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Background Despite an increasing research base about what helps or hinders breastfeeding, there is a dramatic drop in breastfeeding prevalence within the first 6 weeks. Aim To explore the experiences of breastfeeding women. Methods This study used interpretive phenomenology to research the experiences of 22 women who had all breastfed their youngest baby for at least 11 days. Data were collected using in-depth interviews when the women's babies were between 3-6 months of age. Thematic analysis was used to analyse findings. Findings The women described tensions and mixed messages regarding breastfeeding, and contradictions between public health messages promoting breastfeeding and the support received to continue breastfeeding. The women also described how these approaches and messages affected their breastfeeding experiences, and how they managed breastfeeding as a result. Conclusions The findings from this study revealed a patriarchal healthcare support system for breastfeeding whereby the women felt under surveillance and expected to perform to a prescribed ideal, but also a lack of support for exclusive breastfeeding after the initial postnatal period. These findings have clear implications for practice and policy.

Aims To explore the experiences of breastfeeding women. Background There is a plethora of data demonstrating that human breast milk provides complete nutrition for human infants. While the rate of initiation of breastfeeding in the United Kingdom has shown a steady increase in the last 25 years, rates of exclusive breastfeeding in the early weeks and months over the same time period have shown only marginal increases. This study was designed to extend current knowledge around breastfeeding experiences, decisions and behaviours. Design Qualitative, interpretive phenomenological approach. Methods Data were collected between July 2009–January 2010 through in‐depth interviews with 22 women from a city in the East Midlands where the prevalence of breastfeeding has showed a decreasing trend. Data were collected between 3–6 months after the birth of their youngest baby. Findings Analysis of data uncovered a key theme: illusions of compliance. The findings revealed that women's breastfeeding behaviours were socially mediated. They adopted a good mother image by conforming to the moral obligation to breastfeed immediately after their babies were born. Those women who struggled to establish breastfeeding tried to hide their difficulties rather than admit that they were not coping. Conclusion This study provides insights into women's infant feeding decisions and behaviours, building on understandings of ‘good mothering’ in the wider literature. Importantly we highlight some of the previously unknown strategies that women employed to portray themselves as calm, coping and in control when in reality they were struggling and not enjoying breastfeeding.

Summary Midwifery education in the UK has been delivered through the University sector since the mid-1990s, with the requirement to create safe, effective clinicians who are equipped to engage with research and evidence based practice. This paper presents an in-depth analysis of focus group data from 120 senior midwifery students at six British universities to explore the experience of learning to be a midwife. Thematic analysis of the data suggests the following themes pertain to the experience of a number of students: ‘teach yourself midwifery’, knowing it all, right way of doing things, the importance of physical skills. These themes suggest a dissonance for some students between the andragogical methods of learning espoused by universities, and the expectations of students, who express the belief that there is a fixed and finite body of knowledge, without which they feel disempowered, anxious and ill-prepared for clinical practice. This paper argues that there are unresolved tensions between the perceived demands of practice environments and regulatory bodies and the philosophical stance of universities. For some students the concept of a broad discursive education is a distraction from training in discrete clinical skills.

Objective to explore the contribution of midwife teachers in preparing student midwives for competent practice. Design a three phase design using qualitative and quantitative approaches. Phase one involved UK wide on-line questionnaire surveys, phase two was a case study method in six UK approved education institutions and phase three was a diary study with newly qualified midwives. Participants phase one included all UK Lead Midwives for Education (LMEs), midwife teachers and Local Supervising Authority Midwifery Officers; phase two participants were three year and shortened programme student midwives, midwife teachers, LMEs and programme leads from each of the four countries; and phase three included a sample of newly qualified midwives graduating from the case study sites and their preceptors and supervisors of midwives. Findings midwife teachers were valued for their unique and crucial role in supporting the application of knowledge to midwifery practice. Visibility and credibility were two key concepts that can explain the unique contribution of midwife teachers. These concepts included being able to support skills acquisition, understanding of contemporary midwifery practice, having a role in practice contexts and able to offer personal support. Visibility of teachers in practice was vital for students and mentors to assist students put their learning into practice and monitor learning and assessment decisions. Conclusions and implications for practice given the complexity of midwifery education a team approach is essential in ensuring the effectiveness of these programmes. This requires a sufficient differentiation of midwife teacher roles to deliver the pre-registration curriculum. A set of resource quality indicators is proposed to support midwife teacher teams achieving sufficient clinical and academic expertise to deliver effective education programmes.

