter gives words to the embodied wisdom of women and midwives ...
Birth Territory and Midwifery Guardianship: Theory for Practice, Education and Research, 2008
Years ago at a dinner party with a group of fellow architects, I was asked for my view of the Cit... more Years ago at a dinner party with a group of fellow architects, I was asked for my view of the City of London master-plan and whether I thought it should have been altered in any way. My reply was that (in those days) I was primarily concerned with one room only; the first room we enter when we come into this world. I will never forget the pitiful glance my answer received–or my companion's farewell words at the end of the evening.“I look forward to hearing more about your work when you grow up!” Because of my role as an architect, I ...
Birds do it. Bees do it, even bears and humans do it. An instinctive and compelling need to prepa... more Birds do it. Bees do it, even bears and humans do it. An instinctive and compelling need to prepare the environment for birth and the care of offspring, known as ‘nesting’, is common to the females of many living species. The tendency is to seek a safe, out of the way, private place for birth. Depending upon the particular species, preparation for birth can take weeks or merely involve retreating to a secluded, concealed place once labour begins. The birthing process is instinctive, mediated by a genetic programme and deep, ancient brain structures that are common to all mammals. If that birth space is disturbed or the female is threatened in any way, labour will usually slow down. Once the threat has passed, labour will resume. Humans, despite their cognitive brilliance, also require facilitative environments for optional childbearing. Disturbances to that environment can have a cumulative effect, rendering a woman unable to birth normally. If the disturbances occur after birth, the exquisitely orchestrated mother/baby interaction patterns that lay the foundation of attachment can be disrupted with lifelong consequences.
The midwife has a time-honoured, powerful and privileged role in creating a facilitative environment for birth. A midwife has the honour of working alongside a woman, being ‘with’ her, supporting her growth and development as she births new life and becomes a mother. The midwife‘s capacity-building role extends to supporting each woman to discover who she is and what she is capable of. Midwives have a vital and influential part in ensuring the sustainability of the childbearing process and maternity care. Normal, natural birth is eco-friendly; it doesn’t require a great deal in terms of material resources, it does, however, require the loving attention of skilled and caring midwives. Normal birth needs to be protected, promoted and supported because it is the epitome of a human activity with an extremely low carbon footprint.
Following a definition of normal, natural birth and an exploration of why normal, natural birth is important for sustainability, the birth environment and cultural considerations are examined. Finally, suggestions for optimizing a woman’s experience and ways that a midwife can support normal, natural, health birth for the woman and her baby in a sustainable way are explored.
Midwives and other healthcare providers are grappling with the issue of rising intervention rates... more Midwives and other healthcare providers are grappling with the issue of rising intervention rates in childbirth and trying to identify ways to reverse the trend. It is increasingly accepted that intervention in childbirth has long-term consequences for women and their children. Birth Territory provides practical, evidence-based ideas for restructuring the birth territory to facilitate normal birth.
* Links new research findings to birth environments and outcomes.
* Describes the elements of an ideal birthing environment.
* Suggests how to modify existing maternity services to achieve optimal results.
* Investigates the links between the experiences of women and babies, and outcomes.
* Explores the effects of legal and socio-political factors.
Fahy, K. Parratt, J. Foureur, M. & Hastie C. (2011) Birth Territory: A Theory for Midwifery Pract... more Fahy, K. Parratt, J. Foureur, M. & Hastie C. (2011) Birth Territory: A Theory for Midwifery Practice Chapter in Brayer, R.M. Midwifery Theory 2nd Ed.
Brodie, P. Warwick, C. Hastie, C. Smythe, L. & Young, C. (2008) Sustaining Midwifery Continuity o... more Brodie, P. Warwick, C. Hastie, C. Smythe, L. & Young, C. (2008) Sustaining Midwifery Continuity of Care: Perspectives from Managers. Homer, C. Brodie, P. & Leap, N. (Eds) Chapter 8 in Midwifery continuity of care: a practical guide. Churchill Livingstone, Sydney.
Midwifery Continuity of Care includes summaries and vignettes which bring midwifery continuity of care to life and make them relevant to practising midwives, managers and others working within maternity services. Written by an international team of contributors, this book highlights the lessons learned by others to help develop new ways of thinking and practising. It will be an invaluable practical guide to all midwives, midwifery managers, student midwives and educators, and will also be of interest to policy makers and health service executives.
