Back in Ireland this week, this time in Limerick in the Republic. I was delighted to learn that this group will be all the students in their second year (24 of them) plus some physiotherapists and a few midwives from the Maternity Hospital.

It is always good to work with students. There have been dramatic and rapid changes in Ireland around midwifery education and instead of the old hospital based training, students are now based in universities, where they cover the theory, while working in the hospital for their clinical components. In some ways it seems the training has not changed all that much - students are still working in the hospitals as part of the staff complement and there are few opportunities to see and learn from other ways of working (birth centres and home births are not available options in this part of the country).

A couple of midwives and students in the group had seen a home birth, but most are seeing women labour and birth with epidurals and the caesarean section rate stands at 30%. Not a good basis for learning about midwifery care, so I re-arranged the program and showed the film “Inner Strength” early in the day. As I have described before, this film is an eye-opener and is sometimes viewed as a bit shocking (all that raw emotion, verbalisation, close involvement of partners and spontaneity can be confronting for those used to anaesthetised labouring women). The comments afterwards revealed that these were the first really physiological births many had seen and they pointed out the very different birth experiences of women in Limerick. The hospital here has two showers and no baths available, and other basic equipment such as birth balls and mats are in short supply. The maternity unit is, however, being extended - another operating theatre is being built!

I am sure that these students will be disappointed in the quality of their Course and the education they are receiving. We talked about the shortcomings and then I asked them what they were going to do about them, suggesting a number of possibilities.

Students are expected to ask questions, and this can be a useful spur to re-evaluation of policies, routines etc. There will be midwives working in the unit who are more in tune with active birth ideas, so they should seek these out as mentors - working together with them can be a big help for all parties - midwives, women and students. Looking for ways of educating pregnant women about alternatives to epidurals and making sure they know about the effects of epidurals on themselves and their babies can encourage women to try other approaches in labour. Women having second (or subsequent) pregnancies are often keen to have better experiences - these are women that may be prepared to work with a student during labour and experiment with different strategies. There were other ideas as well - students can do a lot to encourage change and at the same time help themselves.

We’ll work on these strategies tomorrow and explore a whole range of simple things they can do to make immediate improvements for individual women. I hope to motivate these students to stick with their studies until they graduate and can take complete responsibility for their own practise. Posted by andrea at October 20, 2004 04:11 AM