Avis M., Mallik M. & Fraser D.M. (2012) Journal of Nursing Management ‘Practising under your own Pin’– a description of the transition experiences of newly qualified midwives Aim Transition experiences of newly qualified midwives were examined in depth during the third phase of a UK evaluation study of midwifery education. Background The fitness to practise and the retention of newly qualified nursing and midwifery graduates are pressing concerns for health care managers. The advantages of preceptorship are reported in the literature but the content and timing of schemes remain unclear. Methods A semi-structured diary was kept for up to 6 months by 35 newly qualified midwives in 18 work sites covering all countries in the UK. The preceptor and supervisor of midwives for each newly qualified midwife completed short questionnaires about their preceptee’s performance, and a further sub-sample of newly qualified midwives and preceptors participated in a semi-structured interview. Data were analysed to elicit aspects of newly qualified midwives transition experiences. Results Findings confirm that structured preceptorship schemes are not widely available. Newly qualified midwives primarily obtained transition support from members of the midwifery team. Conclusion Although perceived as competent, there is no demarcation point in becoming confident to practise as a registered practitioner. Implications for managers include the importance of a supportive culture within clinical teams for successful transition and the introduction of structured preceptorship schemes facilitated by appropriate rotation patterns.

AIM:To explore the concept of informed consent to intrapartum procedures within a hospital labor ward.DESIGN:An ethnographic study using participant observation and follow-up semistructured interviews with women and the attending midwives. Data analysis used principles of grounded theory assisted by the computer-assisted qualitative data analysis software (CAQDAS) package, Non-numerical Unstructured Data Indexing, Searching, and Theorizing (NUD*IST). The study was approved by the Local Research Ethics Committee.PARTICIPANTS AND SETTING:100 healthy English-speaking women in spontaneous labor who were to give birth within the labor ward of a large teaching hospital in England and the attending health professionals.FINDINGS:•The fragmented Western technocratic model of childbirth affected gaining informed consent to intrapartum procedures within the labor ward environment.•Midwives and women adopted certain stereotypical roles relating to how information was given and decisions made about intrapartum procedures.•Not all women wanted to be fully informed about intrapartum care and procedures and trusted the midwife or doctor to make decisions, especially concerning the health of their newborn.•Where a birth plan had been completed, women felt valued and enabled by having contributed to decisions made about their care.CONCLUSIONS:The study revealed that true choices to childbearing women were limited andinformedconsent was rarely obtained. Further exploration is required to establish the optimal timing of information disclosure to gain consent to intrapartum practices prior to the onset of labor, because during labor is not ideal. The 2 typologies may be used by midwives to examine how the culture of the birthing environment can affect women’s choice and the obtaining of informed consent to intrapartum procedures, especially where care is fragmented. Until birth is viewed through a holistic birthing model, health professionals will continue to control the birth experience. However, what is provided in practice should be congruent with the needs and expectations of childbearing women.

Objective to investigate midwives' knowledge and attitudes in relation to caring for women who have been sexually abused. Design survey using a postal questionnaire. The questionnaire looked at midwives' knowledge and attitudes towards a range of aspects of sexuality and childbirth. The area of caring for women who have been sexually abused was one aspect of this study. The questionnaire included fixed response and open-ended questions. Quantitative data were analysed using χ 2 -test, logistic regression, Mann–Whitney U -test, Kruskal Wallis test and Mantel–Haenszel test. Qualitative data were analysed using a modified constant comparative approach as described by Morse and Field [1995. Qualitative research methods for health professionals, second edn. Sage Publications, London]. Setting four National Health Service trusts within the East and West Midlands. Participants 489 community and hospital-based midwives. Findings 372 midwives returned their questionnaire giving a 76% response rate. The majority of midwives in the sample group did not feel adequately prepared to deal with a disclosure of sexual abuse ( n =207, 56%), with a further 109 (29%) midwives being ‘unsure' if they could deal with such a disclosure. Community midwives rated themselves as more able to deal with disclosures of sexual abuse compared with hospital-based midwives ( χ 2 =4.044, df=1, p =0.044). The analysis of the in-depth responses to the open-ended questions showed that a small number of midwives were very knowledgeable about the topic of sexual abuse and had experience in dealing with these situations. In contrast, it emerged that the majority of midwives had little if any education in this area and felt unable to deal effectively with disclosures of sexual abuse. Key conclusions and implications for practice the finding that the majority of midwives did not feel adequately prepared to deal with disclosures of sexual abuse may have implications for the quality of care received by survivors of sexual abuse. It is possible that midwives who have been inadequately prepared for dealing with such disclosures may give inappropriate advice, and may inadvertently compound the feelings of powerlessness that women have experienced. Aspects of sexuality and, in particular, caring for women who have been sexually abused should be included in all pre-registration curricula, and post-registration education should include this topic to either update midwives or introduce these topics to qualified midwives. As the incidence of sexual abuse is high and may potentially affect a significant number of childbearing women, it is recommended that further good-quality research should be conducted in this area.

