Caseload holding practice at Bournemouth University

Originally pioneered by the midwifery team at Bournemouth University in 1996 (Lewis et al 2008), student midwife caseloading has been cited as an example of best practice (DH 2003). However, whilst there is robust evidence of women’s experiences of continuity from qualified midwives (Sandall et al. 2016) there is a lack of information regarding student’s care. Although some studies have been conducted in Australia and Norway, no formal research into women’s experience of this approach to student involvement in their care appears to have been undertaken in the United Kingdom. My doctoral study focussed on hearing women’s personal stories to develop an understanding of how being part of a student midwife’s caseload may have impacted on their childbearing experience and the meanings this had for them. My interest in undertaking this work arose from a desire to enhance my knowledge and understanding of what it is like to be part of a student midwife’s caseload, from women’s perspectives. I was keen to enhance the quality of women’s experiences via development of midwifery student education through bringing women’s experiences into the classroom. Along with an appreciation of student midwife perspectives, I wanted to gain a more in depth understanding by hearing women’s personal stories of experience.

Utilising qualitative methods, data were collected within a longitudinal model through story accounts from six women who had agreed to be part of a student’s caseload. Participant stories were sought on three occasions; twice during pregnancy and once in the postnatal period. This framework mirrored the woman’s student caseloading journey, and enabled the interviews to capture episodes as her story of experience unfolded throughout pregnancy, birth and the early days of mothering. The story accounts were analysed through a narrative framework using a three phase re-storying model to uncover themes of significance to the individual women within the study, and the women as a group. Through this process two interrelated formats of re-telling were created through generation of individual poems and collective stories of experience. This enabled me to develop the women’s stories re-told as poems as a powerful educational resource with which to inform student preparation for the continuity experience.

My study findings provide evidence that this group of women highly valued the student contribution via continuity to their care and this experience may be transferable to other women participating in student caseloading. This understanding adds weight to the Nursing and Midwifery Council expectations and reinforces the value of continuity educational schemes. The knowledge gained provides useful insights for curriculum developers nationally and internationally, educators and practitioners. Dissemination of this knowledge builds on Bournemouth University’s footprint of scholarly work in this field and informs the collective evidence of understanding at a local and wider international level.

References

Department of Health, 2003. Delivering the Best: Midwives contribution to the NHS Plan. London: DH. 

Lewis, P. Fry, J. and Rawnson, S., 2008. Student midwife caseloading – a new approach to midwifery education. British Journal of Midwifery, 16(8), 499-502. 

Nursing and Midwifery Council, 2009. Standards for Pre-registration Midwifery Education. London: NMC.

Rawnson, S. Brown, S. Wilkins, C. and Leamon, J., 2009. Student midwives’ views of caseloading: the BUMP study. British Journal of Midwifery, 17(8), 484-489.

Rawnson, S., 2011. A qualitative study exploring student midwives’ experiences of carrying a caseload as part of their midwifery education in England. Midwifery, 27, 786-792.

Having women phone or message me was useful as one woman was quite shy and never liked to speak over the phone so text messaging between ourselves worked well for her. Being first point of contact for women also enabled me to make autonomous decisions, such as advising one of the women who had experienced reduced fetal movements or another who had experienced a vaginal bleed to seek help immediately at the DAU. I would then update my mentor or another member of the community team shortly after the call to ensure they were happy with my decision/plan.

Communicating with my mentor was vital and I would always email her up to date information regarding the women I was caseloading and what the plan was. Initially I started with supervised contact in clinic for the first couple of antenatal appointments and then visited women in clinic or at home unsupervised. It seemed really odd not having another person overseeing my practice. However, I felt confident in my abilities and knew that if I was unsure, my mentor would be on the end of the phone to support and guide me. My mentor was really supportive, and this helped my confidence grow. The learning I gained from caselaoding was just incredible and my confidence and knowledge soared which really helped me going into my third year.

Although caseloading had its challenges I thoroughly enjoyed it and felt privileged to provide care and support to three women throughout their pregnancy and birth continuum. These experiences have strengthened my ability to build strong trusting relationships, be autonomous and trust my own initiative when making evidence-based decisions. It has opened my eyes to how valuable continuity of care is and the importance of women receiving positive care experiences from continuity of care firsthand.

There were challenges but these were more organisational. Running a family, attending university, revising for an exam and caseloading three women whose due dates were close together. This part of caseloading was hard. But by becoming really organised, and having supportive friends and a family who understood why I was no longer socialising I got through it. I am so glad I have done it as caseloading has been incredibly rewarding. To care for a woman from booking to discharge is just an absolute privilege, to come into someone’s life for a short period of time and give good quality care is so special. Not many university students (unless you are a midwifery student) can say that.  It is odd saying goodbye on discharge day after being a big part of someone’s life for the last 40 weeks but nothing beats the last words I heard from one of the women I caseloaded:, “Thank you so much, you will make an amazing midwife and will always be in our thoughts, see you for the next one”.