Students’ understanding of “Women-Centred Care Philosophy” in midwifery care through Continuity of Care (CoC) learning model: a quasi-experimental study

The philosophy of midwifery care centers upon women-centred primary health care services, which rely on the relationships between women and their midwives during all women’s life cycle [1]. Midwives care for women during pregnancy, childbirth and in early parenting years. Midwives educate women in healthy lifestyle choices, especially those that center around the profound processes and precious events in women’s reproductive lives. These events are also seen as inherently important to society as a whole.

The critical importance of “women-centred care” in midwifery practices has been reviewed in the literature [2-7], including how it promotes an environment of shared power and responsibility between a woman and her midwife [2,3]. The concept of “women-centred care” is central to midwifery practices and underpins the philosophy statement of the International Confederation of Midwives and the Australian College of Midwives [6,8]. “Women-centred care” is a term used to describe a philosophy of maternity care that promotes a holistic approach by recognizing each woman’s social, emotional, physical, spiritual and cultural needs The expectations and context are defined by the woman herself [5,8]. The fundamental principles of women-centred care ensures a focus on pregnancy and childbirth as the start of family life, not just as isolated clinical episodes. These motherhood phases take into complete account the meanings and values of each woman [5]. Women-centred carein the clinical setting is safe, supportive, and gentle. It is the philosophical foundation of undergraduate midwifery courses, which in turn promotes the understanding needed by midwifery students to care for women holistically [3,9].

Continuity of midwifery care means that a woman develops a partnership with a midwife to receive care during pregnancy, labour and the postnatal period [10]. A “continuity of care partnership” between a midwife and a patient is defined as having a ‘professional friend’ [11,12]. In this model of care, midwives have enhanced, high-level opportunities to explore and understand pregnancy, labour and birth and the postnatal period.

The continuity of care model in midwifery care is a way to ensure that women and their babies get the best care from midwives throughout the childbirth continuum [6]. One study found that continuity of midwifery care was associated with lower intervention rates than standard maternity care [13]. The study also mentioned that continuity of midwifery care was associated with less use of obstetric interventions during labour and that there was no maternal death. This is relevant in meeting targets 4 & 5 of the MDGs to reduce maternal and infant mortality.

In a study by Aune et al. [14], continuous care, as opposed to random, fragmented care, enables a close, trusting relationship between a woman and a midwife, and thus it is valuable for both of them. Continuity of care is fundamental to midwifery practice models. It is both a philosophy and a process that enables midwives to provide holistic care and to establish an ongoing partnership with their patients in order to build understanding, support and trust. Continuity of care is facilitated through a one-to-one relationship between the midwife and her patient [5].

Whilst there are many ways in which midwifery care may be organised, midwives can function autonomously as primary care providers. Personalizing (individualizing) care for each woman also includes the ability to refer to other health professionals when necessary [11].

Continuity of care in student midwifery education is defined as the experience of having an ongoing midwifery relationship between students and patients, from initial contact in early pregnancy to the weeks shortly after birth, and across the interface between community and hospital settings. The intention of the continuity of care experience is to enable students to experience continuity with an individual woman through pregnancy, labour, birth and the postnatal period, [15]. It is important for the students to learn the core value of midwifery care philosophy that is Continuity of care (CoC): the fundamental duty of a midwife when delivering women centered care.

The strength of the CoC experience is the concept of patient-based learning and patient as educator. Students learn directly from the patients, and from other healthcare providers, which then consolidates students’ understanding of women-centred care philosophy. Being actively engaged in the CoC experience assists students in developing and/or confirming a women-centred care philosophy [16]. There is limited research on the nature of the midwifery student relationship with patients and the impact this has on student learning. The Australian College of Midwiveshas proposed “follow-through” experiences in their standards for three-year Bachelor of midwifery education programs; this strategy is a means of ensuring midwifery students have continuity of care experiences [17-19]. A similar model of midwifery student clinical education is known as a “student case-loading” in Bournemouth University [20,21].

Studies that explored the experiences of the first cohort of Bachelor of Midwifery students in Australia noted that students valued the opportunity to develop relationships with women [22] and identified that the follow-through experience provided them with this opportunity [23]. Although these models of care are now more evident, students enjoyed this aspect of their course because of the richness of midwifery experiences encountered. However, recruitment of the participant (patient) is challenging [19].

There are limited studies that specifically discuss students’ understanding of the philosophy of midwifery care. One study’s goal was to gain insight into how continuity of care can increase student understanding of midwifery when the emphasis is on the promotion of normal pregnancy, childbirth and the postnatal period [14].

At present, midwifery students in Indonesia may graduate with a limited knowledge of any model of care, for example, the fragmented midwifery care learning model which is implemented during the clinical placement phase of education. Current Midwifery education in Indonesia consists of a three year program in which knowledge and clinical skills are given simultaneously. Begining in semester three, students undergo a clinical phase which typically a “fragmented care” learning model [24]. To achieve clinical competencies, a student is required to provide a number of midwifery cares, involving different patients, during antenatal, intranatal, and postnatal periods (the fragmented care model).

Conducting research with midwifery students in clinical placements is seen as an ideal setting to explore how students’ experiences influence their understanding of midwifery philosophy of care. The CoC learning model has been proven to provide a more contextual learning experince which is similar to future professional midwife practice [16-20]. However, comprehension of the students about midwifery care philosophy prior to clinical placement has not been measured in any study [16-20]. Therefore, the objective of this study was to examine how the students understand midwifery care philosopy “Women-Centred Care” through the CoC experience as a clinical learning model.