Clinical Education for Liberia’s Midwives

Karen Shulman, Senior Manager of Strategic Partnerships, Seed Global HealthBlog, Liberia, Midwifery

Dr. Nicole Geller, a nurse midwife, is in her second year of service as a visiting clinician and educator, teaching and training nurses and midwives in Liberia. Nicole shared her thoughts with me recently on why clinical education is an important component in the education of Liberia’s future midwives. -KS

Clinical education is one of the two most important parts of midwife’s education.  It is where we learn to use our brains the most.  All of our senses are simultaneously gathering the information we need for a diagnosis.  In clinical, what we see will be seen again, what they hear will be heard again, what they smell and touch will also present again.

The clinical instructor is a large part of the educating of a student midwife.  Part of clinical education includes the translation of findings.  Interpreting the student’s experience of labor and birth for them, allows students to remember what to do, when to do it, and to remember all the details involved.  In a way, interpreting or narrating and including the information in class lectures allows the student to integrate the experience into their reality.  My hope is that the student will be more successful when faced with real-time situations after they have graduated, because they have been there before in some way with their clinical instructor.

In lectures, you can have a major impact on the student’s clinical performance, too, because you can create a seamless application of information learned.  One day, in class, I brought in a model abdomen and placed a baby in a breech position.  I demonstrated the hand maneuvers that would help safely deliver the baby.  Everyone in the class had a chance to practice over the course of the two hours.  We repeated, aloud and together, the verbal instructions for each of the many hand maneuvers that could be required of us during a breech birth.

Then, a couple weeks later a student came to tell me that she had examined a laboring woman’s abdomen and identified that the baby was breech.  That was a great moment of pride for both of us, as she had remembered how to apply the skills we learned to make the breech diagnosis.  At the bedside with this student and, over the course of one hour, I watched as she re-examined the patient’s abdomen and could show me how she made the correct diagnosis.  She could describe all the details of a breech birth that she would need to remember as she took care of the patient.  This student was so proud of her work.  The following week, she came back to class and went through, step-by-step, all the details with her classmates.  This is a great example of a student who, with the right forms of instruction in both clinical and classroom settings, now knows what to do when she meets up with an inevitable complex situation.

Knowing what to do is most important because in a few months, this student and her classmates with be practicing in rural Liberia.  When they get there and a patient arrives with a breech baby, this student will not only be able to correctly diagnose, but will be able to intervene with some confidence.  Now, if every newly graduated midwife had a ‘skill tool box’ with this one skill and used it accurately, she would be able to assess, diagnose, and intervene faster.  I suspect there would be more mothers alive and able to take care of their children, and more children would survive childbirth.


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