In June 2016, the UK's European Union (EU) referendum resulted in 51.9% of the electorate voting to leave. Leaving the EU will have wide ranging social, legal and constitutional implications including (but not limited to) trade, business and financial services, employment, transport, immigration, police and justice, health, higher education (Miller, 2016). In relation to health, the EU has a significant role in supplementing national policies, and while the International Confederation of Midwives (ICM) has established the international standards for midwifery education; teaching and practice are regulated through the European Directive 2005/36/EC (European Parliament and Council, 2005), which includes the recognition of professional qualifications and free movement to practise anywhere within the EU.
When it comes to higher education, the UK is a full member of the European Higher Education Area (European Ministers of Education, 1999), whereby members aim to increase compatibility between education and training systems across the EU to promote high quality learning and teaching and to facilitate the free movement of students, researchers and teachers.
The Florence Network
Established in 1995, the Florence Network is one of Europe's oldest nursing and midwifery organisations, with a membership of 40 higher education institutions in 18 countries. It is a co-operation of European nursing and midwifery education departments, all of which share the Network's aim of:
‘Identifying and developing educational, scientific, practice and pedagogical commonalities [in order to] promote mobility between countries and institutions as required by European educational treaties’
The Network hopes to enhance the professional standing of nursing and midwifery and improve the quality of European healthcare. Its main goals are (Florence Network, 2017):
Becoming a member of the Florence Network is by invitation only, and this year was the inaugural meeting for the University of Northampton. This resulted in a double celebration as a second year student, Hollie Townley, was elected to the Student Board as its only student midwife representative. Hollie will be involved in developing communication channels and organising activities and workshops for next year's Annual Meeting, which is to be held in Odisee, Belgium (University of Northampton, 2017).
Mental Health: Global Challenge, Local Actions
The theme of this year's Network meeting in Bern was ‘Mental Health: Global Challenge, Local Actions’, with several interesting keynote lectures delivered by researchers and clinicians from institutions around Bern and Winterhur. While there does not appear to be a clear pathway for the care of mothers who are suffering with postnatal depression, there are some (although limited) initiatives in place to provide a more holistic approach to caring for mothers and babies. An example of this was given in a talk by Katharina Guldimann, who is a founder of a rural mother-child house that offers respite for ‘women who need relief, care and loving care with postpartum mental illness or severe exhaustion’ (Ita Wegman Mutter-Kind-Haus, 2017)
Education: a common destination
Midwifery education in Switzerland differs from the UK in that there are two routes to choose from: a direct-entry 4-year Bachelor degree programme, or a Bachelor degree programme that lasts two and a half years, following nurse training. The 4-year programme is similar to that offered in the UK, with a 50:50 theory/practice split. The main difference is that within the first 3 years there are few practice placements, but the fourth year consists of 40 weeks' practice with 30 weeks on labour ward, and 10–20 weeks' postnatal experience. It is at the end of this period of consolidated practice that the students receive their degree.
Members of the Florence Network had the chance to take part in a small group visit to Engeried Hospital, a private hospital in the suburbs of Bern with a maternity unit that sees around 3000 births per year. During this visit, members were able to share experiences from their own countries in light of the information shared from the two host midwives. Interestingly, from an educational viewpoint, a hospital such as this will receive money if they host students, while a hospital that does not host students has to pay a fee to the government.
Unlike the UK, where the higher education institutions and placement providers work in partnership to support students in practice, the students' learning in the clinical area is the responsibility of the clinicians, and academics are only contacted if a real concern is identified. Within the maternity unit, there were three key individuals responsible for supporting students, rather than academic lecturers visiting students on placement. To that end, the students receive ‘coaching’ by a person who is allocated to provide support in practical training and assessment. A Berufsbildner (vocational trainer), an individual from within the hospital who has an educational background, provides one-to-one teaching twice a month. Lastly, there is a person responsible for the administrative support of students on placement including coaching, classes, and case study reviews.
Benefits of network membership
This was an insightful visit for lecturers and students alike. It was a privilege to be invited to join the Florence Network and attending the Annual Meeting appeared to have a significant impact on Hollie, from showing resilience and confidence through independent travel, to engaging with other students from a variety of institutions and countries, and finally being so motivated as to stand for election on the Student Board. In her own words:
‘I feel this opportunity has allowed me to see my own potential, which I hope others can also experience. It was brilliant meeting other like-minded students and sharing our experiences. I found meeting people from different nationalities so refreshing; it made me reflect on language and people's perception of language. Also, how no matter what country you are from, healthcare is deep rooted by a foundation of love and passion that all individuals share. This emphasised how unity can be so powerful, and conferences such as this should continue in order to encourage and implement positive changes globally. I came home feeling proud of my personal achievements (becoming a board member), thankful for the opportunity, [and] passionate about international interactions and midwifery as a whole.’
Beyond Brexit: what next?
The post Brexit political landscape is undecided, but what is known is that there will be a period of development and reorganisation of the regulation of midwifery pre-registration education that is currently under Directive 2005/36/EC of the European Parliament (Boxes 1 and 2). Amid political uncertainty, it is even more important to maintain strong professional relationships through collaborations such as the Florence Network, as the safety and wellbeing of women and their newborns transcend political and geographical borders.