'But it's not in their book': An interview study exploring the contextual factors influencing senior midwives' facilitation of students' clinical experiences of perinatal loss'.

ABSTRACT

PROBLEM: Midwifery students are seldom afforded experiences of perinatal loss care, potentially depriving them the confidence and competence to provide effective and supportive care in such circumstances. BACKGROUND: Perinatal loss care is predominantly provided by midwives. Students depend on midwives to provide clinical learning experiences of perinatal loss, preparing them for registered independent practice. The reasons behind midwives' decisions regarding the provision of clinical experiences to students remains unexplored. AIM: To identify the contextual factors identified by midwives as influencing the involvement of student midwives in clinical experiences of perinatal loss. METHODS: A qualitative interview study, using semi-structured interviews with 20 senior midwives in New South Wales, Australia. FINDINGS: Four themes describing the contextual factors were identified 1) it's not in their book, 2) unwritten rules, 3) activity, acuity, and 'the numbers', and 4) teaching the teachers. DISCUSSION: The contextual factors influencing decisions of midwives around this issue are complex and interrelated. Commonly held beliefs within the workplace, and hesitancy to challenge the status quo, are complicated by lack of confidence in 'what to do' with a student in the space of perinatal loss. Lack of direction from governing bodies regarding requirements of students in this space, and pressures on staffing, also play key roles. CONCLUSION: Midwives need support, guidance, mentorship, and supervision in what is for many, a new practice. Our findings suggest systems-level changes are needed, to allow midwives the time and space to learn and reflect on this new skill.