Elective placements enable students to pursue an area of interest other than the essential standards required for pre-registration midwifery education (Nursing and Midwifery Council, 2009). Student midwives can organise placements in the UK or abroad, although the timing and length depends on the individual university programme. Increasingly, midwifery students are carrying out elective placements in developing countries to enhance cultural sensitivity and knowledge of global midwifery. I hope that this blog will encourage and inspire students to use their elective placements effectively.
In September 2018, I carried out an observational 2-week placement through an organisation called Work the World. I was based in Effie Nkwanta Regional Hospital in Takoadi, western Ghana and spent most of my placement on the labour ward and triage.
Although I had learnt some of the local language, there were language barriers, which highlighted the importance of good non-verbal communication skills. The hospital was very different from the UK, with reduced documentation, and a lack of resources, privacy, access to pain relief and birth companions. My skills in using the Pinard stethoscope improved, as there was only one Doppler monitor available, despite the busy antenatal clinic.
Women were left to labour alone with limited midwifery support, which is very different to the one-to-one care that we strive to provide in the UK. During the second stage of labour, it was routine practice for women to give birth on a bed in a semi-recumbent position. I was able to see the care provided to high-risk women, including women with severe anaemia and sickle cell disease, and witnessed emergency situations such as postpartum haemorrhage, which I found particularly challenging due to the reduced access to medications routinely used in the UK. I attended a teaching session on the prevalence of jaundice and a mortality meeting, which highlighted the extreme difference in the care available in Ghana compared to the UK. The reduced access to blood products (less than 10 blood donations collected per 1000 people in 38 African countries) means that 50% of blood supply is dependent on family members or paid blood donors (World Health Organization, 2017).
International elective placements develop cultural competence and communication skills and provide many opportunities for learning (Carson and Stronge, 2015). However, international electives are not always an option for student midwives due to family commitments or financial implications, and it should be noted that there are also many options for elective placements in the UK, including working in a different hospital, with private organisations or shadowing specialist midwives. I believe that it is important to make the most of any leaning experiences; for example, observing gynaecology theatre is an opportunity to learn about women's anatomy. Being a student midwife is also an ideal opportunity to gain an insight into the range of career pathways in midwifery. Following different practitioners is a great way to increase knowledge and meet inspirational professionals.
Shadowing different midwives, including a professor of midwifery, the Director of Midwifery and Women's Services for the local health board, a consultant midwife and a Flying Start midwife, has enhanced my knowledge and reinforced my own career aspirations. Bradshaw et al (2018) highlighted that gaining experience in other areas, such as infertility services, improved students' knowledge and practice.
Bradshaw et al (2018) identified that elective placements allowed the sharing of best practice and enhanced midwifery students' employability. Geraghty et al (2019) found that international placements increased midwifery students' confidence, consolidated their knowledge and skills, reinforced career aspirations and taught them to trust physiological birth.
I believe that my elective placements have increased my confidence, knowledge, critical thinking and professional development. Gaining international experience has enhanced my passion and knowledge of global midwifery, which is not covered in depth in the pre-registration university programme. Nevertheless, having the opportunity to shadow inspiring midwives in the UK has also improved my understanding of the role of the midwife and different career pathways available. I would therefore encourage all student midwives to gain as much experience as possible from their elective placement.