Towards sustainable continuity of care: Barriers and facilitators to the professionalisation of midwifery students in supporting physiological birth
Bibliographic record
Abstract
AIM: To analyse, from a systemic perspective, the barriers and facilitators influencing the professionalisation of midwifery students as they learn to support physiological birth during CoC placements in freestanding birth centres. BACKGROUND: Midwife continuity of care models (CoC) are known to improve intrapartum outcomes. However, midwifery students have limited exposure to them, despite their potential role in fostering competencies, professional identity and midwifery culture-a crucial three-dimensional professionalisation process. The systemic contextual elements shaping this process remain underexplored, particularly in learning to support physiological childbirth. DESIGN: Interpretative descriptive study. METHOD: Data were collected from midwifery students and preceptors (n = 14) through audio diaries across four placement levels and from students who kept diaries (n = 7) in two discussion groups. Policy informants from diverse backgrounds (n = 5) participated in semi-structured interviews. A thematic analysis was conducted. FINDINGS: Nine barriers and seven facilitators were identified as elements influencing learning to support physiological birth, offering a systemic view of contexts shaping students' professionalisation. Key facilitators included extended CoC placements, a strong student-woman-preceptor alliance and a dedicated low-tech environment. Barriers included working conditions, rigid placement requirements and devaluation of self-care. CONCLUSIONS: Professionalisation related to physiological birth is closely tied to CoC placements and continuity of preceptorship. Collaborative leadership is necessary to improve placements and working conditions. An innovative community of practice could unite birth centres to address vocation-driven norms, harmonize practices and design sustainable CoC models, thus ensuring midwife retention. Future research should define learning objectives related to self-care and strategies that foster a culture of self-care.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".