Role of the Midwife as an Educator Essay

Role of the Midwife as an Educator Essay

The researcher has used the terms “tutor” and “midwife” in an interchangeable format.
Midwifery is about far more than delivering babies. The skills that a midwife needs to carry out her job successfully are legion. In this essay we shall specifically consider the role of the midwife as an educator, and her ability to impart information successfully to a group in a planned parenting session.Role of the Midwife as an Educator Essay

In order to do this successfully it is obviously important for the midwife (or tutor) to appreciate how adults learn optimally in a different way from children. In this essay we shall explore both the theoretical and practical principles which underpin the delivery of a successful course for prospective parents. We shall also consider the importance of course evaluation in the construction and presentation of future courses.Role of the Midwife as an Educator Essay

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It is important to appreciate that adults learn optimally in a different way to children. The dichotomy is often refered to as pedagogy and andragogy. The fundamental difference between the two is that pedagogy is essentially the process whereby the tutor instructs the students and andragogy is the process which involves more of an interaction between the two, with the tutor guiding the students. (Cervero, R. M et al 1999)

In the prospective parenting classes clearly the group are likely to be mainly young adults (the researcher states that they are making a number of assumptions here) and an alternative name for andragogy is experiential learning. This involves the tutor drawing out various experiences that the group, collectively, have had and using them as a basis for discussion and communal learning. (Donaldson, J. F et al. 2000)Role of the Midwife as an Educator Essay

One could reasonably assume that the participants in the group have not had previous direct experience of parenting, but this does not preclude this method of teaching in this circumstance. They certainly will have observed friends, family and others bringing up their children and of course will have their own experiences with their own upbringing which will have formed a number of their opinions, expectations and values. These can usefully be explored and brought out in discussion for the whole group to use as a learning experience. It is likely that a typical group will include participants from different social backgrounds, ethnic groups and classes. This is also a valuable asset which can be exploited for the benefit of all.

Specific examples could be the breast feeding and weaning habits of different ethnic communities and how they differ from what is currently considered to be best practice. Clearly this type of learning is quite different from that which could be used for children (pedagogy) who have very little life experience to draw on. (Johnson-Bailey, J et al 1997)Role of the Midwife as an Educator Essay

Obviously the midwife will have their own professional learning and agenda together with a vast wealth of practical experience. This should ideally be presented in a sensitive but authoritative way, so that the group can have the opportunity to discuss, evaluate and adopt those elements that they collectively feel are or value and importance to themselves. (Ross-Gordon, J. M et al 2002).

Although adults will clearly need to assimilate information – as this is a basic definition of learning – they are far more amenable to techniques which involve self motivation and self-directed learning. (Sheared, V et al. 2001). In this context it is important that the midwife, in addition to simply acting as a tutor and resource, should also suggest other sources of information. Local libraries, NHS leaflets, Local Authority pamphlets and of course the Internet, are all valuable resource options that the prospective parents can access themselves. Part of the information providing responsibility incumbent on the midwife, is the generation of interest which will allow the group members to feel empowered to make further exploration of the area themselves. (EHC 1999)Role of the Midwife as an Educator Essay

The concept of metacognition is also important in this area. Traditionally a midwife might expect to give a talk on various important points of parenting and the prospective parents would sit passively and absorb the elements that they felt were important to them. The talk would finish and the group would disperse. Metacognition is the ability of the student to appreciate the overall context and content of what they are learning about. This is primarily a two way interaction between student and tutor. (Smith, M. C et al. 1998).Role of the Midwife as an Educator Essay

If the midwife is able to establish a dialogue between herself and the group it is easier to evaluate and assess the gaps in knowledge and then to suggest strategies for filling them. Equally, it is a valid strategy to establish where the gaps are and then to encourage the student to find the information for themselves in order to bring back to the group for discussion on the next occasion. (Titmus, C 1999).

