Transforming midwifery education through continuity of care experiences and heutagogy: a qualitative interpretative study

The research reported in this thesis aimed to develop an understanding of the educational intent of the inclusion of the Continuity of Care experiences (CoCE) in the undergraduate Bachelor of midwifery curriculum. Increased understanding would enable the development of an educational framework that would more clearly articulate learning outcomes of these experiences. Background: One of the requirements in many international midwifery education curricula is for students to provide midwifery continuity of care to women throughout pregnancy, birth and the postnatal period. There is a lack of research that examines the educational purpose of the experience or how the experiences contribute to the development of the profession. Inconsistencies exist around the implementation, facilitation and evaluation of pre-registration continuity of care experiences. Although midwifery practice embraces woman-centred care as its philosophical underpinning, a learning approach that is congruent with this philosophy needs to be clearly articulated. Methods: A qualitative interpretative approach was undertaken to explore the intent and practice-knowledge gained through Continuity of Care Experiences as a pedagogical strategy within pre-registration midwifery education. Four methods of data collection were used: individual interviews with midwifery clinicians, focus groups with students from a Bachelor of Midwifery program, student reflective journals and observation of antenatal encounters between students and women within continuity of care experiences. Reflexive thematic analysis and a conceptual analytical synthesising framework were used. Findings: The key finding was that ‘Learning through relationships’ enables learning the craft of midwifery in ‘Shaping future midwifery practice’. The findings are congruent with heutagogy, a student- centred approach that focuses on the development of autonomy, capacity and capability. Heutagogy provides an educational learning approach to underpin the students’ continuity of care experiences, when compared with traditional learning theories of pedagogy and andragogy. Heutagogy builds on transformational learning theory as an educational strategy, incorporating a distinct shift in determining how, what and when learning occurs. Conclusion: Heutagogy provides a theoretical framework that may enable students to participate more actively in their own education by giving them the ability to be self-determined in not only their approach to learning but also in assessing their own learning needs and identifying how best to meet them. The midwifery continuity of care experience provides an ideal heutagogical learning opportunity because it both facilitates learner autonomy and capability, effectively utilising reflection on and in practice, and fosters transformational and emancipatory midwifery ways of knowing through the development of relationships with women and midwifery colleagues.