Every second counts

on 19 July 2018 Student midwives

The middle year of midwifery training is widely known to bring added responsibility, leaving some students questioning their chosen career path. Helen Bird asks where the challenges lie and identifies the tools you need to survive the so-called ‘second-year blues’.

How would you go about supporting a labouring woman entering the transition phase? Whatever your answer, could it also hold the key to surviving the second year of midwifery studies?

There are certainly parallels between the two experiences, according to Kate Amy, a student at the University of East Anglia. ‘It’s the best way I can describe it,’ she reflects. ‘You’ve been doing the degree for such a long time but you still have a long road ahead of you. What you’ve done so far is a crazy combination of difficult and totally amazing and you’re not quite sure what’s to come.’

It’s an analogy to which many of Kate’s second-year peers will no doubt relate. But while the labouring woman will, with support, find her way to the end of her journey, the same cannot always be said for the student. This is a year during which trainee midwives will question their ability to go the distance, and in some cases decide to quit entirely – whether solely because of the demands of the course or of other circumstances that make continuing untenable.

‘Students report that there is more pressure in the second year, both from the academic and practice settings,’ agrees Carmel Lloyd, RCM head of education and learning. ‘From the academic perspective, their grades start counting towards their final degree award so there is more pressure to do a good piece of work in order to get a good result. Clinically, they’re expected to take more of an active role rather than observatory and take initiative in providing care,’ she adds.

Catching the blues

The additional pressure felt at this time, perhaps alongside the feeling of having a long road ahead, has resulted in the collective coining of the phrase ‘second-year blues’ – a state of mind from which Teeside University student Helena Nguyen reports suffering. ‘I feel an immense pressure to demonstrate knowledge and I am overwhelmed by this expectation of a second year,’ she explains. ‘For example, there is the expectation that, with the support of my midwife mentors, I begin to take the lead in providing care. I know that my mentor will support me in this transition but the thought of needing to evidence such capability to progress to the next level of training is petrifying!’

For Dr Rachael Spencer, principal lecturer in midwifery at Sheffield Hallam University and NMC lead midwife for education, seeing such emotions among students is a familiar story. Although dropouts in the second year ‘rarely’ occur at the university, she reports, the difficulty in transition is likely ‘in part because in the first year, [students] are enthused and excited by the newness of their experiences’, while ‘the second year seems more difficult academically with increased demands placed upon them both theoretically and in clinical practice’.

However, Rachael adds, significant life events and stresses can hamper the ability of student midwives to continue with the course, including pregnancy, financial issues and a partner’s redundancy. In such circumstances, student support officers are there to provide guidance. ‘Sometimes students may take a temporary withdrawal of a year and then return to the next cohort to continue and successfully complete the course,’ says Rachael.

Repair and reflect

The imminent publication of Health Education England’s ‘Reducing Pre-Registration Attrition and Improving Retention’ (RePAIR) project promises to shed more light on the insurmountable challenges that midwifery students can sometimes face. And while a previous UK-wide survey by the RCM found that most students who dropped out of their midwifery studies did so because of family circumstances, it seems likely that the government’s abolition of NHS bursaries could be a pressure too many.

Carmel says that ahead of the RePAIR report, expected at the end of this month, students are ‘positive about what they have heard and seen so far’, and ‘consider it to be realistic and not surprising’. ‘I’m looking forward to seeing the recommendations and what strategies tried by the pilot sites have proved successful in retaining students,’ she adds.

In the meantime, the second-year students we spoke to are applying resolve, positivity and refreshing honesty to their reflections on their mid-course journey. Cara Evans, who studies at the University of Nottingham, describes hers: ‘The truth is that I don’t know what I’m doing. I’m not ready to be a qualified midwife, but at the same time I know so much more than when I first started.

‘I’ve realised that, in the second year, the achievements are a little less obvious; it’s the gradual getting to grips with how to care for women with different needs. [It’s] the time where little things click into place and you grow into the midwife you hope to be one day.’

Transitioning first-years should prepare to see the unexpected aspects of labour and birth in their upcoming year of study, according to Samantha McCoy from Scotland. ‘In our university, the second year mainly focuses on the complications of pregnancy and emergencies,’ she says. ‘That was initially overwhelming and I began to think: “Where is the normality?”

‘However, with the support of very good lecturers and mentors I felt that I acquired all of the new skills and knowledge expected of me. I feel like overall it has been a demanding but amazing year.’

Seeing the light

Despite her testing experience of second year, Helena is resolute about continuing on the course and keeps a realistic outlook. ‘I’m still here and taking each day as it comes,’ she says. ‘I’m trying to be brave, to not be afraid, to ask questions and to remember that I’m a student, not the expert.’

And much like the transitioning woman in labour she likened herself to, Kate looks back on her middle year with a sense of achievement and joy: ‘The phrase “second-year blues” doesn’t come from nowhere,” she concludes, ‘but the struggle is so worth it, and overall it was a positive experience. I’d do it all again if I had to.’

Second years have their say

‘Second year is a rollercoaster! The novelty of the first year has worn off and the end is not quite in sight’ – Sophie, Teesside University

‘At the moment we are all just getting by one week at a time, letting off steam in our group chat and on Facebook while we’re all on different placement schedules’ – Sian, Chester University

‘I have learnt so much about responsibility, how a gas boiler works, and how to comfort a woman who just needs a shoulder to cry on!’ – Georgina, Leeds University

‘You don’t have the excuse, “I’m just a first-year” any more, you need to put effort in and study harder, the responsibility is greater and the emergency OSCE looms over your head’ – Chelsea [university not given]

‘For me, second year has been great: engaging and affirming. I have found “complex care” extremely interesting and lecturers really helpful in facilitating our learning’ – Alison [university not given]

‘It’s been a tough year so far – struggling with both the increased workload and more demanding academic work while dealing with being homesick’ – Iraana, University of Hertfordshire

Second-year survival tips

  • Develop a robust support network – through course peers, social networking and being a member of a midwifery society (and the RCM!)
  • Consider buddying up with a first-year student – a mutually beneficial partnership in which they will learn from your experience and you will gain reassurance as to how far you’ve progressed
  • Communicate regularly with your lecturers and flag it up early on if you feel you’re struggling
  • Talk to senior students and newly qualified midwives to draw on their experiences – they’ll often have had the same doubts and can give advice and strategies to help you manage
  • Lean on your family as much as possible
  • Keep a realistic work/life balance