Discovering the invisible: Transformative learning experiences of midwifery students to support physiological birth during continuity of care placements in Québec's freestanding birth centres

Abstract

Background: Despite international consensus advocating a physiological approach to childbirth, there are inconsistent opinions on how to acquire the competencies needed to successfully carry out this approach. While continuity of care experiences (CoCE) within placements is a valued educational strategy, there are limited studies that focus on the learning experiences to support physiological birth.

Aim: To describe and understand the learning experiences related to physiological birth, as well as the transformations required to become a midwife who supports physiological birth, during the CoCE placement process in a birth centre.

Methods: An interpretive description study design was adopted. Data were collected through audio diaries (n=126) with midwifery students and preceptors (n=14) across four level of placements in birth centres, in Québec, Canada, and discussion groups with students who kept the audio diaries.

Results: Three main themes were identified: 1) appropriating culture: relational autonomy; 2) developing competencies: acknowledging attitude, enabling behaviours and narrative skills; 3) constructing identity: coherence and resistance.

Discussion: The findings demonstrated the importance of CoCE, along with the continuity of preceptorship and a low-tech environment as optimal educational strategies for the acquisition of a culture and competencies that promote physiological childbirth. Resistance is part of identity transformation and represents an opportunity for critical questioning and safe feedback.

Conclusion: This study contributes to the understanding of the nature of the competencies developed and the transformations experienced to support physiological childbirth. It recognises the primacy of CoCE within extended placements, embedded in a workplace culture and environment that support relational autonomy.

Keywords: Audio diaries; Competency-based education; Continuity of care; Midwifery education; Physiological birth; Transformational learning.