Publications by Carolyn R Hastie
An exploratory study of women and midwives’ perceptions of environmental waste management – homebirth as climate action, 2023
Background: Inspired by observing midwives working with birthing women in Bali and at homebirths ... more Background: Inspired by observing midwives working with birthing women in Bali and at homebirths in Australia, this study explores the meanings associated with environmental waste at birth. Aims: The aim is to better understand how and why women and midwives from the homebirth community in Australia choose to manage waste generated during the birthing process. Babies across the globe are born without a carbon footprint and are united, no matter their location, by a future that will require an understanding of and action against climate change. Methods: This qualitative exploratory study investigated midwives' (n = 10) and women's (n = 10) perspectives on environmental waste generated from birth at home. Data were collected through semi-structured interviews and analysed thematically. Results: Three overarching themes were identified from the data. The first theme "There is minimal waste from birth at home" demonstrates participants' perception of the difference in waste generated by birth at home compared to birth in a hospital. The second theme, "Organic waste from homebirth is beneficial to the environment," spoke to participants' embeddedness and connections within their surrounding community environment. The third theme, "Formal education around managing waste at homebirth doesn't exist," indicates a lack of structured or official education or training programs available to individuals interested in learning about sustainable waste management practices during home birth. Conclusion: Birthing at home has a low environmental impact as clinical waste is negligible. This research demonstrates a need to incorporate sustainable waste management into midwifery education while respecting midwifery practices in the home setting.
Influence of grandmothers on breastfeeding practices in a rural community in papua new guinea: a critical discourse analysis of first-time mothers’ perspectives., 2022
Background: Almost all babies are breastfed in Papua New Guinea (PNG); yet appropriate breastfeed... more Background: Almost all babies are breastfed in Papua New Guinea (PNG); yet appropriate breastfeeding practices are not always followed. Aim: To explore the perspectives of first-time mothers in rural PNG on how the language and discourse of grandmothers about infant feeding influence their breastfeeding practices. Methods: A critical discourse analysis (CDA) approach was used to theoretically frame the analysis of twenty firsttime mothers' narratives. Findings: Analysis revealed three themes: (i) prescribed knowledge repository, (ii) social control and dominance, and (iii) disapproval and role conflict, which provides an understanding of grandmothers' differing views and positions on infant feeding practices and their influence on breastfeeding. Conclusion: This study shows that grandmothers remain influential in infant feeding practices in rural PNG. There appears to be a societal expectation that empowers grandmothers in the maternal decision-making processes regarding breastfeeding practice. Grandmothers' influence includes the early introduction of complementary foods to infants less than six months old. Interventions aimed at promoting, protecting, and supporting breastfeeding need to include grandmothers.
Women and Birth, 2021
Aim
To investigate the experiences, perspectives and plans of students who had a six-month placem... more Aim
To investigate the experiences, perspectives and plans of students who had a six-month placement with the midwifery group practice.
Methods
Focus groups were conducted with fifteen third – year Bachelor of Midwifery students who had undertaken an extended placement at a midwifery group practice in a large tertiary referral hospital in Queensland, Australia.
Results
Four main themes were identified in the data: Expectations of the Placement; Facilitating learning within a midwifery group practice model; Transitioning between models of care and Philosophy and culture of midwifery group practice.
Discussion and conclusion
Third-year midwifery students valued the experience of working one-on-one for an extended placement with a midwife providing continuity of care within a caseload model. The experience was the highlight of their degree and they learned ‘how to be a midwife’. Most students found reintegrating back into the hospital system of care challenging, reporting that their developed skills of supporting women holistically and facilitating normal birth were not fully utilised when returning to the task-orientated birth suite. Students valued thoughtful, kind and supportive midwifery preceptors who supported them to transition back into the hospital.
Implications and recommendations
Undertaking an extended placement within a midwifery group practice provides students with a rich and holistic learning experience and helps them develop a sense of professional identity. Student placements situated within models of care which provide continuity of midwifery care should be proactively enabled by health services and universities. Research of the longer-term impacts of an extended midwifery group practice clinical placement on midwifery graduates’ capabilities and competencies 3–5 years post registration should be conducted.
Midwifery , 2021
Objective
The aim of this study was to investigate whether a specifically designed whole-of degre... more Objective
The aim of this study was to investigate whether a specifically designed whole-of degree strategy utilising groupwork assessments was effective in facilitating the development of early career midwives’ teamwork skills.
