This article is the last in a series exploring expert clinicians' participation in teaching pre-registration midwifery students in the classroom setting. It will consider sessions facilitated by Paula Briody, matron for intrapartum care at Northampton General Hospital NHS Trust. Paula facilitates sessions with students in the third year of their programme of study, entitled ‘working as a professional’ and ‘employer/employee responsibilities’. Midwifery students at the University of Northampton are privileged to be taught by an expert clinician such as Paula, whose varied career to date has equipped her with a unique set of skills that she is keen to share with the next generation of midwives. The unpredictable nature of the clinical area means senior midwives cannot commit to facilitating student learning in the hospital environment as the demands of the service must come first; however, the timetabling of classroom-based sessions means students are guaranteed protected time to learn about this key position.
Matron: role and responsibilities
The NHS Plan (Department of Health (DH), 2000: 5) cited the introduction of matron posts in England as key to the NHS policy objectives in order to give senior midwives and nurses the authority to ‘get the basics right on the ward’. The Royal College of Midwives (RCM, 2008) suggests the responsibilities of a matron typically include:
This role is currently particularly challenging in the context of a rising birth rate, an increase in the proportion of ‘complex cases’ as a result of social, economic and clinical challenges, staff shortages and an impending ‘retirement time bomb’ (RCM, 2015: 2), as approximately 4628 midwives retired between 2010 and 2016 (Centre for Workforce Intelligence, 2012).
The journey to becoming a matron: Paula's story
I qualified as a registered general nurse in January 1985 and worked for several years as a staff nurse in oncology and female surgery/gynaecology before commencing my midwifery training in November 1988. I qualified in April 1990, and my journey as a midwife began. I worked in all areas of midwifery and was passionate about providing woman-and family-centred care to ensure that women were empowered and fully informed of their choices to achieve a positive birth outcome.
I spent a couple of years living in San Francisco, where I worked with a group of independent midwives providing antenatal, intrapartum and postnatal care for women who had opted for homebirth. Obstetric care in the state of California is very different to the UK; community midwifery does not exist and there is no support for homebirth unless you employ an independent midwife.
On my return to the UK in 2002, I was employed as a community midwife in Northampton. At that time we did not have a birth centre, and homebirth was becoming more popular. At booking and during the antenatal period, low-risk woman were offered the option to birth at home and, gradually, the number of women choosing homebirth was rising. It became difficult to support the growing number of homebirths and cover antenatal clinics and postnatal visits, and so the concept of a homebirth team was discussed. The idea was conceived in 2009, and in April 2010 the team was born. It would provide antenatal visits at home, be available for birth 24/7 and provide postnatal care. The team celebrated its 6th birthday this year, having attended more than 1500 homebirths. In 2011, the homebirth team won the RCM's Implementing Government Policy Award.
I went to work in Australia, on the delivery suite in a private hospital, which was completely different to what I was used to from my work as an autonomous midwife in the UK. The model of care was obstetric-led and, at times, it was a challenging environment to work in. However, during my time there I was able to ensure the women I cared for were empowered and had informed choice regarding birth options.
I returned to the UK permanently in May 2012 and worked on the maternity day unit, helping to implement and support the area as the unit was now seeing women for triaging who were over 20 weeks' gestation. It involved multidisciplinary working and ensuring that women were signposted to the correct area. In December 2012, I was appointed as matron for intrapartum care. My areas of responsibility are the labour ward, maternity day unit, homebirth team and, since December 2013, our birth centre. Shortly after I came into post we were successful in a bid to obtain funding to improve the environment, and we used that money to develop the birth centre. It has four birth rooms (three with pools), a new pool room on the labour ward which can be used for high-risk women, and a new ward area close to the labour ward for inductions of labour and high-risk antenatal and postnatal women.
During my time in post, I have endeavoured to reduce our lower segment caesarean section (LSCS) rate and increase our normal births supported by midwives. A birth-after-caesarean clinic was started and has been successful in increasing our vaginal birth after caesarean rate. The LSCS rate has gone down, and now the challenge is to sustain that along with our increase in the normal birth rate.
I also co-run a weekly ‘Meet the Matrons’ clinic, which is open to women in the antenatal and postnatal periods. The all-day clinic runs once a week. The rationale for setting it up was because I was always keen to meet face-to-face with anybody who had issues, complaints or concerns in the antenatal period. It became apparent that this service was much-needed, so we decided to pilot a clinic. It is proving to be very successful. Students are more than welcome to contact me if they wish to attend one of the sessions.
