A five-country comparison of midwifery students' confidence in facilitating normal labor and birth

Midwifery students need confidence in recognizing and supporting normal birth, the backbone of the midwifery professional role. Developing this confidence in the face of decreasing rates of physiological birth worldwide is a critical challenge. Midwife researchers from Australia, England, Northern Ireland, Poland, and the USA investigated midwifery student confidence for supporting normal birth and explored enhancing and detracting factors.

A cross-sectional survey design was undertaken with 570 midwifery students at 8 academic midwifery programs across 5 countries The Student Confidence for Supporting Normal Birth Questionnaire with free text and Likert-type questions on a 1 (least influential) to 4 (most influential) scale was used. The survey was distributed between 2019 and 2023. Quantitative data were analyzed using descriptive statistics and Kruskal-Wallis tests of difference. Free text responses were analyzed thematically.

Overall confidence mean was 2.06/4.00, with Poland (1.67) having the lowest confidence and the USA the highest (2.88). Factors rated most influential were the student-mentor midwife relationship (3.40) and theoretical education (3.09). In addition, birth environment emerged as important in the qualitative themes.

Interacting with a mentor midwife that supports physiological birth and is respectful of students, and repeated exposure to birth environments that privilege women-centered physiological birth are crucial to ensuring midwifery students can transition to confident midwifery professionals who are advocates for physiological birth. Didactic education that emphasizes the basic physiological and psychological principles that underlie midwifery care processes, contributes to midwifery student confidence for supporting normal birth.