A Participatory Action Research Project: Investigating a Structured, Whole-of-degree Approach to Developing Undergraduate Midwifery Students’ Teamwork Skills

I'm delighted to share the news that I've passed examination for my PhD.

 

The abstract for my thesis is presented below.  I've added the link to the thesis to anyone who would like to explore further. 

Teamwork skills are an intrinsic part of day-to-day activities of maternity services, influencing workplace culture, midwife retention and quality, safe care. Effective teamwork depends upon the social and emotional competencies involved in interpersonal interactions in the workplace. Intra- and inter-professional relationship components of effective teamwork are contingent upon the individual’s social and emotional skills. A regional university implemented a whole-of-degree educational strategy aiming to facilitate the development of midwifery students’ teamwork skills that are sustainable in real-world practice following graduation. A PAR methodology to develop and refine the strategy, which engaged educators and students in an iterative process over 3 years of their undergraduate degree, was approved by University Ethics Committee. The study resulted in theory and evidence to describe, explain and predict the effects of implementing the strategy designed to teach and assess teamwork skills. Newly graduated midwives who had been taught teamwork skills and practice, and developed those skills throughout their degree, appeared to be more effective team members, despite their junior status. Implementing a whole-of-degree educational strategy to develop teamwork skills in undergraduate midwifery students may improve inter-professional interactions, reduce the incidence of bullying and make health care safer. The study contributes to understanding how to teach and assess undergraduate health students’ teamwork skills in ways that students find effective and satisfying. It adds to the midwifery body of knowledge about teaching and assessing teamwork skills and may provide a useful template for professional development in teamwork skills for graduate midwives and doctors.

A Participatory Action Research Project: Investigating a Structured, Whole-of-degree Approach to Developing Undergraduate Midwifery Students’ Teamwork Skills

Midwives, exhaustion and safety

A recent survey of midwives and maternity support workers in the UK, found that the majority were stressed because of their workload and fearful of making mistakes because of exhaustion. Over half of those surveyed had observed errors and incidents which could have caused harm to women and their infants. These stressors are not restricted to the UK. I hear similar concerns from Australian midwives.

This situation is untenable for the midwives and the women and families in their care. 

 

It's about time governments and funding decisions reflect and respect the vital importance of childbearing to the fabric of society and fund maternity care appropriately. 

Better staffing levels are required. 

Staffing of maternity services decisions need to be made in acknowledgement of: 

• The increasing complexity of maternity care
• The fundamental requirement for adequate time for antenatal visits
• One-to-one care from a known midwife in labour 
• The need for adequate postnatal care

Only when these aspects are factored into the staffing model can we ensure that women of all risk and their infants get the care they deserve and the care which keeps them safe. 

Midwifery Continuity models for women of all 'risk' are what's required. 

Whatever model of maternity care is provided however, there must enough staff to provide the service safely - safely for women, their infants and safely for the midwives.

Midwives are dedicated professionals and consistently go above and beyond to care for women and their infants. That dedication should not be exploited. The current practice of staffing to the bare minimum, putting midwives on call after they've already had a full day at work in case there's an increase in activity, coupled with the ever-expanding list of mandatory education and competency requirements means the demands on midwives are creating a pressure cooker environment.  

Running midwives 'ragged' is not good government or health service policy. 

Appropriate and adequate funding of maternity care is essential.

We have a duty of care as a society to care for midwives and other maternity health care providers so they can care for the women and families they work with in the best possible way. 

The future depends upon it. 

Midwives warn of making mistakes due to burnout

The secret life of a midwife: I feel I work in a factory

Staff levels the risk: midwives

Fads, birth and safety

A 'prominent' Perth obstetrician and president of the Australian Medical Association (WA) Dr Michael Gannon, was reported as saying that "an “obsession” with skin-to-skin contact between mothers and babies after birth is a fad that is putting newborns at risk of death and serious injury".  His comment appeared in the article 'Skin-to-skin' fad blamed for deaths of babies published in The West Australian online newspaper 5 March 2016.

The coroner is investigating the death of a newborn at the Fiona Stanley Hospital. The article suggested that the baby is thought to have died 'after the mother fell asleep while holding or breastfeeding the baby'.

