122 Chapter 5 Box 2. Overview of main themes and subthemes 3.1 Knowledge – learning from different sources 3.1.1 Getting the basics 3.1.2 Deepening the knowledge base 3.1.2.1 Learning through experience 3.1.2.2 Reflection on evidence 3.2 Critical thinking skills – advanced knowledge in context 3.3 Communication skills – making knowledge work 3.3.1 Communication with women: giving and gaining background information 3.3.1.1 Instrumental communication 3.3.1.2 Affective communication 3.3.2 Communication with colleagues: the ability to speak up 3.1 Knowledge – learning from different sources The midwives in our study described how their knowledge on the use of interventions developed from the basics towards a deeper understanding. 3.1.1 Getting the basics Midwives from both high and low intervention groups elaborated how their use of interventions is first of all based on knowledge acquired during their midwifery training. Parameters for a physiological progress of pregnancy and birth were taught, which they used for the rest of their working life. ‘They [educators] really taught me to act according to the physiology. They also taught me to show what you can do as a primary care midwife.’ (Midwife 7) In the Netherlands, half of the four-year midwifery education program consists of clinical placements in both primary care midwifery practices and hospital settings. Midwives from both groups reported that their clinical decisionmaking and use of interventions is strongly influenced by these placements, especially the final placement before graduation. Some midwives described how they replicate the clinical decision-making style of the midwifery practice where they had taken their final placement. Either because they believed this was the appropriate care to provide, or as habitual standard. Some participants mentioned the lack of specific experiences during their placements. For example, midwives questioned if knowledge about a topic such as the pros and cons of different birth places and how you discuss this
RkJQdWJsaXNoZXIy MTk4NDMw