When the tutor is constructing the course, if the andragogical approach is chosen as the most appropriate then they should:

Encourage the group members to participate and put forward their own life experiences as much as possible in order to utilise them as exploratory and discussion tools for the group as a whole.

Demonstrate to the group how their collective life experiences can be adapted and utilised within the framework of the current discussion (after Merriam, S. B et al. 1999).Role of the Midwife as an Educator Essay

This is a difficult topic since evaluation is ultimately the most appropriate tool to assess whether the particular course has been successful. There are basically three appropriate viewpoints of evaluation – whether the tutor feels that they have delivered the course successfully, whether the student feels that they have benefited from the course and whether an independent assessor would consider the course appropriate. (Vaske, J. M et al 2001).Role of the Midwife as an Educator Essay

There is not space to fully appraise all of these eventualities, but clearly it is utterly appropriate to consider the student’s appreciation of the course, whether it fulfilled their expectations and needs together with an assessment of the various areas where they felt that the learning experience was either good or lacking.

This is clearly vital, not only from the point of view of deciding whether it is appropriate to continue delivering the course as a public service, but possibly more importantly, to provide feedback to the tutor on just how their delivery was perceived and received. There is obviously no value in presenting a course which is neither appreciated nor useful to the recipients (Tice, E. T et al 1997).Role of the Midwife as an Educator Essay

Conclusions

It is clear that the presentation of a successful adult-orientated course is not just a matter of chance and an informed professional standing up and presenting a series of facts. It is obviously important to optimise the impact and usefulness of the effort involved with an appreciation of the theory and practice of adult learning.

The involvement of the audience group, particularly with an invitation and an expectation to share and learn from their own collective experiences, is clearly an important learning tool and should be maximally exploited by the tutor.Role of the Midwife as an Educator Essay

It is also important to the overall optimisation of the learning experience for the student, that the tutor should develop clear and concise learning objectives for the group and tailor the structure of the group to those objectives. Central to that process is the formulation of an appropriate learning plan, which, in this particular format does not necessarily have to be a formal written plan, but can take the form of either notes or a mentally organised format by the tutor. (Taylor, K et al 2000).

As a midwife, it is imperative that they support and empower women, ensuring they receive the best possible care, support and advice during pregnancy, labour and postpartum period.
Midwifery is an extremely diverse profession; whether it be working in the community, teaching parent and education classes or working within the clinical setting. All aspects require the same standard of care to be adhered to at all times. Providing support to the mother and her family throughout the childbearing continuum is an essential in order to help them adjust to their parental role.
A midwife is usually a woman’s first and main point of contact throughout this process. They are responsible for providing individualised care for both mother and her family, encouraging them to determine how their pregnancy progresses. This includes assisting the woman to make informed decisions about the services and options available to them and supporting them throughout the decision making process.Role of the Midwife as an Educator Essay

Hearing the word midwife leaves many people thinking of unprofessional, inexperienced women who help deliver babies naturally, without the help of medication. In truth, nurse-midwives are registered nurses who have attended additional schooling for women’s health and are taught to make women feel as comfortable as possible. In the beginning, remedies were the females’ legacies, their “birthright”; these females were known as “wise-women by the people, witches of charlatans by authorities”. (Ehrenreich, 1973). “Females were wanderers, traveling from one place to another, healing the sick and wounded.” (Ehrenreich 1973). These women were among the first human healers and they were especially helpful when it came to childbearing. Role of the Midwife as an Educator Essay
MD Marden Wagner said, “In every country where I have seen real progress in maternity care, it was woman’s groups working together with midwives that made the difference.” The Marriam Webster dictionary defines midwifery as “The art or act of assisting at childbirth”. The definition is a spot-on explanation. Midwifery is not very broad; it’s pinpointed as a specific job with detailed instructions that only deal with pregnancies. Many will argue to say that midwives only work with women who are having “normal-pregnancies”.(Goer, 2002). Normal pregnancies include a healthy mother and fetus, with no complications. “Approximately 10% – 30% of pregnant women will experience Bacterial Vaginosis (BV) during their pregnancy. An ectopic pregnancy happens in 1 out of 60 pregnancies. About 1% of all pregnant women will experience placental abruption, and most can be successfully treated depending on what type of separation occurs.” (Pregnancy Complications).