Objective to explore the factors that influence student midwives' constructs of childbearing, before and during their undergraduate midwifery programme. Design a naturalistic, qualitative study. Setting a university in the East Midlands, UK. Participants 58 women registered on a 3-year midwifery education programme. Measurements focus groups were conducted at programme commencement and at 9–12 monthly intervals with two cohorts of midwifery students who were separated into groups of mothers and non-mothers (32 focus groups in total). This paper draws on data from the nine focus groups held at the start of the students' programme. Findings the main themes that emerged from the data were in relation to image during pregnancy, expectations/experiences of childbirth and parenting. In particular, students believed that pregnancy and childbirth should be special. They suggested that a lack of knowledge about sexuality and choice options affected women's ability to be in control. Although normality was the students' expectation of childbirth, they also assumed that hospital birth was the norm. They were unsure whether the baby's father was the best birth partner. Their mothers were suggested as likely to be more supportive, but there was lack of agreement regarding whether they were the best parenting role models. Students also said that there was a lack of positive images of breast feeding. The overall motivation to become midwives was ‘to make a difference'. Conclusions students need to be facilitated early in their programme to explore their belief systems and constructs of childbearing critically so that they are equipped to support parents to have a positive experience, whether childbirth is normal or complex, and so that they can cope with any dissonance between their own expectations and the uncertainties and realities of practice.

A decision was taken that investigating the effectiveness of labour suites as learning environments for students is part of quality management rather than research. However, a traditional quality assurance model of audit was rejected in favour of an ethnographic approach because of the need to observe the culture of the setting as well as to understand teaching and learning from the perspectives of the teacher and the learner. Observation took place on six different labour suites over a 3-year period. Data were coded and analysed using a constant comparative approach. Three key needs emerged: to improve the learning culture in the practice environment; to address the differing effectiveness of practice mentors teaching and learning strategies; and to develop students personally and professionally. Further research is recommended into the role of those coordinating areas of high stress such as a hospital labour suite, because the cultural differences they create can cause barriers to learning.

Postnatal care is often described as the ‘Cinderella’ of the maternity services. It is now becoming recognised that inadequate support, advice and treatment can impact quite considerably upon a woman’s daily life, her relationships with family and friends and her parenting abilities. This review provides an overview of the management of postnatal care and breastfeeding, and the factors most likely to promote mothers’ health and well-being.

Professional stereotyping is considered to cause barriers to effective working relationships and team approaches to care. Learning together at undergraduate level can promote different professional groups' understanding and respect for one another and an appreciation of the importance of team working in the health sector. This paper describes how interprofessional education initiatives were implemented during an obstetrics and gynaecology attachment for medical students and highlights the mistakes that can be avoided in such a process.

Objective: to investigate the relationship between information giving by midwives and decision-making by women offered nuchal translucency (NT) screening. To establish how risk figures are discussed in practice, with the intention of relating this to the existing, and often critical, literature on women's accounts of antenatal screening. Design: a qualitative study following women through the process of being offered and deciding to undergo NT screening. Tape recording of consultations, analysed in their entirety, was combined with post-screening interviews. Setting: a large teaching hospital in the UK. Participants: fourteen pregnant women eligible for NT screening at the time of recruitment. Data collection: (i) tape recordings of consultations between community midwives and pregnant women where nuchal translucency screening was offered; (ii) tape recordings of consultations between hospital midwives and pregnant women immediately post-screening; (iii) individual face-to-face interviews with pregnant women between two and six weeks after the screening, carried out by the first author. Findings: NT screening was in general well received, particularly by those women who had undergone serum screening with previous pregnancies. However, communicating the nature of a risk figure is an interactionally complex process. A large amount of interactional work is required by midwives both before and after screening to ensure that women comprehend this information. Despite the emphasis placed in these consultations on understanding the purpose of NT screening and the status of the results, women often framed their decision to undergo NT screening in terms of it being a formality, or of presuming that all was well. This sometimes created practical and personal difficulties in terms of decision-making. Key conclusions and implications for practice: previous sociological and psychological research has tended to be critical of midwives in terms of ensuring informed choice in screening, but this research is often based on post hoc accounts. Examining actual consultations with these accounts helps to illustrate the other factors that affect women's perceptions of testing, and the way in which risk, choice and decision-making are introduced and discussed in practice. Encouraging women to consider what action they might take on the basis of a personally unfavourable NT result in advance of undergoing the scan may help them to decide whether the information gained will be useful to them. Recognising the complex interactional work required in making sure that women understand the nature of the results that will be obtained is an important issue for the education and training of midwives.