Design and Methods
A qualitative study using in-depth, semi-structured interviews was undertaken with early career midwives who had graduated within the previous two years. This study is the final cycle of a larger participatory action research project. Qualitative data was analysed using thematic analysis.
Participants
Nineteen early career midwives from one Australian university participated. Their preregistration education was via a Bachelor of Midwifery. Their education included a whole-of-degree educational strategy to facilitate the development of teamwork skills.
Findings
One overarching theme “Becoming an Effective Team Member’ and three sub-themes: ‘Learning and developing Teamwork Skills’; ‘More secure and confident’ and ‘Self-Assurance in interprofessional interactions’ were identified in the interview data. Despite their junior status, the midwives demonstrated the knowledge, skills, and attitudes of an effective team member. Their social and emotional skills appeared well developed and they felt confident interacting with other health care workers in a professional manner.
Key conclusions
Early career midwives who were taught and practiced teamwork skills throughout their degree, appear to have developed the social and emotional competencies required for effective teamwork. Implications for Practice: The capacity for effective teamwork of this small group of early career midwives has the potential to improve the quality and safety of their care for childbearing women. Learning teamwork skills in the educational setting appears to have generated skills focused on conflict resolution, emotional self-regulation and social and emotional competency in these new midwives. These are favourable skills in the emotionally charged environment of maternity care, where inter-collegial bullying is present and where new midwives can experience poor psychological wellbeing. Health care employers want new graduate health professionals to be work ready and to have the skills necessary to be effective team members. The program undertaken by these new graduates may be of assistance in developing these capabilities in other health students.
The known
Teamwork skills are an intrinsic part of the day-to-day activities of maternity services, influencing the workplace culture, retention of midwives and the quality and safety of care. Poor teamwork is associated with clinical errors, bullying and high turnover of staff.
The new
Early career midwives who were taught teamwork skills and practice these skills using their groupwork assignments throughout their undergraduate degree appear to demonstrate the social and emotional competencies required for effective teamwork.
The implications
Implementing a whole-of-degree program to develop teamwork skills in undergraduate midwifery students may improve early career midwives’ social and emotional competencies and interactions with other health professionals. Learning teamwork skills in the educational setting may generate skills in the new midwife that focus on conflict resolution, emotional self-regulation, and social and emotional competency. These are favourable skills in the emotionally charged environment of maternity care, where inter-collegial bullying is present and where new midwives can experience poor psychological wellbeing.
Journal of Medical Ethics, 2021
Disproportional morbidity and mortality experienced by ethnic minorities in the United Kingdom ha... more Disproportional morbidity and mortality experienced by ethnic minorities in the United Kingdom have been highlighted by the Covid-19 pandemic. The 'Black Lives Matter' movement has exposed structural racism's contribution to these health inequities. 'Cultural Safety', an anti-racist, decolonising, and educational innovation originating in New Zealand, has been adopted in Australia. Cultural Safety aims to dismantle barriers faced by colonised Indigenous Peoples in mainstream healthcare, by addressing systemic racism. This paper explores what it means to be 'Culturally Safe'. The ways in which New Zealand and Australia are incorporating Cultural Safety into educating healthcare professionals and in day-today practice in medicine are highlighted. We consider the 'nuts and bolts' of translating Cultural Safety into the UK to reduce racism within healthcare. Listening to the voices of Black, Asian and minority ethnic NHS consumers, education in reflexivity, both personal and organisational within the NHS, are key. By listening to Indigenous colonised peoples, the ex-Empire may find solutions to health inequity. A decolonising feedback loop is required; however, we should take care not to culturally appropriate this valuable reverse innovation.
Midwifery, 2019
Objective
To determine the incidence of immediate, uninterrupted skin-to-skin contact and breastf... more Objective
To determine the incidence of immediate, uninterrupted skin-to-skin contact and breastfeeding after birth; and which factors are associated with it.
Design
Cross-sectional e-survey was developed and piloted prior to distribution. Sampling was purposive and included snowball sampling. Associations between maternity care practices and the primary outcome measure were examined using logistic regression.
Setting
Australia
Participants
Women who birthed a term baby within the previous three years, in any Australian setting (hospital, birth centre or at home), were eligible to participate.
