References
Student midwives' experiences of the personally facilitated birth requirement
Abstract
Background/Aims
Nationally, spontaneous vaginal births have been decreasing, accompanied by an increase in caesarean sections and assisted vaginal births. Nevertheless, the Nursing and Midwifery Council standards for pre-registration midwifery education state that student midwives should facilitate 40 vaginal births. This study aimed to explore student midwives' experiences of this requirement and its impact on woman-centred care and student mental health.
Methods
This exploratory study collected data from purposively selected midwifery students using an anonymous online survey carried out at one university in the East of England. Quantitative data were subjected to descriptive analysis. Free text data were analysed thematically.
Results
A total of 86 responses were received. The majority of participants (69%) reported that the requirement impacted their mental health. Qualitative analysis identified four themes: the competition, requirement not reflecting the landscape, missed learning opportunities and mental health.
Conclusions
There is a disconnect between the current clinical landscape and the expectation for student midwives to facilitate 40 spontaneous vaginal births. With declining vaginal birth rates, this requirement fosters competition, limits exposure to complex cases and impacts student wellbeing, potentially compromising woman-centred care.
Implications for practice
The findings suggest that education providers and regulatory bodies should reconsider the use of fixed numerical requirements for assessing competence.
The Nursing and Midwifery Council (NMC, 2023) standards for pre-registration midwifery education state that student midwives should personally facilitate 40 vaginal births. Spontaneous vaginal births have decreased nationally from 64% in 2012–2013 to 43% in 2022–2023 (NHS, 2023). One in four women have a caesarean section (National Institute for Health and Care Excellence, 2024) and 10–15% have assisted vaginal births (Murphy et al, 2020), which would not count towards the required facilitated birth number (NMC, 2023). This decline in births could present collaborative and practical challenges that may hinder students in obtaining the necessary hands-on experience.
In this context, competition among student midwives for limited access to facilitating births can lead to disappointment, low self-esteem and anxiety (Khursheed, 2023). This pressure can hinder collaboration among students, promote a logic that ‘ends justify means’ and place an undue focus on meeting this goal at any cost. As a result, students may compromise their educational experience, face ethical dilemmas and experience deteriorating mental health, raising wider concerns around wellbeing, retention and readiness for practice.
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