This paper provides an overview of the processes involved in implementing an interprofessional education (IPE) strategy in a recently established School of Human Development at the University of Nottingham. The merger of the academic divisions of child health, midwifery, obstetrics and gynaecology was a deliberate initiative to create an organisational infrastructure intended to enhance opportunities for interprofessional collaborations in research and education. As a first step, a small group of academic midwives and obstetricians formed a project group to find the best way of facilitating IPE for medical and midwifery students at undergraduate level. A discussion is provided of the work the project group undertook to: determine an agreed definition of IPE; decide an action research approach was needed; determine the ways in which teaching and learning strategies were to be implemented, evaluated and compared; and identify the factors inhibiting and enhancing developments. Evaluations have demonstrated that the Interprofessional Team Objective Structured Clinical Examination (ITOSCE) focusing on intrapartum scenarios is effective in promoting interprofessional learning. Both medical and midwifery students and facilitators agree that team working and understanding each other's roles has been enhanced and that although resource intensive, IPE is worth the time and effort involved.

Summary Postnatal care is often described as the ‘Cinderella’ of the maternity services. It is now becoming recognised that inadequate support, advice and treatment can impact quite considerably upon a woman's daily life, her relationships with family and friends and her parenting abilities. This review provides an overview of the management of postnatal care and breastfeeding, and the factors most likely to promote mothers’ health and well-being.

Shared learning at undergraduate level provides a potential means of promoting a more multi-professional approach to maternity care. Interprofessional education uses shared interactive sessions to promote different professional groups' understanding of each other and working together. This paper describes the use of a formative objective structured clinical examination as a method of interprofessional education. Mixed groups of student doctors and student midwives rotate through a series of clinical stations based on common labour ward scenarios. After completing each station they are given feedback by a facilitator on their problem-solving skills, knowledge and attitude to team working. The interactive nature of the sessions encourages deep learning, is student centred and promotes a positive attitude to multidisciplinary working. Both student groups felt they benefited from shared learning in this way and that the formative OSCE was an effective method of developing their clinical skills.

Objective: to design and implement a robust assessment scheme to more effectively identify student midwives' fitness for midwifery practice. Design: five inter-related action research cycles. Methods included: documentary analysis, interviews, observation, questionnaires, focus groups. Setting: a large university in England. Participants: student midwives, practising midwives and midwife teachers, childbearing women, course planning team and EME project team collaborators. Findings: whilst there was evidence that the majority of students are fit for midwifery practice by the end of the course, assessment schemes were found to be unreliable. In particular there was the potential for ‘borderline' students to register as midwives if assessors were inadequately prepared for their responsibilities; assessment documentation was not ‘user' friendly; evidence of competence was inadequately recorded or there was a lack of systematic monitoring by university teachers and examiners of the assessment in practice scheme. Conclusions and implications for practice: the gap between curriculum aspirations and actual implementation needs to close. The assessment matrix, developed as part of the national evaluation study, could usefully be used as a framework when designing assessment schemes. The difficulties for midwife assessors in each locality need to be identified and solutions incorporated into workable but robust strategies. University midwife teachers/lecturers have a responsibility to work in partnership with assessors and students to monitor assessment in practice schemes and, where local circumstances and confidence in reliability permit, grade and award credits for practice-based assessment of student capability.

