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Never be afraid to question practice: the professional dilemma of a student midwife

02 August 2019
14 min read
Volume 27 · Issue 8

Abstract

As a third-year caseloading student midwife, I experienced a professional dilemma during an intrapartum placement while working on a busy obstetric unit: to use vaginal examination to confirm full dilatation (a medical approach) or advocate normality and a woman-centred approach. This article explores the three influential forces that contributed to the dilemma: the culture of obstetric units, the midwife-woman relationship, and the importance of assertive behaviours to achieve autonomy. Through reflection and use of Gibbs' (1988) reflective cycle, I highlighted the need to develop my assertive skills, which also led me to make amendments to my own practice; this helped me transition from student to a newly qualified midwife.

Midwives must be autonomous practitioners, a stipulation of the Nursing and Midwifery Council (NMC, 2018). This article will present a case study in which I was presented with the challenge of conforming to a medicalised approach to care, or upholding my values and philosophies as a student midwife and using a non-interventionist approach to achieve autonomy. It was therefore essential for me to consider my skills and attributes as a student midwife, reflecting on and analysing key factors that determined my decision-making in practice. Throughout this article, I will refer to the woman I cared for as ‘Faye’.

I first met Faye when she arrived at the obstetric unit for triage in suspected labour. I had already begun building a trusting relationship with Faye and she requested my care when admitted to the unit in established labour two days later. Faye had previously experienced a traumatic birth and described feelings of powerlessness and loss of control; she hoped that this labour would be positive and I was aware that she trusted me to help her.

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