All midwives are educators. While not all midwives are preceptors (clinical teachers who train students), educating birthing families is an integral part of midwifery care. As such, learning principles of adult education can help midwives become more effective for their clients and also will help those who train students to be better preceptors.Role of the Midwife as an Educator Essay

Parents will most often parent their children the way they were parented; our early experiences, good or bad, influence us. It can be the same in clinical midwifery education; we often train midwives the same way we were trained. If weak areas existed in our own clinical training, we have to work hard to improve and create better learning experiences for our own students.

Being a good midwife does not necessarily make one a good teacher. Knowledge of basic educational principles will help a person be a more effective teacher. Theories of education regarding how people learn best are tremendously varied. Some of the early work focused on Bloom’s Taxonomy of Intellectual Behavior (1956), which defines the three overlapping learning domains: cognitive, affective and psychomotor. Further research by Howard Gardner (1983) led to the proposal of the Theory of Multiple Intelligences, using seven styles of learning: verbal/linguistic, logical/mathematical, visual, kinesthetic, musical, interpersonal and intrapersonal. A more modern approach focuses on only four types of learners: visual, aural (hearing), read/write and kinesthetic. Many educators theorize that when students know their learning style and use it to help them study, their learning, will improve. The theory of hemispheric dominance—how the right or left sides of our brains affect learning—is often used in midwifery programs because it emphasizes intuition and empathy.Role of the Midwife as an Educator Essay

Midwifery programs are often written using woman-centered learning, which is more empathic and connected. It involves the learner in the process and is less hierarchal. Many of the concepts in woman-centered learning also are present in constructivism (Bruner 1990), which is the belief that people actively construct new knowledge as they interact with their environment. When people take notes or use learned material in a practical way, such as to restate or teach, they learn it better.

Constructivism Promotes Learner Involvement
A constructivist perspective views learners as actively engaged in making meaning based on their prior knowledge and experiences. Teaching with that approach focuses on what students can analyze, investigate, collaborate, share, build and generate, based on what they already know, rather than what facts, skills and processes they can memorize and regurgitate. Some of the ways the tenets of constructivism apply to training midwives are:Role of the Midwife as an Educator Essay

Students’ prior experience and learning is recognized and valued.
New knowledge is constructed using the individual student’s prior knowledge.
Students learn from each other as well as from the teacher.
Students learn better by doing.
Allowing and creating opportunities for all to have a voice promotes the construction of new ideas.
Learning is particularly effective when constructing something for others to experience.
Ways to Incorporate Constructivist Learning Principles in Clinical Education:
Observe students teaching clients.
Role-play complications. For example, get out the pelvis and baby and have the student show you how to get some pesky shoulders unstuck.
Ask her, “How would you handle this?” at every opportunity. And listen to the response.Role of the Midwife as an Educator Essay
Provide opportunities for hands-on involvement, early and often.
If you have more than one student, have the students work together. They can practice clinical skills on each other, do group research projects, etc.
Recognize that your student has her own world-view; respect it and know that changing it takes work.
Being an effective clinical teacher is important, no matter what type of midwife you are or where you practice. Clinical experience is the core of midwifery education. All midwifery educators can improve in this area.