The purpose of this first of three papers is to discuss the rationale and appropriateness of an action research approach to bring about curriculum improvement. This abstract relates to the study as a whole. The abstracts for the subsequent two papers relate to the specific parts of the study they describe. Objective: to improve the pre-registration midwifery curriculum locally and influence national policy and guidelines for these programmes. Design: action research provided the framework for the study where a multi-method approach was largely qualitative to attempt to capture the context and complexity in which the midwifery programme operates. The study comprises a synthesis of two separate but interwoven research projects: a national study about the effectiveness of midwifery education (the EME project) and an evaluation and re-design of the three year pre-registration midwifery programme in a large multi-sited university in England. Setting: a large university in England. Participants: the EME project 39 case study students, their teachers, practice-based mentors/assessors, preceptors and supervisors of midwives or managers; 50 students from the local university's midwifery programme, their teachers and practice-based mentors/assessors from six sites; 41 women who gave birth to their babies in a large teaching hospital in the East Midlands; and a professional network of experienced midwives whose role is to advise the statutory body regulating midwifery programmes in England. Findings: overall the three-year, pre-registration route into midwifery was found to be an effective preparation for contemporary midwifery practice as judged against a model of a competent midwife at the point of registration. However, there was evidence to suggest that not all students are equipped to practise competently and confidently in contexts of uncertainty and change in the National Health Service. Factors which emerged as influencing curriculum effectiveness related to: recruitment and selection; curriculum structure, appropriateness; and robustness of assessment schemes; the preparation of and support for assessors; and the role of the midwife teacher in assessment in practice settings. Conclusion and implications for practice: diagnosing problems and initiating actions as a collaborative process formed an important part of designing and implementing an ‘ideal' curriculum in constrained health and higher education contexts. The need for on-going dialogue, critical reflection, and research to facilitate and assess learning more effectively in the ‘caring' professions emerged as necessary to ensure that only competent practitioners have a licence to practise.

The aim of this study was to assess whether the smoking habits of women during pregnancy had changed since the baseline survey conducted in 1986 in Nottingham (Madeley et al, 1989). The study design involved a quantitative survey of all pregnant women attending the two hospital antenatal clinics in Nottingham over a six week period in 1997. A total of 1716 self-completion questionnaires were returned, representing a response rate of 80%. It was found that although the percentage of women smoking in pregnancy had fallen from 31% in 1986 to 24% in 1997, there were still similar factors associated with prevalence of smoking in pregnancy. For example, the largest proportion of smokers by age group was in the 14–20 age range but this had increased from 47% in 1986 to 56% in 1997. The study concluded that although there had been an increase in the percentage of women receiving advice about smoking and pregnancy from midwives and nurses, there are some worsening trends in the prevalence of smoking in pregnancy, particularly in the teenage population. It is therefore recommended that smoking intervention strategies are specifically targeted towards young, disadvantaged women and those with no live-in partner and those in their household.

Background Health and education services are increasingly expected to focus on the consumer. The perceptions of childbearing women should be incorporated into midwifery curricula, but often they are given minimal attention or not sought for this purpose. This study was designed to enable the views and experiences of local women to influence curriculum development in a large university in England. Methods A descriptive, longitudinal, qualitative study was conducted using semistructured and unstructured interviews with women, and data from their maternity records. Forty-one pregnant women were recruited and interviewed during pregnancy, in the early postpartum period in hospital, and in their homes 2 to 3 weeks after the birth. Results Themes were clustered into three categories: the characteristics and qualities of the caregivers, the individualized nature of care, and the clinical competence of the caregivers. Continuity of caregiver was desired but accepted as probably unrealistic by many. Developing a "special" trusting relationship with a female midwife was perceived as essential to promoting a positive childbirth experience. Clinical competence was expected and largely experienced. Negative feelings related to individual caregivers more than the type of care given. Conclusions Most women had positive experiences, finding midwives and doctors with good knowledge, interpersonal skills, and abilities. Examples of poor communication skills and interprofessional conflict indicated a need to give priority to developing and assessing students' interpersonal skills. Evidence of interprofessional conflict acted as the catalyst to merge midwifery with the department of obstetrics in the university to enhance interprofessional learning.

In April 1990, Trent Regional Health Authority reorganized nursing and midwifery education into four large colleges. In the north of the region the Sheffield and North Trent College took over five midwifery schools in South Yorkshire and North Derbyshire; in Mid Trent the college encompassed all of Lincolnshire (two midwifery schools), Nottingham and Central Nottinghamshire Schools of Midwifery; to the south, Leicester School of Midwifery became the Charles Frears College of Nursing and Midwifery; and in the west, Derby College comprised just one midwifery school.

