Group 1 - Medical students' experience of working with midwives during their training in NHS hospitals in England: a qualitative study

BACKGROUND The study was prompted by informal conversations with medical students, who reported mixed experiences when working alongside midwives. Such undergraduates often rely on midwives to facilitate opportunities to see... [ view full abstract ]

BACKGROUND The study was prompted by informal conversations with medical students, who reported mixed experiences when working alongside midwives. Such undergraduates often rely on midwives to facilitate opportunities to see natural birth, but some said they had faced resistance at the labour room door. This, some felt, had the potential to impact negatively on doctors' inter-professional behaviour, choice of specialism, and - for those who become obstetricians - clinical management of birth. A literature search yielded little relevant evidence. The aim of this study was to investigate medical students’ experience of placements with midwives in NHS hospitals in England.

METHODS Online adverts were used to recruit individuals who had worked with midwives in hospitals across England. Ten current students were selected to give in-depth interviews of about an hour, by phone or Skype, in June 2016. The researcher purposively sought demographic variety in age, gender, school type and race, with a view to optimising the breadth of experiences. Conversations were recorded and transcribed. Qualitative framework analysis was used to code the data and identify key themes. Ethics committee approval had been granted.

FINDINGS Some medical students enjoyed easy and mutually respectful rapports with midwives. Others reported hostile, passive or rude interactions. Participants’ success in witnessing vaginal births often seemed to mirror the warmth of their relationship with the midwife. It also often related to whether the midwife had enough time to engage properly in teaching; the degree of ‘competition’ with student midwives; and university oversight of placements so both students and midwives were prepared. At this impressionable time in future doctors’ training, early experiences of collaborating with midwives (or not) seemed likely to have a long-lasting impact. Several participants felt it had affected their respect for midwives, risk perceptions about birth, and career choices. One individual who had previously wanted to become an obstetrician was deterred by a series of stressful encounters with midwives. Others reported that a warm welcome and positive experiences had attracted them to obstetrics.

DISCUSSION These findings indicate unspoken social tensions within maternity teams. There is a well-documented history of ‘turf war’ between doctors and midwives, stemming from a patriarchal, doctor-dominated history of struggle for clinical autonomy. The Royal Colleges have worked to promote inter-disciplinary collaboration, but this study suggests further initiatives are needed to address deep-seated issues. Future research could probe the topic further, notably in seeking midwives’ opinions about working with medical students. Limitations of this study included the subjectivity of a single researcher, though efforts were made to maintain reflexivity. Responses may have been skewed towards extremes, if the decision to participate was prompted by particularly positive or negative experiences. Despite the small sample size, transcripts yielded a rich body of data.

CONCLUSION Some medical students could receive a warmer welcome to the field of normal birth. Additional educational planning might help create named midwife mentors, allocated teaching time, and strategies so students of midwifery and medicine need not feel they are competing for births.