The word ‘transition’ can apply to many areas of our lives. Our very first transition is that from the warm, usually inverted world of in-utero existence, into the air- and light-filled birth room, where our lungs must inflate in order to make the change from umbilically sustained life to autonomous respiration and circulation. Then there is the transition from childhood to adolescence, or the onset of puberty, which marks a biological change and brings emotional tumult in its wake. In labour, women are said to be in the transition phase as they enter the active phase of labour (Royal College of Midwives, 2012). The fetal head begins to press down onto the taut pelvic floors, priming the mother's body for the second stage of labour, releasing hormones that let the uterus know it is time to contract, and engaging all other abdominal muscles to achieve that final descent from in- to ex-utero. Women often become agitated and frightened, and phrases such as ‘I can't do this anymore’, and ‘I just want to stop now’ are not uncommon. Witnessing this period of a woman's labour is a sign used by experienced midwives that full cervical dilatation is near, and the midwife's role at this part of the labour is significant, as the woman needs quiet reassurance and encouragement.
There are some similarities between transition in labour and the transition from a student midwife to a safe, autonomous practitioner. Despite the fact that pre-registration education prepares students to become competent, autonomous midwives who can safely care for mothers and babies (Nursing and Midwifery Council, 2008; Skirton et al, 2012), student midwives often feel anxious, frightened and sometimes most certainly want to shout ‘I just want to go home!’ Student midwives experience different types of transitions on a regular basis, such as rotating from area to area, changing mentors, graduating to the next academic year and tackling new situations every shift. The pressure builds as each placement passes and, at the end of the third year, expectations from mentors, and from students themselves, are high. In the back of a third-year student midwife's mind is that, in a few months, the responsibility for the care and safety of women and babies lies with them.
Students are often reminded of their impending transition by university lecturers, although it is regularly reported that there is not enough support to facilitate a smooth change to a registered practitioner (Nolan, 2017). The desirable attributes of a newly qualified midwife have been listed as independence, self-governance and self-determination (Pairman et al, 2015). This, coupled with a large dose of resilience, should mean that the transition is manageable. The reality is often different.
Research has shown that the first few weeks into a new role is a time of vulnerability for the newly qualified midwife, and attrition nationally from the profession in the first 5 years is high (Chief Nursing Officers of England, Northern Ireland, Scotland and Wales, 2010). One study found that some of the biggest challenges that face students transitioning to newly qualified midwives included the heavy workload, and no longer being supernumerary, which means conducting drug rounds alone, remembering everything that needs to be done and prioritising effectively (Kitson-Reynolds et al, 2015). The same study also found that being able to justify decisions based on evidence gave newly qualified midwives confidence in their own practice, which, coupled with a robust preceptorship and named mentors that could support the transition from student to newly qualified midwife, resulted in a less challenging experience. Taking this into account, the best advice would appear to be: