Uncharted territory: the challenges experienced by four direct entry midwives practising in the tertiary hospital setting

Abstract

Over the past fourteen years midwifery education and practice in New Zealand has undergone fundamental changes. In 1990 registered midwives were granted autonomy within their practice and more recently direct entry midwifery programmes were introduced in New Zealand for which a nursing qualification is not a prerequisite. Direct Entry Bachelor of Midwifery programmes are designed primarily to educate potential midwives to practise independently within the primary care setting. This is in keeping with the New Zealand College of midwifery philosophy that childbirth is a normal, healthy process. Anecdotal evidence however, suggests that this education focus might not adequately prepare new midwives for the skills required to practise within the tertiary level care hospital environment, where they encounter pregnant women with complex health needs. How then does the direct entry midwife cope with the challenges of caring for women with complex and multiple needs? Little has been written about the challenges direct entry midwives experience when they choose to practise in a tertiary hospital setting. I have used a qualitative approach to explore the challenges experienced by four direct entry midwives practising in a tertiary maternity hospital. Through a process of thematic analysis their experiences were analysed to determine a pertinent theme or themes that best described the challenges they faced. Four main themes emerged and were named: uncharted territory the tertiary hospital setting; being responsible - living in fear; coping with attitude sickness; and nurturing the new'- supportive components. Sub-themes emerged with each of the major themes and are used throughout the data chapters. The conclusion that can be drawn from this research is that direct entry midwives practising in the tertiary hospital setting do need the support of an orientation programme, but that they also need additional support. It is recommended that this additional support be provided by a mentorship programme that runs parallel with an orientation programme. Recommendations for education of tertiary skills either incorporated in the midwifery education curriculum or provided by the tertiary institutions is discussed. The introduction of a postgraduate tertiary midwifery course is also suggested. Combining an orientation programme which incorporates a mentor as well as the introduction of a postgraduate tertiary midwifery course may well ensure a less stressful experience for the direct entry midwife who chooses to practise in the tertiary hospital setting.