This paper explores the ethical dilemmas and problems encountered when undertaking an action research study in my own school. The study was designed to evaluate a contentious part of a new midwifery programme as it was being implemented. A range of potentially problematic issues are discussed from the practitioner researcher perspective. Some of these problems were anticipated but others had not been addressed and had to be responded to as they arose, More careful thought at the planning stage about the potential effects on others, as well as action-in-reflection are presented as important considerations for other practitioners contemplating action research in their own place of work.

Childbearing women should be able to contribute to the development of a model of competence in midwifery. This article explores the relative value of three distinct methodologies for obtaining a deeper understanding of parents' perspectives of midwifery care.

Transition experiences of newly qualified midwives were examined in depth during the third phase of a UK evaluation study of midwifery education.The fitness to practise and the retention of newly qualified nursing and midwifery graduates are pressing concerns for health care managers. The advantages of preceptorship are reported in the literature but the content and timing of schemes remain unclear.A semi-structured diary was kept for up to 6 months by 35 newly qualified midwives in 18 work sites covering all countries in the UK. The preceptor and supervisor of midwives for each newly qualified midwife completed short questionnaires about their preceptee's performance, and a further sub-sample of newly qualified midwives and preceptors participated in a semi-structured interview. Data were analysed to elicit aspects of newly qualified midwives transition experiences.Findings confirm that structured preceptorship schemes are not widely available. Newly qualified midwives primarily obtained transition support from members of the midwifery team.Although perceived as competent, there is no demarcation point in becoming confident to practise as a registered practitioner. Implications for managers include the importance of a supportive culture within clinical teams for successful transition and the introduction of structured preceptorship schemes facilitated by appropriate rotation patterns.

It has become widely accepted that the profession of midwifery needs a comprehensive definition of competence to ensure that its practitioners are safe and able to meet the changing needs of childbearing women and society. This article explores some of the difficulties in agreeing a definition and seeks to clarify whether a single formulation of a definition of competence is feasible and desirable.

Objective this study was part of a larger project commissioned to ascertain whether midwife teachers bring a unique contribution to the preparation of midwives for practice. The aim of this phase was to determine whether the student midwives' educational programme had equipped them to practise competently after entry to the professional register. Design this was a prospective, longitudinal qualitative study, using participant diaries to collect data. Setting data were collected from newly qualified midwives during the initial six months after they commenced their first post as a qualified midwife. Participants the potential participants were all student midwives who were completing their education at one of six Universities (three in England, one in Scotland, one in Wales and one in Northern Ireland). Diary data were submitted by 35 newly qualified midwives; 28 were graduates of the three year programme and seven of the shortened programme. Measurements and findings diary entries were analysed using thematic analysis (Braun and Clarke, 2006), with a focus on identification of key events in the working lives of the newly qualified midwives. A total of 263 key events were identified, under three main themes: (1) impact of the event on confidence, (2) gaps in knowledge or experience and (3) articulated frustration, conflict or distress. Key conclusions essentially, pre-registration education, delivered largely by midwife teachers and supported by clinical mentors, has been shown to equip newly qualified midwives to work effectively as autonomous practitioners caring for mothers and babies. While newly qualified midwives are able to cope with a range of challenging clinical situations in a safe manner, they lack confidence in key areas. Positive reinforcement by supportive colleagues plays a significant role in enabling them to develop as practitioners. Implications for practice whilst acknowledging the importance of normality in childbearing there is a need within the curriculum to enable midwives to recognise and respond to complex care situations by providing theory, simulations and practice experience.

Summary Background It is essential that Approved Education Institutions (AEIs) support practice learning to the education standards required by the Nursing and Midwifery Council (NMC, 2009). Evaluating whether midwife lecturers bring a unique contribution to the outcomes of preregistration midwifery education programmes was investigated through a national research project (Fraser et al., 2011). The study task addressed in this paper was to establish which roles and responsibilities of lecturers have most impact on student learning and capability as midwives and provide best support for mentors' teaching and assessment decisions. Methods Data were collected through United Kingdom (UK) wide survey of Lead Midwives for Education, midwife lecturers and questionnaires and focus groups of student midwives from six case study sites. An activity analysis tool was completed by lecturers in these sites, as well as individual interviews with LMEs and Programme Leads. Findings The nature of midwife lecturers' engagement with practice is variable and is determined by the particular organisation model used. There is an overall agreement that midwife lecturers have a vital role in supporting the practice based curriculum. Key findings highlight the link lecturer role in supporting students, participating in assessments, supporting mentors and maintaining clinical credibility. Enhancements and deterrents to undertaking the link role are also outlined. These findings are relevant to health care programmes worldwide where clinical practice is an essential component. Implications: contribution to knowledge development about models to support and enhance practice-based learning.

