The recent Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries across the UK (MBRRACE-UK) report has exposed some shocking findings regarding the maternity outcomes amongst women who are from black, Asian and minority ethnic communities. How can it be possible that in this day and age, ‘black women are five times more likely to die in childbirth?’ (Knight et al, 2019). With the midwifery profession striving to provide woman-centred ideologies and models of care that are based upon a premise of continuity (Cumberledge, 2016), it remains inexplicable that mortality rates for these women remain so high.
The findings of this report led to much soul-searching by two midwifery educators, who were deeply committed to making an impact and contribution to improving the care of these women and their families. What followed was a deep reflection on how these inequities might be addressed. The adage ‘education is power’ (Nelson Mandela Foundation, 2003) led the authors to believe that they were in a prime and privileged position to make an impact through midwifery education.
Therefore, a service user group was created, that would later call themselves the University of West England Midwifery Community Partnership Group (lucas and Meen, 2019). This group was intended to be diverse and representative of women who currently access maternity services. However, the trajectory did not stop there and the authors wanted to take others on this journey. Therefore, midwifery students who wanted to make a difference to the service user's experience of maternity care were invited to join. This was with a firm belief that they could help in contributing to addressing the current shortfalls in care for women who are from diverse communities, as well as recognising the wider importance of the service user's voice.
Figure 1. Midwifery service user lifespan continuation model
The aim was to work in partnership with other service users and student representatives, by having an impact on midwifery education. This was seen as the starting point, but students are the future catalysts in making a difference, and using their skills set to enhance and prioritise future care challenges in maternity service users' care was regarded as pivotal.
The authors believe that this can be achieved through a combination of shared service user learning experiences, where equality is respected, the service user's voice is acknowledged, and their experience is respected. It is anticipated that the inclusion of service users within midwifery education in this way will support future generations of student midwives to role model excellent practice. A collaborative group of women who use maternity services, and student midwives and educators open a unique dialogue and insight into each woman's community, including the available support services. Nurturing partnership working with women and families to promote wellness enables midwives to actively listen to the needs of all women, through shared learning and action.
Whilst the hierarchy of evidence is pivotal in providing ‘gold standard’ evidence-based practice, storytelling and personal narratives of healthcare and maternity experiences form an additional platform of knowledge acquisition. Maternity services are conisistently striving to improve quality of care, enhance women's experiences and birth journeys, and gather both positive and constructive feedback from a number of varying sources. These include friends and family surveys, local maternity voices partnership group involvement and, on a professional level, revalidation for midwives.
The dialogue and phenomenon of women's voices are deeply valued by student midwives and midwives themselves. Students report high satisfaction levels and deep application of learning when birth stories and experiences are shared (Burgess, 2017; Weston, 2012). Downe (2018) believes that storytelling can transform the way maternity care is thought of and can bring about change not only in staff, but also in public perception and curiosity. As a result of this, the authors have collaborated with their group to incorporate women's voices through the BSc midwifery curriculum and beyond, including through the production of a number of learning artefacts and sources. These include storyboards, podcasts, journal extracts, simulation and adjustments to current assessment documentation and feedback resources. The latter was developed by a second year midwifery student and the women in the group, and is actively being used to gather feedback that directly feeds into the clinical assessment and development of student midwives.
The authors have constructed a model to demonstrate the lifespan of learning that can be gained from the valuable contributors from pre-pregnancy towards adult involvement at all stages of healthcare involvement. This will afford midwifery students at the University of the West of England a unique insight into partnership working and collaboration. It is also a unique way in which students can go on to practice with impact and shape the future health needs of women and their families. The transformative narratives of women are inspirational and able to incite action at each stage of the life course (Lucas and Meen, 2019).
The NMC (2015) Code and the Standards for Midwives (NMC, 2019) lay out the standards and expectations that are required of qualified midwives with disseminating new knowledge and promoting excellence being at the forefront of fostering midwifery leadership. By embedding these core behaviours and attributes in the curriculum, through shared learning, and co-creating with our diverse communities, it is possible to truly embody role modelling midwifery excellence and professionalism from the very beginning of a student's journey, whilst also improving women's experiences and the quality of care received.
The authors encourage midwives, educators and students to nurture these privileged opportunities afforded to the midwifery profession, enabling midwives to work with women to empower them, and raise their voices to be heard loud and clear, to facilitate active change. This is power in its truest form.