The emotional and physical demands of the pre-registration midwifery programme should not be underestimated. A ‘traditional’ degree generally has a 26-week academic year; however, since student midwives are also studying for a professional qualification, the academic year is 45 weeks in duration, meaning that student midwives have less time to recharge their batteries and reflect on their learning and development before the start of the next academic year.
The role of the midwife in contemporary maternity services is ever more demanding due to staff shortages; an impending ‘retirement timebomb’, with 33% of midwives in their fifties and sixties (Royal College of Midwives (RCM), 2017:3); increasing birth rates and evermore complex cases to lead and coordinate (RCM, 2017). In a bid to explore why some midwives were leaving the profession, Hunter and Warren (2013) were commissioned by the RCM to research the concept of resilience in midwifery by seeking the views of senior midwives who self-reported as being able to ‘bounce back’ after a difficult shift. The study explored the traits and characteristics of resilience, with findings suggesting the need for more robust support systems to be put in place for practising midwives.
Approximately 2500 student midwives commence training each year in the UK. This sounds like a healthy number; however, in real terms, after retirements and midwives leaving the profession for other reasons, the workforce grows by only 100 midwives year-on-year (RCM, 2017). The midwifery profession needs all midwifery students who commence the programme to successfully complete it to join the workforce thereby improving numbers and the age profile of the profession.
Previous articles in this series have discussed whether student midwives are adequately prepared for practice (Power, 2016a) and have provided ‘Survival Guides’ for students commencing their studies in both theory (Power, 2015a) and practice (Power, 2015b). This article will suggest tips and strategies to maintain momentum and motivation for students who are progressing from years one and two of their programme. Anecdotal evidence suggests that year two is particularly emotionally demanding, with some students experiencing ‘year two blues’. In year one everything is new and exciting, and motivation is high. In theory, the focus is on normality and low-risk midwifery, which reinforces students' perceptions of the midwife being ‘with woman’. In practice, students are under direct supervision at all times, affording them a sense of safety and security.
‘Students have renewed motivation as they approach the finish line—three stripes on the epaulette signifying that qualification is calling; however, this year also has its challenges, particularly in practice, where the phrase, “come on, you're a third year now” rings loud’
There is a shift in expectations for year two: the focus of the curriculum moves from normality to caring for women with complex needs; issues of perinatal mental health; the compromised neonate and research studies. This is accompanied by a change in expectations in clinical practice as supervision becomes indirect, with students being encouraged to be more proactive and assertive in their practice. For some, the wide-eyed optimism of the first year has dimmed and the excitement of completing the programme and qualifying as a midwife is still a distant dream, leading to a sense of despondency and a questioning of career choice.
Moving in to year three, students have renewed motivation as they approach the finish line—three stripes on the epaulette signifying that qualification is calling; however, this year also has its challenges, particularly in practice, where the phrase, ‘come on, you're a third year now’ rings loud in their ears from day one of their placement (Power, 2016b). Despite the challenges, it is important that students take time to reflect on their journey and celebrate their successes. This article will suggest ways for students to cope with the demands of their studies as they progress to the next year of their programme, reinforce the culture of ‘lifelong learning’ and remind them of why they started this journey in the first place.
Reflect on the last year and be honest with yourself
Reflection is a skill that all midwives and students need to develop, having been integrated into the revalidation process for all registered midwives by the Nursing and Midwifery Council (NMC) (2018). Being able to think about your own experiences on placement allows you to process and assimilate knowledge, and identify any gaps. Looking back over the last year, take time to reflect on how far you have come. Remember how much learning has taken place and the skills you have that you didn't have a year ago.
Taking abdominal examination as an example, most student midwives will not have palpated a pregnant woman's abdomen before starting the course; yet by the end of the first year, they would be confident in assessing the fundal height. Taking that a step further into second year, the development of the skill then includes identifying the presenting part and by third year, moving on to engagement and accurate assessment of the position of the baby. At the end of third year, when you have acquired the knowledge and skills to carefully examine a pregnant woman's abdomen, remember that learning continues every time you assess a different abdomen, because no two women are identical, and no two babies present in exactly the same way.
Be honest with yourself and ask whether you are ready to progress to the next level with your clinical skills. Perhaps take the time to look back on lecture notes or at a textbook and make sure your knowledge base is sound. At the start of each placement, have an open and honest discussion with your mentor, outlining your strengths and areas for development, so that together you can put in place a learning plan to re-visit and consolidate clinical skills before moving on.
Be ready for feedback
Being able to give and receive feedback is invaluable for student and qualified midwives. Feedback gives the student an indication of how they are progressing and what improvements might need to be made. Seek out this feedback from mentors whenever you can, ideally at the end of every shift. This then gives you an opportunity to reflect and be ready for the next shift. Feedback should not be taken personally: if your mentor says you need to improve on vaginal examinations, this does not mean you're not good enough; rather there is room to develop your knowledge and skills. Feedback should be specific and constructive, ideally giving the student stepping stones to achieve the appropriate level of competency. It can also be positive, reinforcing the student's confidence when a skill is performed well. For those skills which are difficult to teach, such as empathy, emotional intelligence and compassion, it can help students to identify role models who show the desired traits. Don't be afraid to model your behaviour on midwives you admire and practise these skills outside of placement areas, too.
Revalidation requires midwives to provide five pieces of practice-related feedback (NMC, 2018), stating how this will improve their practice. Students should be encouraged to feed back to mentors when learning has gone well and also suggest areas for their professional development. This requires advanced communication and interpersonal skills, and will prepare students for their role in supporting students and peers once they are qualified (NMC, 2015).
Set yourself one challenge
Considering the year ahead, it may feel like you have enough to do, with theoretical assignments, dealing with shift patterns, gaining skills and competencies, and juggling the demands of the course with family commitments. If you can, set yourself a challenge, something you haven't yet accomplished. It might be quickly achieved, like attending a study day with other midwifery students or with your mentor. The RCM conference in October 2018 has a day dedicated to student midwives and is free to attend. You might feel inspired after attending a study day to organise one locally. Get your university's midwifery society involved, and see if you can recruit speakers from your local Trust to speak for free. Many of the midwives you work with have specialist interests that they would love to share.
Read an article per day just for interest, rather than in preparation for an assignment. Pick a topic with which you are unfamiliar to challenge yourself and widen your knowledge base. Identify role models in the profession and read their publications or follow them on social media to act as a reminder of the midwife you aspire to be. Attend some of the meetings at your Trust that are open to everyone working in maternity services, such as clinical governance, risk and fetal monitoring meetings, to further consolidate your knowledge and understanding of underpinning theory and interprofessional working.
Look after yourself
Ultimately, your midwifery career is a marathon and not a sprint. Lifelong learning is exactly that, and that takes commitment, determination and resilience. To get that far, you need a good friend and that's you. You've already shown you have what it takes with either one or two successful years of study behind you. Keep the faith in yourself and take time this year to build your resilience. A difficult shift or constructive feedback shouldn't derail your thinking. Be kind to yourself this year: find ways to relax in a healthy way that work for you. Keeping fit is a good places to start—for some, that means yoga and gardening; for others its full-on triathlons, but however you like to exercise, it's a good way to stay healthy, both mentally and physically. Make sure that at work you take breaks, drink plenty of water and eat well.
And finally…
Never forget how far you've come and your significant achievements to date. Remember what a privilege it is to be ‘with woman’ throughout her journey through the childbirth continuum. You have a team of highly motivated educators and clinicians to support you, so don't be afraid to reach out to someone if you're struggling in theory or clinical practice. Huge congratulations for your achievements thus far and keep at it—your profession needs you!