2023 State of Midwifery: The Key to Making More Midwives

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Welcome to the second post in the 2023 State of Midwifery series.

In case you missed the first post, catch it here: 2023 State of Midwifery: The 10,000 Foot View of the Profession.

Precepting is the only path forward. If you were looking for the BLUF, or the bottom line up front, there it is. Precepting is the only path forward.

Making more midwives is a multi-faceted problem. The art of midwifery is learned at the bedside, from other midwives, 24/7/365. A computer module will never be able to replace that. And in order to teach the art of the profession, we need midwives willing to teach midwives.

I recently posted two posts on precepting in preparation for this part of the state of midwifery series:

For this post, I wanted to focus on content that would bolster preceptors. The tips that would make precepting easier, clearer, and help prevent burnout from teaching. Honestly, no one teaches you how to be a preceptor in midwifery school or afterwards. Teaching is inherent in the profession – we’re always teaching our patients, families, team members and colleagues. But teaching midwifery is really an entire other level.

Don’t believe me? Try teaching a midwifery student how to repair a second degree laceration while an entire family is around the new babe that just arrived in the world. It’s a delicate situation for everyone involved.

These are the things that I come back to again and again with students and find most helpful. I hope you’ll think the same. And if you’re not teaching students now and are a student, come back to this post later when it’s your time to lead in the classroom of birth.

(Keep scrolling….at the end of the post I’ve got resources for preceptors and I’ve also updated the MAKE MORE MIDWIVES page – are you tracking that there are 4 new midwifery programs coming online?!)

You are a team.

Introduce you and your student as a midwife team.

Example: “Hi, I’m Jamie, a staff nurse midwife for the practice. This is Justine, a student midwife working with me. We’re your midwife team today!”

What’s better than one midwife? Two!

But you, the preceptor, have to present it that way and present it confidently.

Make goals with your student that are actionable.

Every time I have a student, I always ask what their goals are.

“What are you goals for today?”

“What are your goals for your clinical time at this site?”

“What are you goals for midterm evals?”

The questions is important because it makes the student think about their goals. A lot of students need this prompt from their preceptor because it tells them that their preceptor is motivated and engaged. It also helps the student to set realistic goals. Preceptors understand their clinics and units better than most students and can tell quickly if “place 20 IUDs” or “attend 60 births” are realistic goals for the student based on the opportunities available.

For example, I had a student that wanted to do more menopause management recently. I asked her what she knew about management options and she knew very little. I explained that even if we have a patient that desires hormone replacement therapy, if she doesn’t know the basics of HRT and how to counsel about it, it becomes a difficult learning situation quickly. Alas, we printed out NARM’s most recent HRT update and she took it home for some homework.

Personally, I like to set goals in clinic for “% of clinic that the student is managing.” It might be a strange goal but I get a lot of students for a part of their clinicals. Taking a student in the middle of their clinical training is difficult because you aren’t quite sure what they know and you’re not sure what they need to know.

For a brand new student, being able to write a full H&P, or do a complete well woman exam, may be simple goals but those are very actionable to that level. Seeing a half a clinic would be overwhelming.

But a student that’s had 200 hours of training can probably see half a clinic fairly successfully. That might look like seeing patients all morning and working on notes in the afternoon, or, seeing every other patient and charting in between.

For a student in the latter half of clinicals, independent management is the goal.

Even though these might seem like simple goals, preceptors should be asking about student goals often and moving the bar as appropriate. Talk to students about real life expectations for management: i.e., pretend you have this full clinic today… when are you going to check your labs? Help them to understand real world practice and they will be stronger after graduation because of your efforts.

Learn the brief and de-brief.

I’ll tell you where I really love a brief and de-brief: parenting. My husband and I took a course on parenting in 2021 that really changed how we speak to our kids. One of the components of the course was the brief. For example, when we go to the library, I park the car and then turn around and ask my big kids what the rules of the library are. The instantly race each other to list “No running, no screaming. Use whisper voices. Put books back….”

It’s fantastic. And so are the library visits.

I’ve found the same is true for midwifery students. They need someone to walk them through the brief.

“Mrs. Jones is here for pre-eclampsia and is on magnesium sulfate. What do you think of her blood pressures? What blood pressure

Tools for precepting: how to debrief; how to set goals/review goals; make your grey’s anatomy intro ” i expect you ot be on time, if you dont know the answer i am going to have you look it up”

Make sure your students are touching patients.

Touching patients? What? Isn’t that an integral part of clinicals.

Yes, yes it is. But I have had multiple students that report prior preceptors were so busy in their clinics of 30 to 40 patients that they simply followed the preceptor around all day and didn’t have time to even do fundal heights or heart tones.

This isn’t the norm. But it’s happening at some sites. For these sites, you might be too busy to have a student. And that’s okay. (See my post on when it might be time to take a break from precepting.)

But I even see this trend on labor and delivery with nurses. How often do you see a nurse look at a toco on the monitor to see when a contraction is coming instead of palpating?

Touch is an integral part of midwifery. Always has been, always will be.

Prune for growth.

I think a lot about pruning my succulents. But here’s why: after pruning comes new growth and beautiful blooms.

I want to encourage preceptors to be upfront with students about where they need pruning.

I think it’s different for each student.

But I believe that preceptors can see what each student needs and how it will help them.

Don’t discount shedding the old to make room for the new.

It’s okay to let your students flail a little. That’s where the real learning takes place.

This is my last and favorite tip. Most student midwives have no idea what it’s like to be a provider and I was recently reminded by a friend that the jump is huge. You don’t realize the difference between nurse and midwife, or student and midwife, until you are on the other side.

But there’s this place where students can start to feel that responsibility if you’re willing to let them flail a little while they are still in clinicals.

Start with a good silence. It allows students to feel the knowledge, counseling and guidance that they know and don’t know instantly. I like to use silence on clinic and labor and delivery. But I use it with grace.

For example, my student and I are headed into a labor room to admit a patient/family for induction. We just did a brief about the admission, exam and likely plan for the induction and the student is going to lead the entire admission.

While in the room, I let the student guide most of the admission but I’m noting the things they forget as they go from point to point. At the end of the talking, the student always looks to the preceptor to see if they forgot anything. This is where I say gently, “Just a few things, but take a second to think about it, you’ve got this.”

Another great way to let students feel the provider responsibility is to let those notes they need to chart pile up. When students realize they have 2 H&Ps, 3 triage notes, and 6 postpartum notes to get written, they feel the sweat glisten and their heart race a little.

That’s exactly where you want them to be. They will flail a little but you are there to give them a soft landing.

Those are the tips! I hope they help someone out there on the journey to making more midwives.

If you’re looking for some additional help with precepting, check out these links:

Stay tuned for next week’s post in the series…my thoughts on becoming a postpartum warrier on the front lines.

And please share this post with a newbie to precepting! I wish someone would have told me all this 10 years ago.

Hugs until then,

Jamie

1 year ago on the blog…What do you pack in your hospital bag for birth?

2 years ago on the blog…The State of Midwifery Part 2: How to Bolster The Force

3 years ago on the blog…What is shared decision making?