Stories of companionship and trust: women’s narratives of their student midwife caseloading experience.

Abstract

It is national policy that midwifery students, as part of the undergraduate midwifery curriculum, gain experience of providing continuity of care for women throughout the childbearing continuum via caseload practice (NMC 2009). Student midwife caseloading has been cited as an example of best practice (DH 2003). However, whilst there is robust evidence of women’s experiences of continuity from qualified midwives (Sandall et al. 2016), there is a lack of information regarding student’s care. Although a small number of studies have been conducted in Australia and Norway, no formal research into women’s experiences of this approach to student involvement in their care appears to have been undertaken in the United Kingdom. This study focussed on hearing women’s personal stories to develop an understanding of how being part of a student midwife’s caseload may have impacted on their childbearing experience. Utilising qualitative methods, the study followed women’s experiences of continuity of care provision from a student midwife, supervised by a qualified midwife, throughout pregnancy, birth and the early days of mothering. I was interested to hear women’s stories of their relationships with students and how these were developed, how they described the care provided in relation to their holistic needs and how, and if, they linked the continuity of care by the student with the outcome of their experience. Data were collected within a longitudinal model through story accounts from six women who had agreed to be part of a student’s caseload. Participant stories were sought on three occasions: twice during pregnancy, and once in the postnatal period. The data gathered at these points in time were viewed as a continuing story that unfolded over the woman’s childbearing event. The story accounts were analysed through a narrative framework using a three phase re-storying model to uncover themes of significance to the individual women within the study, and the women as a group. Phase 1 involved the analysis of the three interview transcripts of the individual woman’s unfolding story. Phase 2 included the construction of an interpretative story or personal experience narrative poem for each participant. Phase 3 provided a synthesis of the data to construct a collective story that encapsulated the emergent narratives themes of significance to the women as a group. The three longitudinal narrative themes of significance to the women as a group were identified as: ‘mutually supportive partnerships’; ‘just like a midwife’ and ‘extra special care’. All women recognised the status of their caseloading student as that of learner, as someone working to become a qualified midwife, and described the reciprocal supportive relationships they developed with students through relational continuity within this context. While identifying the caseloading student as requiring supervision from a qualified midwife, women expressed high levels of trust and confidence in ‘their’ student’s knowledge, clinical competence and caregiving abilities. Being with a student in a continuity relationship, and the extra support it engendered, was highly valued by women. The student’s perceived ‘constant’ presence across the childbearing experience was welcomed and described as central to the women’s comfort and contentment. Study findings provide evidence that this group of women highly valued the student contribution via continuity to their care and this experience may be transferable to other women participating in student caseloading. This understanding adds weight to the Nursing and Midwifery Council expectations and reinforces the value of continuity educational schemes. The knowledge gained provides useful insights for curriculum developers nationally and internationally, educators and practitioners. Recommendations from the study are made for research, education and practice.