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I was trained much the same way as most direct entry midwives (DEM) in the US in the early seventies: a combination of self-teaching and informal apprenticeship. Many of us started attending births with very little experience and even less training. We learned from experience and shared knowledge with our peers, doctors, chiropractors and anyone else we could. Very soon we had our own students. Our students had advantages we did not, especially more formal one-on-one apprenticeships. Some midwives included classes and directed learning activities. Others focused only on the clinical aspects of training; and their students relied on self-study, distance learning and any related training they could find.Role of the Midwife as an Educator Essay

The midwife credentialing process of the North American Registry of Midwives (NARM) was designed to fully incorporate and support the apprenticeship model of training through the Portfolio Evaluation Process (PEP). As direct entry midwifery schools formed, the Midwifery Education Accreditation Council (MEAC) began accrediting schools and NARM included a track for those who graduated from an accredited program. While NARM remains committed to the PEP, the philosophical trend is toward all midwives attending an accredited school, regardless of whether they are direct entry midwives or nurse-midwives.Role of the Midwife as an Educator Essay

Some have expressed concern about the loss of the “apprenticeship model” of training. Midwives have been trained throughout the ages using the apprenticeship model. While the science of midwifery is taught in the classroom and in books, the art of midwifery is taught in a one-on-one relationship between preceptor and student. We are fortunate in this country to have such a diverse range of training options for women to become midwives. As long as NARM continues to offer the PEP, the apprenticeship model will remain a viable method of becoming a midwife.

The Midwives Alliance of North America (MANA) created the core competencies, or standards of learning, for direct entry midwives. It also provides clear and written objectives for clinical practice that were written largely by early midwives, most of whom were self-taught and apprenticeship-trained. The values of the apprentice model are built into the system.

One of the drawbacks to the apprentice model has been the reliance on only one midwife for the bulk of a student’s education. Midwifery is so complex, and so many diverse approaches are possible for handling the same situations, that the more places students can learn from the better. Today’s midwifery students have more options. They may get their didactic instruction or academics from one place, their clinical training from a number of places and their one-on-one training with one or two midwives, in a high volume birth center or from working in hospitals in the developing world.

Nurse-midwifery students have long had the advantage, in the clinical part of their training, of clear written objectives, skill check-off sheets and other written guidelines. Now, with NARM and MEAC, direct entry students have the same options. These are important tools for clinical training.Role of the Midwife as an Educator Essay

Direct entry midwives in the US face an uphill battle to have our training models recognized with the same validity as the American Council of Nurse Midwives (ACNM) models. American College of Obstetrics and Gynecology (ACOG) recently released a Statement of Position which essentially says that all midwives who do not graduate from a program accredited by ACNM’s agency, the American Midwifery Certification Board, are “lay midwives” and are unsafe and not trained. This is a slap in the face to all the work that direct entry midwives have done with our training models and our credentialing processes.Role of the Midwife as an Educator Essay

The MANA study (Johnson and Daviss 2005) was an important step in demonstrating the safety of midwifery care by certified professional midwives (CPMs). More research needs to be done on the effectiveness of various educational models. Since ACOG has recognized that midwives do not need to be trained as nurses first, with the certified midwife (CM) recognized by ACNM, the next step is just a turf battle between accrediting agencies.

Unfortunately, research is limited on midwifery education for direct entry midwives in the US. If our position in relation to out-of-hospital deliveries is that mandatory CPM training is as valid as that required for a certified nurse midwife (CNM), we need to ask whether the evidence supports our assumptions. We do not truthfully know. We can make educated guesses, but we do not have the research to support our position either way.Role of the Midwife as an Educator Essay

In my experience as a midwifery educator over the last 30 years, I have witnessed tremendous growth and change in how we train midwives. MEAC and NARM have helped us raise the bar. However, I still see the quality of direct entry midwifery education all over the map, from excellent to poor. This includes those who graduate from MEAC programs and those who don’t. We still need to ask: How do midwives think their training prepared them for practice? Are students learning what they are taught? How do students graduating from self-study and apprenticeship-only models hold up in comparison to graduates from accredited schools? How does distance education compare to onsite programs?

To answer some of these and other questions, I conducted a short, informal study that focused on the clinical aspects of training midwives. Role of the Midwife as an Educator Essay

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