Birthing in rural South Australia: The changing landscape over 20 years.

OBJECTIVE: To map trends in the maternity service availability for rural women in South Australia and identify the frequency of women birthing outside of their region of residence. DESIGN: A retrospective review of birth location for rural South Australian women from 1991 to 2010. SETTING: Rural maternity units in South Australia. PARTICIPANTS: Birthing statistics from the Pregnancy Outcomes Statistics Unit in South Australia MAIN OUTCOME MEASURES: Rural birth statistics, including place of birth in relation to place of residence and location of maternity units. RESULTS: Over 60% of maternity units across rural South Australia have closed since 1991. There has been a rise in the percentage of women birthing away from their usual region of residence, rising from 18% in 1991-1995 to 24% in 2006-2010. CONCLUSIONS: This study has revealed that almost one quarter of all women residing in rural South Australia relocate to another area to give birth. This is a significant concern for rural women and their families through the expectation of separation, and for the local health services who might now not have the facilities and skills to manage an unplanned maternity presentation. These concerns need to be considered and addressed in order to provide safe and effective care for child-bearing women regardless of location.

An exploration of the midwifery continuity of care program at one Australian University as a symbiotic clinical education model.

OBJECTIVE: This discussion paper analyses a midwifery Continuity of Care program at an Australian University with the symbiotic clinical education model, to identify strengths and weakness, and identify ways in which this new pedagogical approach can be improved. BACKGROUND: In 2002 a major change in Australian midwifery curricula was the introduction of a pedagogical innovation known as the Continuity of Care experience. This innovation contributes a significant portion of clinical experience for midwifery students. It is intended as a way to give midwifery students the opportunity to provide continuity of care in partnership with women, through their pregnancy and childbirth, thus imitating a model of continuity of care and continuity of carer. METHODS: A qualitative study was conducted in 2008/9 as part of an Australian Learning and Teaching Council Associate Fellowship. Evidence and findings from this project (reported elsewhere) are used in this paper to illustrate the evaluation of midwifery Continuity of Care experience program at an Australian university with the symbiotic clinical education model. FINDINGS: Strengths of the current Continuity of Care experience are the strong focus on relationships between midwifery students and women, and early clinical exposure to professional practice. Improved facilitation through the development of stronger relationships with clinicians will improve learning, and result in improved access to authentic supported learning and increased provision of formative feedback. This paper presents a timely review of the Continuity of Care experience for midwifery student learning and highlights the potential of applying the symbiotic clinical education model to enhance learning. CONCLUSION: Applying the symbiotic clinical education framework to evidence gathered about the Continuity of Care experience in Australian midwifery education highlights strengths and weaknesses which may be used to guide curricula and pedagogical improvements.

The midwifery miniCEX--a valuable clinical assessment tool for midwifery education.

BACKGROUND: Midwifery students, clinicians and educators in Australia identified the need for improved feedback for midwifery students whilst they are on clinical placement; in particular formative assessment. The miniCEX or mini-clinical evaluation exercise is one approach to assessment that has been proven valid and reliable in medical education. The aim of this research was to develop, implement and evaluate a miniCEX tool for midwifery education. METHODS: Using an action research approach, this project engaged midwifery clinicians and midwifery students to adapt and implement the miniCEX in a postnatal ward environment. Focus groups were held to establish the clinical expectations and develop performance guidelines of students across the domains of midwifery practice, as well as evaluate their use in practice. FINDINGS: Evaluation of the midwifery miniCEX, including its applicability from the perspective of staff and students was positive. The miniCEX was found to be easy to use, time efficient and valuable for learning. DISCUSSION: The miniCEX is an innovative approach to assessment and feedback in midwifery education, and there is currently no identified evidence of its use in midwifery education despite broad use globally in medical education. CONCLUSION: The implementation of the midwifery miniCEX offers broad benefit to both midwifery students and midwifery clinicians and educators globally.