Giliane McKelvin

The gap between maternal mortality for Black and White women in the UK continues to widen. Deprivation significantly increases the risk of maternal morbidity, mortality and adverse birth outcomes, affecting access to nutritious foods and antenatal care as well as increasing the likelihood of negative health behaviours such as smoking and substance use. However, ethnic health disparities exist regardless of social or economic status, meaning social disadvantage fails to explain these differences alone. Studies have identified racial discrimination and bias as important factors fueling the disparities in pregnancy outcomes among Black women. Black women report dismissal of concerns, assumptions and stereotypes among other negative experiences of their maternity care. This ultimately fosters fear and mistrust in maternity services, causing Black women to report health concerns later and avoid attending for care. Acknowledging that racism exists in maternity systems is a crucial step in addressing inequalities in maternal outcomes.

Women's experiences of childbirth have generally been considered through a pathological lens. Wider sociological arguments associated with salutogenesis stress the need to depict health on a continuum to help understand what constitutes positive health as well as ill-health. Similarly, to fully understand women's experiences of childbirth, it needs to be explored on a continuum, considering salutogenic and pathogenic factors. In this paper we report on qualitative data collected as part of a wider mixed-methods study to describe the continuum of women's different childbirth experiences (‘positive’ ‘neutral’ or ‘traumatic’). A mixed-method explanatory sequential design was undertaken comprising validated measures and in-depth interviews. Primiparous women who were expecting a healthy term infant were recruited and participated in an in-depth semi-structured interview at 12 weeks postnatal. Thematic analysis was used to analyse the data. Ten women took part in an interview and three main themes were identified. The first theme ‘before it all started’ showed how stories impacted women, with women trying to ‘keep an open mind’ or ‘accepting and expecting the worst’. The second theme ‘arriving at the destination’ emphasised the importance of midwifery support through ‘continuous compassionate presence’ while others reported ‘feeling forgotten’. Finally, ‘the days that followed’ highlighted how women tried to ‘focus on the outcome’ while others ‘wished it had gone better’. This study identified how women's subjective appraisals of childbirth are on a continuum and influenced by several factors including birth narratives and the quality of midwifery care from the early onset of labour. The kinds of experiences associated with reports that the birth was ‘neutral’ are reported for the first time.

Objective
To explore students’ and midwives’ preparation and experiences of supervision and assessment in practice using the new Standards for Student Supervision and Assessment (SSSA).
Design An exploratory qualitative study was undertaken. Student midwives and registered midwives were invited to participate using online recruitment strategies across closed groups. Participants were required to complete either an open-ended questionnaire or participate in an in-depth interview. The demographics and background data were presented in a descriptive format and qualitative data was analysed thematically.
Setting and participants Twenty-two student midwives and thirteen registered midwives from across the United Kingdom that had experience using the new Standards for Student Supervision and Assessment were recruited for this study.
Findings The thematic analysis identified three key themes: ‘Thrown in the deep end’ where a lack of preparation, training, time, resources, and communication were identified. ‘A double-edged sword’ in which staff and students identified the benefits of working with different professionals whilst acknowledging the significant challenges they faced without the student-midwife relationship and lack of supervisor continuity. ‘A daily struggle’ was expressed due to burnout which many students faced. Overall, one overarching theme that threaded itself through the narrative was that ‘it takes a village’ to create competent and confident midwives.
Key conclusions and implications for practice This study highlights some of the benefits students and midwives experience using the new standards but they are marred with significant challenges which need to be addressed to protect the future workforce and the public. There needs to be a more collaborative effort to ensure that midwives have the right resources, training, and protected time to fulfil their roles as supervisors and assessors. The student journey across placement needs to be mapped out carefully to ensure that an element of continuity that builds a student-midwife relationship is maintained. This will alleviate the impact on student learning, confidence, and burnout.