The AMA president rightly raised concerns about drug affected, exhausted women:

"New mothers are often exhausted by a long day in labour and there are the side effects of opioid drugs, epidurals or c-section"

 Photo from Midwifery Today site

However, he also criticises what he calls a

" new obsession amongst mothers and midwives with immediate skin-to-skin contact after birth ... which "stemmed from taking whatever possible measures that might lead to small increases in the number of women who breastfeed"

Far from a fad, skin-to-skin contact for women and their newborns at birth and beyond is a well-researched instinctive behaviour. This instinctive behaviour has been shown to not only improve breastfeeding success, but also, combined with breastfeeding attempts, reduce the rate of primary PPH, along with enhancing the sense of safety and attachment for the newborn and her mother. There are implications for the newborn's microbiome and there is some evidence that skin-to-skin experience reduces mothers' stress levels.

The doctor is reported to have said, in response to the claims for skin-to-skin, that:

 “I think that gets over-interpreted. Babies, instead of being in a safe environment like a warming crib, are being left on their mother’s chest”

Now the attitude that a newborn is better off in a warming crib than with its mother is the nub of medicalisation of the childbearing process and the disconnect between the use of technology and our humanity.

The medicalisation of childbirth is a done deal. Whilst physiological birth is appealing from both an evolutionary and capacity building perspective, the reality is the majority of women in the western world, are already heavily socialised into accepting and wanting medicalisation. Whilst choosing and embracing medicalisation and interventions, women are drawn to the idea of having their newborns with them skin-to-skin from birth and in the main, to breastfeed them. There is even a push (excuse the pun) for 'natural' and 'self-assisted' surgical births. Midwives are drawn to 'keeping things normal' and whilst supporting women in their choices; they are also drawn to facilitating skin-to-skin for the woman and her newborn at birth.

There is no doubt that 'drug affected, exhausted women' are vulnerable, as are their newborns, to the creation of potentially asphyxiating situations. A review of Apparent Life-Threatening Events in Presumably Healthy Newborns During Early Skin-to-Skin Contact  highlighted the issues for six babies left prone, unsupervised by a midwife or other health professional, on their mothers' abdomens. 

The reality is that midwives are increasingly having to care for postnatal women who are 'drug affected and exhausted'. The current staffing levels are woefully inadequate to care properly for these 'drug affected and exhausted women' together with their newborns.  Some people suggest recruiting partners or other family members to observe the newborn who is skin-to-skin with its mother, but that's a cop-out. 

Daily Mail

Often partners and others don't know what to look for and the bottom line is, the woman and infant's well-being is the responsibility of the institution that provides the 'care'. 

Whilst a decrease in medicalisation of birth would be ideal, that ideal will need a revolution in society's attitudes. In the meantime, what the good doctor and the AMA should be arguing and agitating for is not a separation of a mother and her infant, but for women and their infants to be treated with the profound respect they deserve and adequate midwifery staffing levels so that women and their infants can benefit from best practice and have the support and expertise of the midwife's presence to ensure that experience is a safe one.

Dr Gannon and the AMA need to understand that it is not skin-to-skin experience at birth that is putting newborn babies at risk.

What's putting newborns and childbearing women at risk is the rampant, unfettered medicalisation of childbearing that pervades modern maternity services coupled with ridiculously inadequate staffing levels - that situation is lethal.

The mother whose baby died at the Fiona Stanley hospital deserves our heartfelt love and support, kindness and respect - not blame for her baby having skin-to-skin and breastfeeding at birth - she was doing the very best she could for her baby.

If the little one is found to have succumbed because of airway obstruction, then our society has failed her and her family.  Our society does not value childbearing women enough to provide adequate staffing levels and midwifery expertise to be their guardians through their most vulnerable time. 

Midwifery voices needed on WHO draft of Every Newborn Action Plan

Calling all midwives: Please read this request from the International Confederation of Midwives and ensure the midwifery perspective is included in this important plan to save newborn lives.

Your voice is urgently needed: The WHO together with partners have drafted an action plan to end preventable newborn deaths (Every Newborn Action Plan). The draft is now online for a public consultation process with the deadline on the 28th of February. It is crucial that midwives have an input as the plan will affect midwives in their work and midwifery on a global level. Strong indications from midwives are needed that this Action Plan is about high quality midwifery, normal birth and normal care of healthy babies (as well as the complications and treatments highlighted in the document).

Feedback is coming in to WHO, but sadly not (yet!) from midwives. The voices of midwives are urgently needed!

Thank you to those who have responded. For those who have not yet, kindly take some time from your busy schedule and provide feedback to this important document. 

Don’t miss this opportunity to make your voice heard and make sure the midwife perspective is included in the plan! Click on the link to comment: http://www.who.int/maternal_child_adolescent/topics/newborn/enap_consultation/en/ 

The deadline is FEBRUARY 28th and unfortunately cannot be extended.

Thank you for the time and effort.

Kind regards

Charlotte Renard
International Confederation of Midwives