“Learning and growth can be solitary pursuits. We close doors, turn inwards, seek a private space in which to thrive. And yet, we need each other as friends, as family, as fellow students in the school of life.”

Last week I had decided to blog about some of the technological differences that I had noted during Episode 1. This week, Episode 2 started with our new student midwives, Rosalind and Joyce, studying in their bedroom. I noted their book with its nice red jacket written by Margaret F. Myles entitled Textbook for Midwives. It made me smile and reflect on my prior textbooks and education. This week I wanted to blog on some differences that I note as a Modern Day Midwife in the educational realm from our Call the Midwife series.

My undergraduate nursing education was at the University of Windsor in Windsor, Ontario, Canada. My favorite course was, of course, the obstetrical (OB) course. Our professor for the class was Dr. Mary Louise Drake (Monaghan at that time). She had been educated as a midwife in England. Our textbook was the same textbook that I noted the student midwives studying from, albeit it was now the 9^th edition and in the show they were using what I believe was the 5^th edition. I did investigate and now that specific textbook is on its 17^th edition!! I wonder if the choice of the textbook by my professor was influenced by her British educational background and experiences or that I was educated in a Commonwealth country. When I was in my nurse midwifery education at the University of Illinois at Chicago in the United States our textbook was Varney’s Nurse-Midwifery. I almost got rid of my text when I was getting an up to date version and then noted mine was the 2^nd edition and then could not part with it. The book is proudly on my book shelf beside the newer 7^th edition.

When I was in my nursing program I always sat beside my friend Ann Marie Della Valle. I can still close my eyes and can envision our seats in the amphitheater style classroom. We always chose to sit in the same seats in the same row for all 4 years. We were obviously creatures of habit. Unlike the show we did not ride bikes to our clinical experiences. However, we did get community and hospital clinical experiences. We also were exposed to experiences in Ontario and because we were a border town (Windsor and Detroit are separated by the Detroit River) we had the opportunity to have clinical experiences in both countries. I was so happy to be able to go to Hutzel Women’s Hospital and be exposed to midwives. Hutzel was a part of the Detroit Medical Center. As well, midwifery had not been regulated in Canada. Midwifery regulation did not occur in Canada until January 1^st, 1994 with the implementation of the Midwifery Act in the province of Ontario. At that time Canada was the only developed nation in the world without a system of regulated midwifery.

Unlike the show none of my professors were nuns and my professors had different educational backgrounds. They had Masters and Doctoral degrees. However, the similarity that I note is that the focus was on evidence and shared decision making. When I was at school for my undergraduate education and then my Master’s program I was in a brick and mortar university setting and often studied at the library. We bought our books at the school bookstores and used the card catalogues to look up other learning material, books, and journals. We handed in our papers that we had typed on typewriters. Even during my Master’s graduate degree my computer was more of a glorified typewriter. The internet availability was not really wide spread until 1993-1994. Our charting was done by hand and not entered into computer based filing systems. In our episode, I loved seeing Phyllis instructing them in a community setting with a flipchart.

Today I am on faculty and teach in an online program (Frontier Nursing University), and I doubt my students would know how to use the Dewy decimal system. Instead they have a choice of reading their textbooks from the digital library system or purchasing the books—often from Amazon. They progress through 11 week terms and move through the learning material or modules using varied learning opportunities and varied platforms. They can watch and listen to their lectures (either live or watch later on) from the comfort of their homes and in their own community via their personal computers. When I meet with my students we see each other on a computer screen. In our program we have students from every State in the USA and some of our students are studying while they are abroad.

We have many ways of disseminating knowledge and information—and many opportunities to engage with the material. Examples are online simulations in groups of 3-4 students with actors as the client and then reflection exercises and clinical notes that are written up for feedback. We use ungraded self-check exercises, graded exams, and case studies as we work through application of the concepts. We have discussion boards where they can process the learning material and have concept clarification. We meet in person on campus 2 times during their education—once for team building and onboarding during Frontier Bound and again during Clinical Bound. Clinical Bound is a time for in person preparation before they venture out with a midwife preceptor in their own community. A regional clinical faculty member will then continue to follow their progress before they write the National Board exams.

There are similarities and differences from Call the Midwife. There are differences in how the learning material is delivered; however, I note the similarity of emphasis on evidence and clinical reasoning. Information literacy is something that is so important. As a modern day midwife there seems to be a huge volume of new information coming at us all the time. It is important that our students have the ability to identify the need for information and to be able to find, evaluate, assess, and use information ethically for the purpose of best practice. Today there are so many platforms for information (some examples are textbooks and journals, online or hard copies, apps to use on their computers and phones). Our students need to be able to communicate and to write. It is essential that the midwives can act professionally while exchanging ideas, thoughts, opinions, and information in both oral and written formats. I love watching the professionalism of the midwives in Call the Midwife; however, I note the hierarchy and some level of disrespect towards the nurses and midwives in the hospital setting. This is reflective of the era and the times. The saying “You’ve come a long way baby” is true; however, we still have a long way to go with practicing to the full extent of our education and training. As well, I am sure all of us can recount multiple personal stories of hierarchy and elements of disrespect that we have encountered. Another aspect of the series is equity—I have noted this time and time again. In our educational program health equity is also a strong element of focus.

One big difference I do note and I am concerned about in our modern period is the amount of time with our clients and families. In the show I love the amount of time that is spent really engaging and being embedded in the community. In this episode we saw Dr. Patrick Turner ask Nancy Corrigan to delve deeper into Mrs. Khan’s health situation and she stopped by her home to invite her to Coffee Morning and then got her to open up a little more. We saw Cyril Robinson communicating with Sister Julienne regarding Mrs. Edna Bristol’s life situation and her need for increased support. When I started my career there was more time during visits, births, and with our follow up. I have practiced in varied setting such as homebirth, freestanding birth centers, and hospital settings. I still get Christmas cards from families that I have attended their births from these practices. When you have this time you can be really invested!! I know most midwives in the US would be jealous of the amount of time that the nuns and midwives in Call the Midwives get to engage with their clients. In the show, the same care team crosses community, clinic and home. In the USA it is not like this and care can occur in separate silos. In the National Vital Statistics Report (2018) it was reported that 94.1% of Certified Nurse Midwives and Certified Midwives attended births that occurred in hospitals, 3.2% of their births occurred in freestanding birth centers, and 2.6% occurred in homes. But usually each setting has different providers/midwives. Also, your care may get transferred once you transfer from home to a hospital setting.

Thank you for letting me think through changes –time marches on and we engage in new and varied ways. It is important to think about learning styles and have diverse teaching styles.

“Sometimes life expands and embraces us in unexpected ways. We can be more, we can know more, we are shown more. Togetherness is the key to all of this. It opens doors, makes progress possible. Together we can forge a brighter future. Together we can find out our essential worth.”

REFERENCES

ACNM (2019) Fact Sheet: Essential Facts about Midwives

Programs to explore

University of Windsor, Faculty of Nursing

University of Illinois at Chicago, College of Nursing

Frontier Nursing University