Why Erasmus matters

Students consider embarking on the Erasmus+ programme for a variety of reasons. While some students view it as an opportunity for an extended holiday, others embrace it is an experience to be immersed in a different culture and an opportunity to explore differing healthcare systems and provision. The world in which we live is continually evolving and, as midwives, we need to change with it.

As society wakes up to the injustices faced by people of colour, we need to train a generation of midwives who are not scared to face this head on. Similarly, the COVID-19 pandemic has reinforced the fact that healthcare is a global issue and to make a real difference, we need to work together as an international community. Erasmus+ can lay the foundations for this, equipping students with the ability to consider the bigger picture and challenge the status quo.

Greater appreciation of diversity

It is well established that diversity is an issue within midwifery practice. The most recent MBRRACE report stated that black women are five times more likely to die and Asian women are almost twice as likely to die in pregnancy or during the postpartum period in comparison to women who identify as white British (Knight et al, 2019). This is a painful reality that needs to be addressed. These findings are unacceptable for a nation with a healthcare system as respected as the NHS.

My Erasmus+ placement took place in Malta. In 2019, they received a record number of applications for asylum (National Statistics Office Malta, 2020). As such, my Erasmus+ experience afforded me the opportunity to care for increasing numbers of women from black, Asian and minority ethnic (BAME) groups. One particular experience was the opportunity to care for a woman following her immigration from Sudan. She spoke neither Maltese nor English and we did not have access to a translator. This was something I had never experienced before, and it presented several challenges around communication and informed consent that compelled me to adapt my practice. While this is only a personal anecdote, it demonstrates an interesting point about the need to constantly adapt and ensure care is truly woman centred.

The UK has a diverse population and students can gain experiences like this with the NHS. However, working outside of what I was familiar with afforded me the opportunity to consider how I can adapt my care in more creative ways to meet the needs of women in the UK. Midwives in the NHS are experiencing greater demands on services from an increasingly diverse population (HM Gov, 2018). Therefore, they need to be equipped to cope with this demand and provide women with the best possible care. Exposure to these situations as a student can help to prepare future midwives for what they will encounter when qualified.

As recent events have drawn attention to the entrenched racism within our society (BBC, 2020), midwives need to lead the way in breaking down the barriers faced by these women to improve outcomes and protect lives. A greater level understanding of the challenges faced by BAME women and a continued focus on woman-centred care can only improve outcomes and elevate the maternity care we provide.

Enhanced global perspective

My time in Malta was my first experience of midwifery outside of the NHS and it opened my eyes. Midwifery students in the UK become accustomed to the way the NHS operates within society. While this national health system is unique to the UK, a wider appreciation of other healthcare systems allows further appreciation of healthcare on a global level, and this can be useful when caring for women born outside of the UK.

The COVID-19 pandemic has highlighted the globalisation of healthcare and the need for cross-border innovation. By exposing midwifery students to other healthcare systems, their understanding of what they believe healthcare should look like can be challenged and this begins the process of developing international relationships between professionals.

Midwives share a bond regardless of what country they work in-this is something that should be utilised and celebrated. By working together, we as both qualified midwives and students can achieve more than we ever could alone. It is universally accepted that communication is key to effective team work; why can't we apply this on an international scale, creating a space where professionals can share and innovate for the benefit of all involved? While this is starting to happen, it is not the accepted norm yet. As we become a more global society, we as midwives need to invest in these relationships to protect from the division that can be seen in the world.

Practice development

As with developing a global perspective, working outside the NHS can have a significant impact on a midwifery student's professional practice. Caring for women without the trust policies and National Institute for Health and Care Excellence guidelines that we are so familiar with encourages students to question the reasoning for the practices they have observed and participated in.

Personally, I found I had to utilise my underpinning knowledge more than ever, in an effort to fully understand the basis for the care I witnessed. The different practices I saw encouraged me to look to the evidence to make a judgement, rather than relying on what I was told was the right thing to do. Often, midwifery students in the UK become so comfortable with the guidelines of the hospitals in which they work, they forget to consider the evidence base that underpins it. When those guidelines are taken away, there is no choice but to look to the evidence for clarity.

In addition to this, by working outside of the environment I was comfortable in, I found myself thinking more about the Nursing and Midwifery Council (NMC, 2018) code than I would normally, as I could no longer rely on my mentor's knowledge of it, as I often did at home. I was always aware of the fact that I had to hold myself to the standards of my professional statutory regulatory body. To achieve this, I had to make autonomous decisions about my personal practice. As a midwifery student working with midwives unfamiliar with the code and the scope of practice of British students, I had to speak up and communicate the limits of my practice. This was incredibly intimidating, but I had a professional responsibility and, by exercising this, my confidence in my professional judgement grew.

Returning to practice in the UK, I have found that the experience has helped me to find my voice, and trust in my knowledge and understanding. As qualified professionals, midwives need to be confident enough in their professional judgement to know when not to do something, as well as when to act. Knowledge of the code is key, and the experience of having to continuously consider your actions really solidifies this understanding.

Conclusions

In summary, the benefits of the Erasmus+ programme are extensive and it is a struggle to articulate them all fully. The experience has had a profound impact on me, both professionally and personally, and I feel this is an opportunity that should be more widely available to student midwives. While students can gain a wealth of experience working within the NHS, there is an extra layer to the experiences gained by working abroad that cannot be replicated on a placement in your home nation. If we want to train a generation of midwives who are dynamic, resilient, and have a real appreciation for different approaches to healthcare, we should encourage students to embrace these opportunities and share their learning with others.