This post is co-authored by Dr Annabel Sheehy and Loretta Musgrave.
How can we prepare graduate midwives to respond to the complex maternity care needs they will face in their early career experiences? What kinds of strategies can support student knowledge and clinical competence when caring for women who experience perinatal grief, loss or trauma?
Dr Annabel Sheehy, Lecturer in Midwifery, and Loretta Musgrave, Course Co-ordinator Graduate Diploma of Midwifery, recount the development of a comprehensive teaching and learning approach in the Bachelor of Midwifery, underpinned by student feedback and research by Dr Annabel Sheehy and Professor Kathleen Baird.
The need for early career and student support
As part of their roles, midwives care for women who experience poor perinatal outcomes like stillbirth and neonatal death. For new midwives to provide safe and quality midwifery care to women, specific training that includes clinical preparedness and emotional competence is essential.
Annabel and Kathleen’s study of early career midwives’ experiences with perinatal loss and trauma found that students’ exposure to these events, clinical preparedness and quality institutional and collegial support were important to participants. Novice midwives wanted clinical upskilling and safeguarding from emotional and psychological distress.
Significant findings of their study showed that overall, participants:
- perceived a paucity of experiences with loss and death during clinical placement;
- acknowledged numerous technical and communication skills were required for this care;
- considered a lack of cohesion in the university teaching and learning on the topic;
- encountered fragmented education on perinatal loss at university which hindered the acquisition and strengthening of essential skills.
Recommendations and potential solutions included:
- a dedicated perinatal loss subject in midwifery curriculum to establish and consolidate foundational skills;
- clinical simulations with realistic environments and case scenarios of death and loss;
- opportunities to engage in experiences with perinatal loss in the latter stages of education when accumulated knowledge and skills could be employed within the safety of the student-midwife relationship.
Scaffolding across multiple subjects
These findings were applied in the development of the newly introduced teaching and learning strategies of perinatal loss in 2021. Three second-year subjects (theoretical and clinical) were redesigned by Loretta to allow for the delivery of scaffolded education sessions on perinatal grief, loss and trauma midwifery care.
Building learning across multiple subjects allowed considerable class time to be dedicated to this complex and emotionally challenging subject matter. Different teaching and learning approaches ensured active and collaborative student learning, with a focus on evidence-based skills for clinical care, communication, and clinician resilience. With a mix of in- and out-of-class time learning and individual, small, and large group learning experiences, students gained an in-depth understanding of perinatal loss midwifery.
Applying diverse learning and teaching strategies
Second-year students engaged in a variety of learning modes across a series of teaching weeks and subjects, including:
- Completing the Stillbirth Centre of Research Excellence resources for stillbirth prevention education for clinicians known as the Safer Baby Bundle;
- Listening to a podcast of a couple’s experience of stillbirth followed by blended-learning activities;
- A panel discussion with a couple who lost their daughter in birth and a perinatal grief and loss specialist midwife;
- Practicing clinical skills required in perinatal loss care in simulation labs.
The use of case scenarios of death and loss helped students develop the numerous technical and communication skills required for this care. Further in-class discussion with students centred on ways of requesting to be involved in cases involving death as a student and channels of seeking emotional and psychological support in the hospital setting.
Impact through scaffolding, interaction and real-world relevance
Although the delivery mode was online via Zoom due to COVID-19, a delivery mode which is potentially challenging due to the sensitive subject matter, UTS Student Feedback Surveys and verbal feedback indicated improved student satisfaction regarding the quality of learning compared to earlier years.
The scaffolding approach, inclusion of interactive activities, focus on clinically relevant skills, access to real-world perspectives and opportunities for student reflection aimed to provide greater insight into this complex area of midwifery practice. Future discussions with industry partners and clinical educators about the value of including students in perinatal loss care are an important next step for the midwifery team.
Read more about Dr Annabel Sheehy and Professor Kathleen Baird’s research in a qualitative study of early career Australian midwives’ encounters with perinatal grief, loss and trauma.
Feature image by Andy Roberts