Measurements and findings
1200 postpartum women met the eligibility criteria and completed the e-survey. The primary outcome, ‘pronurturance’, included: 1) immediate mother/baby holding; 2) skin-to-skin contact; 3) uninterrupted holding for at least 60 minutes; 4) breastfeeding in the birth setting. Of 1,200 participants, 22% (n=258) experienced pronurturance. Pronurturance was less likely following caesarean section (adjusted Odds Ratio (aOR) 0.07, 95% Confidence Interval (CI) 0.03-0.17). Pronurturance was more likely with a known midwife during labour and birth (aOR 1.89, 95% CI 1.35-2.65). Contributing to the low rate of pronurturance were lack of antenatal skin-to-skin information; babies being wrapped; women wearing clothing; and non-urgent caregiver interruptions including weighing the baby or facilitating the mother to shower.
Key conclusion
Health services must strategically address the institutional processes which delay and/or interrupt skin-to-skin contact and breastfeeding in both birth suite and operating theatre settings.
Implications for practice
Midwives and midwifery students providing continuity of carer are best placed to provide pronurturance to mothers and babies. Caregivers should educate women about pronurturance antenatally, and actively support immediate, uninterrupted mother/baby skin-to-skin contact and breastfeeding after birth.
Keywords
Midwifery
Skin-to-skin
Breastfeeding
Health Services
Newborn
Surveys and Questionnaires
Midwifery, 2018
Objective: To develop an effective model to enable educators to teach, develop and assess the dev... more Objective: To develop an effective model to enable educators to teach, develop and assess the development of midwifery students' teamwork skills Design: An action research project involving participant interviews and academic feedback. Setting: A regional university Participants: Midwifery students (n=21) and new graduate midwives (n=20) Interventions: A whole of course program using a rubric, with five teamwork domains and behavioural descriptors, to provide a framework for teaching and assessment. Students self and peer assess. Lectures, tutorials and eight different groupwork assignments of increasing difficulty, spread over the three years of the undergraduate degree are incorporated into the TeamUP model. Findings The assignments provide students with the opportunity to practice and develop their teamwork skills in a safe, supported environment. Key conclusions The social, emotional and practical behaviours required for effective teamwork can be taught and developed in undergraduate health students. Implications for practice: Students require a clear overview of the TeamUP model at the beginning of the degree. They need to be informed of the skills and behaviours that the TeamUP model is designed to help develop and why they are important. The success of the model depends upon the educator's commitment to supporting students to learn teamwork skills.
Birth Territory and Midwifery Guardianship: Theory for Practice, Education and Research, 2008
Description Nature is always seeking to express itself. Everywhere we look there is evidence of t... more Description Nature is always seeking to express itself. Everywhere we look there is evidence of the profusion of life. Farmers know when conditions are favourable, the harvest is bountiful. The natural world has an innate, constantly evolving blueprint for creating, growing, developing and reproducing itself. Scientific understanding about the complexity of life is also growing and developing. Scientific perceptions are shifting from the limitations imposed by the fixed, mechanical Newtonian view of a material universe which contains ...
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Books by Carolyn R Hastie
The midwife has a time-honoured, powerful and privileged role in creating a facilitative environment for birth. A midwife has the honour of working alongside a woman, being ‘with’ her, supporting her growth and development as she births new life and becomes a mother. The midwife‘s capacity-building role extends to supporting each woman to discover who she is and what she is capable of. Midwives have a vital and influential part in ensuring the sustainability of the childbearing process and maternity care. Normal, natural birth is eco-friendly; it doesn’t require a great deal in terms of material resources, it does, however, require the loving attention of skilled and caring midwives. Normal birth needs to be protected, promoted and supported because it is the epitome of a human activity with an extremely low carbon footprint.
Following a definition of normal, natural birth and an exploration of why normal, natural birth is important for sustainability, the birth environment and cultural considerations are examined. Finally, suggestions for optimizing a woman’s experience and ways that a midwife can support normal, natural, health birth for the woman and her baby in a sustainable way are explored.
* Links new research findings to birth environments and outcomes.
* Describes the elements of an ideal birthing environment.
* Suggests how to modify existing maternity services to achieve optimal results.
* Investigates the links between the experiences of women and babies, and outcomes.
* Explores the effects of legal and socio-political factors.
Midwifery Continuity of Care includes summaries and vignettes which bring midwifery continuity of care to life and make them relevant to practising midwives, managers and others working within maternity services. Written by an international team of contributors, this book highlights the lessons learned by others to help develop new ways of thinking and practising. It will be an invaluable practical guide to all midwives, midwifery managers, student midwives and educators, and will also be of interest to policy makers and health service executives.
