Abstract
Background
The needs of our pregnant population are evolving with more of our service users needing complex maternity care due to a significant number of them choosing pregnancy when living with pre-existing medical comorbidities. In addition, the national maternity service reviews in the UK continue to highlight failures of maternity professionals to identify common medical conditions and recognise deteriorating maternal health of which the consequences can be fatal. Some midwives have developed their clinical skills, knowledge of pathophysiology and disease presentation in pregnancy, to be able to meet the needs of those women requiring additional complex pregnancy care.
Aim and Objectives
To explore how direct entry midwives develop and practice at an advanced level and to identify the barriers and facilitators to their roles.
Method
Ten direct entry midwives who have completed or are currently undertaking their advanced clinical practice (ACP) training were interviewed using semi-structured questions. The data was analysed using a thematic analysis model by Braun and Clarke (2021). Ethical approval was not required as all research participants were NHS staff.
Findings
Four themes were identified: (1) ‘I didn’t know what I didn’t know’, (2) knowledge as empowerment, (3) challenges and enablers and (4) purpose filled drive. Midwives identified they had a deficit in both knowledge and in the clinical presentation of complex medical disease in pregnancy once they started their ACP training. They had to seek additional external support and resources in order to address this gap.
Conclusion and Impact
Midwives need to develop advanced clinical practice skills to meet the increasing demands of complex pregnancies. Direct entry midwives rely on their clinical midwifery leaders who understand and endorse the vision of advanced midwifery practice for mentoring in these roles. Seeking out learning opportunities within general medical environments should be considered to maximise learning for direct entry midwives.
The needs of our pregnant population are evolving with more of our service users needing complex maternity care due to a significant number of them choosing pregnancy when living with pre-existing medical comorbidities. In addition, the national maternity service reviews in the UK continue to highlight failures of maternity professionals to identify common medical conditions and recognise deteriorating maternal health of which the consequences can be fatal. Some midwives have developed their clinical skills, knowledge of pathophysiology and disease presentation in pregnancy, to be able to meet the needs of those women requiring additional complex pregnancy care.
Aim and Objectives
To explore how direct entry midwives develop and practice at an advanced level and to identify the barriers and facilitators to their roles.
Method
Ten direct entry midwives who have completed or are currently undertaking their advanced clinical practice (ACP) training were interviewed using semi-structured questions. The data was analysed using a thematic analysis model by Braun and Clarke (2021). Ethical approval was not required as all research participants were NHS staff.
Findings
Four themes were identified: (1) ‘I didn’t know what I didn’t know’, (2) knowledge as empowerment, (3) challenges and enablers and (4) purpose filled drive. Midwives identified they had a deficit in both knowledge and in the clinical presentation of complex medical disease in pregnancy once they started their ACP training. They had to seek additional external support and resources in order to address this gap.
Conclusion and Impact
Midwives need to develop advanced clinical practice skills to meet the increasing demands of complex pregnancies. Direct entry midwives rely on their clinical midwifery leaders who understand and endorse the vision of advanced midwifery practice for mentoring in these roles. Seeking out learning opportunities within general medical environments should be considered to maximise learning for direct entry midwives.
| Original language | English |
|---|---|
| Journal | British Journal of Midwifery |
| Volume | 37 |
| Issue number | 7 |
| Early online date | 27 Jun 2025 |
| DOIs | |
| Publication status | Published - 02 Jul 2025 |
Publications and Copyright Policy
This work is licensed under Queen’s Research Publications and Copyright Policy.Keywords
- Advanced practice
- midwifery
- career pathways
- skills development