I have always been conscious of how important it is to have a happy and supportive work environment, so that women are cared for by midwives who come to work feeling valued. I take a proactive approach with regard to recruitment, ensuring that I am involved in all of the shortlisting and interview process. I feel ultimately responsible for all midwives who are employed to work in my unit and want to ensure that those we employ share our core value of being ‘with woman’ to provide high-quality woman-centred care.
Why teach?
My journey into teaching and involvement with the university stemmed from my involvement in recruitment. I am as passionate about midwifery today as I was when I started. It is a privilege to be a midwife and be part of a woman's journey into motherhood. When I interview midwives—whether they be students about to qualify or experienced midwives—I want to be able to hear and feel their passion. I feel that it is so important that students understand that being a midwife really means being ‘with woman’, watching and listening. As matron for intrapartum care, I am acutely aware that it takes a huge amount of compassion, care and courage to support a woman through labour; in today's labour wards, the focus can shift to caring for pumps and monitors, with a danger of losing sight of the needs of the woman and her partner. Of course, there is always going to be a percentage of women who need high-risk care and we all need to be competent in this area, but we must, as midwives, always keep the woman at the centre of care. There are times when this can be challenging.
I think it is important for placement providers to work closely with education providers to educate and support the future midwifery workforce. Personally, I feel it is hugely important, as a clinician, to be involved with the university to prepare students for the realities of life as a midwife, as this transition can be very difficult.
The sessions
To date, my involvement in the classroom has been with third-year students as part of a module that explores how contemporary midwifery practice requires midwives to demonstrate the ability to work autonomously within legal and ethical frameworks. The sessions were entitled ‘working as a professional’ and ‘employer/employee relations’; topics covered can be seen in Box 1.
| The Code (Nursing and Midwifery Council, 2015) |
| An awareness of policies, procedures and guidelines |
| The requirement to be professional at all times, including an awareness of safe and appropriate use of social media |
| Respect for colleagues, women and families |
| The importance of multidisciplinary working |
| An awareness of appearance |
| Appropriate behaviours |
| Organisational culture and how to promote a positive work culture |
| Multidisciplinary and multi-professional working |
| Autonomy and continuing professional development—midwives are responsible for their own individual practice and have a responsibility to keep up to date with current knowledge |
| Pay structure |
| Mandatory training for preceptor midwives |
| Midwifery supervision |
From the next academic year, I will also be facilitating ‘working as a professional’ sessions with students in the first and second years of their programme of study, as I think the concept of professionalism in all domains should be introduced early in students' training and revisited throughout the course.
Conclusion
Despite the complex demands of modern-day maternity services—further complicated by ongoing staff shortages—women and their families need and deserve a safe service provided by midwives who are knowledgeable, research-aware and professional. Policy dictates that matrons should take the lead in ensuring women receive high-quality care in clean and safe environments and, if service users' expectations are not met, the matron's remit includes the management and resolution of complaints (DH, 2000). Having a senior clinician with such wide-ranging responsibilities come into the classroom helps student midwives become better equipped to meet the expectations of service users, policy makers and their prospective employers.
Final thoughts
This series of articles has explored the impact of expert clinicians on students' learning in the classroom environment (Power, 2016; Power and Gupta, 2016; Power and Rea, 2016; Power and Rooth, 2016). It has detailed the clinical roles and responsibilities of senior and specialist clinicians (bereavement midwife, consultant midwife, consultant anaesthetist and matron); explored their motivation for engaging with learning and teaching in the classroom environment; outlined the content of the sessions they facilitate; and, where appropriate, shared student feedback.
The midwifery pre-registration curriculum is required to be ‘no less than 50% practice and no less than 40% theory’ (Nursing and Midwifery Council, 2009: 19) and should include a variety of learning and teaching strategies. Inviting experts into the classroom provides students with a unique opportunity to learn about specialist roles in a ‘safe’ environment to complement learning in the clinical environment, which is dynamic and unpredictable in nature.
An additional benefit of this initiative is that it provides students with the opportunity to interact with leaders of maternity services in a non-hierarchical setting, so that when they go into the clinical area they should feel more able to approach and interact with senior staff. This may have a positive impact on their self-confidence and morale and, as a consequence, the quality of the care they provide.