Confidence in Midwifery : Midwifery students and midwives’ perspectives

Sammanfattning: A confident midwife has an impact on a pregnant woman’s clinical outcome and birth experience. Knowledge acquisition, competence, and confidence develops over a lifetime and is of great importance in developing and forming personal skills and allowing the personal traits to grow and mature. Previous international studies have shown that midwifery students do not feel confident in many areas in which they are supposed to practice independently. The aim of this thesis was to investigate confidence levels in basic midwifery skills in Swedish midwifery students in their final semester just before entering the midwifery profession. An additional aim was to describe clinical midwives’ reflections about learning and what factors that developes professional competence, and confidence.Study I was a cross-sectional survey with Swedish midwifery students (n=238). They assessed their own confidence in all competencies that a midwife should have and could practice independently. The results of study I confirmed that Swedish midwifery students feel confident in dealing with the most common procedures during normal pregnancy, childbirth, and postpartum and newborn care. However, they do not feel fully confident in cases in which there are deviations from the normal procedures and obstetric emergencies. When comparing groups of midwifery students, the younger group of midwifery students felt more confident in general compared to the older group. Students at a university with a medical faculty were also more confident than the students at a university without a medical faculty.In study II, focus group discussions were held with 14 midwives emphasizing the way in which midwives reflect on learning and the development of competence and confidence. Content analysis was used to analyze the focus group discussions. Four categories were identified as a result of study II: 1.) feelings of professional safety evolve over time; 2.) personal qualities affect professional development; 3.) methods for knowledge and competence expansion; and 4.) competence as developing and demanding. The conclusion of this thesis is that more practical and clinical training during education is desirable. Midwifery students need to have access and the opportunity to practice obstetrical emergencies within a team of obstetricians and pediatricians. Learning takes time, and one improvement is to extend midwifery education to include and increase in clinical training. This would strengthen the students theoretical, scientific, and clinical confidence. Clinical midwives claim that it takes time to feel confident and that there is a need to develop professionalism.