Publications by Carolyn R Hastie
To investigate the experiences, perspectives and plans of students who had a six-month placement with the midwifery group practice.
Methods
Focus groups were conducted with fifteen third – year Bachelor of Midwifery students who had undertaken an extended placement at a midwifery group practice in a large tertiary referral hospital in Queensland, Australia.
Results
Four main themes were identified in the data: Expectations of the Placement; Facilitating learning within a midwifery group practice model; Transitioning between models of care and Philosophy and culture of midwifery group practice.
Discussion and conclusion
Third-year midwifery students valued the experience of working one-on-one for an extended placement with a midwife providing continuity of care within a caseload model. The experience was the highlight of their degree and they learned ‘how to be a midwife’. Most students found reintegrating back into the hospital system of care challenging, reporting that their developed skills of supporting women holistically and facilitating normal birth were not fully utilised when returning to the task-orientated birth suite. Students valued thoughtful, kind and supportive midwifery preceptors who supported them to transition back into the hospital.
Implications and recommendations
Undertaking an extended placement within a midwifery group practice provides students with a rich and holistic learning experience and helps them develop a sense of professional identity. Student placements situated within models of care which provide continuity of midwifery care should be proactively enabled by health services and universities. Research of the longer-term impacts of an extended midwifery group practice clinical placement on midwifery graduates’ capabilities and competencies 3–5 years post registration should be conducted.
The aim of this study was to investigate whether a specifically designed whole-of degree strategy utilising groupwork assessments was effective in facilitating the development of early career midwives’ teamwork skills.
Design and Methods
A qualitative study using in-depth, semi-structured interviews was undertaken with early career midwives who had graduated within the previous two years. This study is the final cycle of a larger participatory action research project. Qualitative data was analysed using thematic analysis.
Participants
Nineteen early career midwives from one Australian university participated. Their preregistration education was via a Bachelor of Midwifery. Their education included a whole-of-degree educational strategy to facilitate the development of teamwork skills.
Findings
One overarching theme “Becoming an Effective Team Member’ and three sub-themes: ‘Learning and developing Teamwork Skills’; ‘More secure and confident’ and ‘Self-Assurance in interprofessional interactions’ were identified in the interview data. Despite their junior status, the midwives demonstrated the knowledge, skills, and attitudes of an effective team member. Their social and emotional skills appeared well developed and they felt confident interacting with other health care workers in a professional manner.
Key conclusions
Early career midwives who were taught and practiced teamwork skills throughout their degree, appear to have developed the social and emotional competencies required for effective teamwork. Implications for Practice: The capacity for effective teamwork of this small group of early career midwives has the potential to improve the quality and safety of their care for childbearing women. Learning teamwork skills in the educational setting appears to have generated skills focused on conflict resolution, emotional self-regulation and social and emotional competency in these new midwives. These are favourable skills in the emotionally charged environment of maternity care, where inter-collegial bullying is present and where new midwives can experience poor psychological wellbeing. Health care employers want new graduate health professionals to be work ready and to have the skills necessary to be effective team members. The program undertaken by these new graduates may be of assistance in developing these capabilities in other health students.
The known
Teamwork skills are an intrinsic part of the day-to-day activities of maternity services, influencing the workplace culture, retention of midwives and the quality and safety of care. Poor teamwork is associated with clinical errors, bullying and high turnover of staff.
The new
Early career midwives who were taught teamwork skills and practice these skills using their groupwork assignments throughout their undergraduate degree appear to demonstrate the social and emotional competencies required for effective teamwork.
The implications
Implementing a whole-of-degree program to develop teamwork skills in undergraduate midwifery students may improve early career midwives’ social and emotional competencies and interactions with other health professionals. Learning teamwork skills in the educational setting may generate skills in the new midwife that focus on conflict resolution, emotional self-regulation, and social and emotional competency. These are favourable skills in the emotionally charged environment of maternity care, where inter-collegial bullying is present and where new midwives can experience poor psychological wellbeing.
To determine the incidence of immediate, uninterrupted skin-to-skin contact and breastfeeding after birth; and which factors are associated with it.
Design
Cross-sectional e-survey was developed and piloted prior to distribution. Sampling was purposive and included snowball sampling. Associations between maternity care practices and the primary outcome measure were examined using logistic regression.