To explore newly qualified midwives' and preceptors' view of the preceptorship period.Qualitative design utilising focus groups as a means of collecting data.Hospital trusts partnered with three Universities in England.In total there were 62 participants; 40 newly qualified midwives, 20 preceptors and two practice development midwives participated in focus group interviews.The findings suggested that newly qualified midwives and preceptors found it difficult to meet due to time constraints and either working different shifts or in different clinical areas. In addition three main themes emerged in relation to what affected effective preceptorship. The most important areas to improve the preceptorship period were to appoint midwives responsible for the organisation and support of newly qualified midwives. In addition, each new midwife should have a programme tailored to their needs which avoids repetitive learning.The transition period causes anxiety for newly qualified midwives, especially when there is a long delay between qualification and taking up their first post. There appears to be some confusion over induction and preceptorship paperwork. The majority of midwives described their initial experience of working as a qualified midwife as 'SINK or SWIM'.

The primary purpose of practice improvement is to improve clinical practice through changing the behaviour of healthcare professionals. Breastfeeding is a key public health issue, conferring benefits associated with both infant and maternal health, yet breastfeeding rates in the U.K. and Ireland are among the lowest in Western Europe. In this paper, the ways in which practice improvement can be utilised to enhance both efficiency and effectiveness are described, using a case study of the potential contribution of health visitors to increasing breastfeeding duration in primary care in order to illustrate this in clinical practice.

Objective to explore student midwives' experience and views on the role of the mentor in practice, and to survey perceptions of the qualities required for mentorship. Design qualitative longitudinal cohort study using focus groups. Setting an academic division of midwifery at a university in the East Midlands region of the UK. Participants 58 women enrolled in a three-year midwifery education programme at the university. Measurements the focus groups were conducted with two cohorts of midwifery students at four time points during their three-year education programme. Findings the themes that emerged from the data were: qualities of good mentors; relationships; expectations of mentors; role models; and mentorship experience. Conclusions mentors are used as role models by the students in both positive and negative ways. The relationship that the student has with a mentor is fundamental to their confidence in practice, although there is an appreciation that sometimes there are problems with personality clashes. Expectations of the mentor are a major issue for student midwives, and this can be affected by the length of time they have worked with a mentor. There was general consensus about the qualities of a good mentor.

Objective to identify the essential competencies required of a midwife at the point of registration. Design qualitative, descriptive, extended case study and depth interviews. Setting pre-registration midwifery education in England. Participants 39 qualifying midwives, their assessors, midwives and midwife teachers across six higher education institutions, and 20 experienced midwives at two sites. Findings essential competencies were identified relating to (1) being a safe practitioner; (2) having the right attitude; and (3) being an effective communicator. In order to be a safe practitioner, it was proposed that a midwife must have a reasonable degree of self-sufficiency, use up-to-date knowledge in practice, and have self and professional awareness. It was suggested that having the right attitude involves being motivated, being committed to midwifery and being caring and kind. Participants highlighted the importance of effective communication so that midwives can relate to and work in partnership with women and provide truly informed choice. Essential communication skills include active listening, providing appropriate information and flexibility. Key conclusions the most important requirement at registration is that a midwife is safe and will practise safely. However, this capability to be safe is further mediated by attitudes and communication skills. Implications for practice models of midwifery competence should always include personal attributes and effective communication in addition to the competencies required to be able to practise safely, and there should be an explicit focus in curriculum content, skills training and assessment on attitudes and communication.

Objective : to determine what impact the changes from consultant-led care to midwife-led care in a local maternity service have had on women using that service. Design: case study, data were collected by postal questionnaire, semi-structured, tape-recorded interviews, observations and scrutiny of records. Setting: a small town in rural England. Participants: all pregnant women eligible for a midwife-managed unit (MMU) birth in a small rural town in England. Findings: the women using the MMU were satisfied with the care they received and the MMU style of care. Women giving birth at the MMU and at home required less pain relief and were more likely to have an intact perineum than a similar group of women giving birth in hospital. Continuity of carer did not appear to be an issue for women as long as they felt supported by a known team of midwives. Transfer for complications during the birthing process was a cause for anxiety and stress for women and their partners. Women, whilst satisfied with the MMU, would prefer the consultant-led maternity hospital to be re-established in the town. The home-birth rate rose by 28% when the consultant unit closed. Implications for practice: while the establishment of a midwife-managed unit has provided increased choice for a minority of women, the removal of the consultant unit in the town has disadvantaged the majority of pregnant women. While guidelines are needed when establishing these units the application of restrictive inclusion and exclusion criteria can sometimes force women to make less appropriate birth choices.