Setting
Australia
Participants
Women who birthed a term baby within the previous three years, in any Australian setting (hospital, birth centre or at home), were eligible to participate.
Measurements and findings
1200 postpartum women met the eligibility criteria and completed the e-survey. The primary outcome, ‘pronurturance’, included: 1) immediate mother/baby holding; 2) skin-to-skin contact; 3) uninterrupted holding for at least 60 minutes; 4) breastfeeding in the birth setting. Of 1,200 participants, 22% (n=258) experienced pronurturance. Pronurturance was less likely following caesarean section (adjusted Odds Ratio (aOR) 0.07, 95% Confidence Interval (CI) 0.03-0.17). Pronurturance was more likely with a known midwife during labour and birth (aOR 1.89, 95% CI 1.35-2.65). Contributing to the low rate of pronurturance were lack of antenatal skin-to-skin information; babies being wrapped; women wearing clothing; and non-urgent caregiver interruptions including weighing the baby or facilitating the mother to shower.
Key conclusion
Health services must strategically address the institutional processes which delay and/or interrupt skin-to-skin contact and breastfeeding in both birth suite and operating theatre settings.
Implications for practice
Midwives and midwifery students providing continuity of carer are best placed to provide pronurturance to mothers and babies. Caregivers should educate women about pronurturance antenatally, and actively support immediate, uninterrupted mother/baby skin-to-skin contact and breastfeeding after birth.
Keywords
Midwifery
Skin-to-skin
Breastfeeding
Health Services
Newborn
Surveys and Questionnaires
The midwife has a time-honoured, powerful and privileged role in creating a facilitative environment for birth. A midwife has the honour of working alongside a woman, being ‘with’ her, supporting her growth and development as she births new life and becomes a mother. The midwife‘s capacity-building role extends to supporting each woman to discover who she is and what she is capable of. Midwives have a vital and influential part in ensuring the sustainability of the childbearing process and maternity care. Normal, natural birth is eco-friendly; it doesn’t require a great deal in terms of material resources, it does, however, require the loving attention of skilled and caring midwives. Normal birth needs to be protected, promoted and supported because it is the epitome of a human activity with an extremely low carbon footprint.
Following a definition of normal, natural birth and an exploration of why normal, natural birth is important for sustainability, the birth environment and cultural considerations are examined. Finally, suggestions for optimizing a woman’s experience and ways that a midwife can support normal, natural, health birth for the woman and her baby in a sustainable way are explored.
* Links new research findings to birth environments and outcomes.
* Describes the elements of an ideal birthing environment.
* Suggests how to modify existing maternity services to achieve optimal results.
* Investigates the links between the experiences of women and babies, and outcomes.
* Explores the effects of legal and socio-political factors.
Midwifery Continuity of Care includes summaries and vignettes which bring midwifery continuity of care to life and make them relevant to practising midwives, managers and others working within maternity services. Written by an international team of contributors, this book highlights the lessons learned by others to help develop new ways of thinking and practising. It will be an invaluable practical guide to all midwives, midwifery managers, student midwives and educators, and will also be of interest to policy makers and health service executives.
To investigate the experiences, perspectives and plans of students who had a six-month placement with the midwifery group practice.
Methods
Focus groups were conducted with fifteen third – year Bachelor of Midwifery students who had undertaken an extended placement at a midwifery group practice in a large tertiary referral hospital in Queensland, Australia.
Results
Four main themes were identified in the data: Expectations of the Placement; Facilitating learning within a midwifery group practice model; Transitioning between models of care and Philosophy and culture of midwifery group practice.
Discussion and conclusion
Third-year midwifery students valued the experience of working one-on-one for an extended placement with a midwife providing continuity of care within a caseload model. The experience was the highlight of their degree and they learned ‘how to be a midwife’. Most students found reintegrating back into the hospital system of care challenging, reporting that their developed skills of supporting women holistically and facilitating normal birth were not fully utilised when returning to the task-orientated birth suite. Students valued thoughtful, kind and supportive midwifery preceptors who supported them to transition back into the hospital.
Implications and recommendations
Undertaking an extended placement within a midwifery group practice provides students with a rich and holistic learning experience and helps them develop a sense of professional identity. Student placements situated within models of care which provide continuity of midwifery care should be proactively enabled by health services and universities. Research of the longer-term impacts of an extended midwifery group practice clinical placement on midwifery graduates’ capabilities and competencies 3–5 years post registration should be conducted.
The aim of this study was to investigate whether a specifically designed whole-of degree strategy utilising groupwork assessments was effective in facilitating the development of early career midwives’ teamwork skills.
Design and Methods
A qualitative study using in-depth, semi-structured interviews was undertaken with early career midwives who had graduated within the previous two years. This study is the final cycle of a larger participatory action research project. Qualitative data was analysed using thematic analysis.
Participants
Nineteen early career midwives from one Australian university participated. Their preregistration education was via a Bachelor of Midwifery. Their education included a whole-of-degree educational strategy to facilitate the development of teamwork skills.
Findings
One overarching theme “Becoming an Effective Team Member’ and three sub-themes: ‘Learning and developing Teamwork Skills’; ‘More secure and confident’ and ‘Self-Assurance in interprofessional interactions’ were identified in the interview data. Despite their junior status, the midwives demonstrated the knowledge, skills, and attitudes of an effective team member. Their social and emotional skills appeared well developed and they felt confident interacting with other health care workers in a professional manner.
Key conclusions
Early career midwives who were taught and practiced teamwork skills throughout their degree, appear to have developed the social and emotional competencies required for effective teamwork. Implications for Practice: The capacity for effective teamwork of this small group of early career midwives has the potential to improve the quality and safety of their care for childbearing women. Learning teamwork skills in the educational setting appears to have generated skills focused on conflict resolution, emotional self-regulation and social and emotional competency in these new midwives. These are favourable skills in the emotionally charged environment of maternity care, where inter-collegial bullying is present and where new midwives can experience poor psychological wellbeing. Health care employers want new graduate health professionals to be work ready and to have the skills necessary to be effective team members. The program undertaken by these new graduates may be of assistance in developing these capabilities in other health students.
The known
Teamwork skills are an intrinsic part of the day-to-day activities of maternity services, influencing the workplace culture, retention of midwives and the quality and safety of care. Poor teamwork is associated with clinical errors, bullying and high turnover of staff.
The new
Early career midwives who were taught teamwork skills and practice these skills using their groupwork assignments throughout their undergraduate degree appear to demonstrate the social and emotional competencies required for effective teamwork.
The implications
Implementing a whole-of-degree program to develop teamwork skills in undergraduate midwifery students may improve early career midwives’ social and emotional competencies and interactions with other health professionals. Learning teamwork skills in the educational setting may generate skills in the new midwife that focus on conflict resolution, emotional self-regulation, and social and emotional competency. These are favourable skills in the emotionally charged environment of maternity care, where inter-collegial bullying is present and where new midwives can experience poor psychological wellbeing.
To determine the incidence of immediate, uninterrupted skin-to-skin contact and breastfeeding after birth; and which factors are associated with it.
Design
Cross-sectional e-survey was developed and piloted prior to distribution. Sampling was purposive and included snowball sampling. Associations between maternity care practices and the primary outcome measure were examined using logistic regression.
Setting
Australia
Participants
Women who birthed a term baby within the previous three years, in any Australian setting (hospital, birth centre or at home), were eligible to participate.
Measurements and findings
1200 postpartum women met the eligibility criteria and completed the e-survey. The primary outcome, ‘pronurturance’, included: 1) immediate mother/baby holding; 2) skin-to-skin contact; 3) uninterrupted holding for at least 60 minutes; 4) breastfeeding in the birth setting. Of 1,200 participants, 22% (n=258) experienced pronurturance. Pronurturance was less likely following caesarean section (adjusted Odds Ratio (aOR) 0.07, 95% Confidence Interval (CI) 0.03-0.17). Pronurturance was more likely with a known midwife during labour and birth (aOR 1.89, 95% CI 1.35-2.65). Contributing to the low rate of pronurturance were lack of antenatal skin-to-skin information; babies being wrapped; women wearing clothing; and non-urgent caregiver interruptions including weighing the baby or facilitating the mother to shower.
Key conclusion
Health services must strategically address the institutional processes which delay and/or interrupt skin-to-skin contact and breastfeeding in both birth suite and operating theatre settings.
Implications for practice
Midwives and midwifery students providing continuity of carer are best placed to provide pronurturance to mothers and babies. Caregivers should educate women about pronurturance antenatally, and actively support immediate, uninterrupted mother/baby skin-to-skin contact and breastfeeding after birth.
Keywords
Midwifery
Skin-to-skin
Breastfeeding
Health Services
Newborn
Surveys and Questionnaires