Objective: to identify factors which facilitate and inhibit the effectiveness of current pre-registration midwifery programmes. Design: the case study part of an action research project. Setting: seven case study institutions in England. Participants: student midwives, midwives, midwifery managers/supervisors of midwives, midwife teachers, collaborators in the study. Findings: it emerged, following a synthesis of all data, that the pre-registration midwifery curriculum should have five key outcomes: students should feel confident and competent as midwives; students must have achieved the statutory requirements for registration; students should be committed to undertaking the whole role and responsibilities of a midwife; students must be equipped to take responsibility and accept accountability for their actions; students must recognise the need for career long learning. Whilst overall these new programmes were considered to be effective in preparing students for their role as midwives, there was variability in the degree to which these five key outcomes were achieved by the case study students. Implications for practice: there needs to be agreement as to what constitutes fitness for practice at the point of registration; assessment schemes, particularly those relating to practice capabilities, need to be valid, reliable and robust with the benefit of the doubt being given in favour of childbearing women when students are ‘borderline'; fitness for purpose requires clarification to avoid employers having unreal expectations of new qualifiers which may result in attrition due to excessive stress; review of curricula should take account of the importance of personal qualities and learning strategies which enable students to cope with complexity, uncertainty, decision making and ‘being a midwife' before course completion.

Against a background of increasing concern over the widening theory practice gap and research evidence of problems in providing quality practice education, the English National Board (ENB) commissioned an 18 month study into the role of the teacher/lecturer in practice. This article, after providing a brief overview of the background, literature and methods, outlines the results from the Adult Case Study stage of the research. Documents, individual and focus group interviews of lecturers (n = 76), practitioners (n = 46) and students (n = 131) in five schools of nursing and midwifery provided data for analysis. A role labeled as 'link lecturer' was the most common approach acknowledged by all respondent groups. Despite overt commitment to the practice role by schools of nursing and midwifery, findings indicate that lecturers are unprepared, unsupported and unmonitored. Students and practitioners had very variable experiences and expressed a strong need for a better-organized approach which would provide them with consistent and sustained support in the practice setting. Overall the study highlighted a lack of strategic management of the practice role by university schools of nursing and midwifery. Convergence of findings from midwifery and the other branches of nursing provides strong research evidence for recommendations for more active management of the practice curriculum to be implemented as part of any future proposed reforms for nurse education in the UK.

Facilitating a unified interpretation of new or re-designed curricula can be problematic in multi-sited universities. This paper discusses the use of the Delphi technique when implementing an innovative pre-registration midwifery curriculum. It formed one of the action research cycles of the author’s doctoral study and was used in an attempt to seek the views of all midwife teachers and achieve a critical mass consensus. The most important issues that emerged from the Delphi process were grouped into four categories. These four categories (the teacher’s base site, communications, staff development and administration issues) formed the agenda for a staff away day. The outcome of the process was the generation of a list of priorities and actions for curriculum implementation and the identification of ways in which staff development needs might be met more effectively. An unexpected, but equally important, outcome was the way it helped with team building and agreement on positive actions for its further development.

Currently in the UK, there is no consensus as to what constitutes an adequate definition of a competent midwife. Yet, given the rapidly changing midwifery needs of childbearing women and society, such clarification has never been more important. In this paper some concepts of competence taken from a review of midwifery, nursing, educational and industrial literature are reviewed, and it is hoped that discussion leading to conceptualisation of an integrated model of competence in midwifery will be stimulated. Questions raised include--What is it that makes midwives competent? Can competence be inferred from performance? How can capability be recognised? Can competence be broken into elements for assessment without losing meaning?

How can we be sure that future midwife practitioners have developed the right blend of knowledge, skills and attitudes? A recent ENB commissioned study found no common definition of a competent midwife (Fraser et al, 1997). If we cant agree about what constitutes competence, how can we say someone is fit to practice?