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Reflective practice skills reading list

Reflective practice reading list.

This reading list covers a range of reflective practice skills. Some resources may only be available to RCN programme participants and RCN members.

Use the menu on the left hand side to view more pages within the reading list.

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Reflective practice is, in its simplest form, thinking about or reflecting midwifery practice. It is closely linked to the concept of learning from experience, in that you think about what you did, and what happened, and decide from that what you would do differently next time. Thinking about what has happened is part of being human. However, the difference between casual ‘thinking’ and ‘reflective practice’ is that reflective practice requires a conscious effort to think about events and develop insights into them.

The purpose of reflecting on your midwifery practice is to build a better understanding of your professional actions, and to develop professionally by using this knowledge to modify and adapt practice. It also assists you to demonstrate your competence to practice in relation to the Scope of Practice and Competencies for Entry to the Register of Midwives.

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Contribute to MIDIRS Midwifery Digest by writing for us

Would you like to write for midirs midwifery digest .

MIDIRS is here to allow all midwives, student midwives, Maternity Support Workers (MSWs) or any health professional caring for women, babies and their families during pregnancy, birth and the postnatal period, worldwide, to share their knowledge and experiences to improve practice and outcomes. We are dedicated to helping you learn, grow and share from the start of your midwifery training all the way through your career.

We welcome original contributions from new, aspiring, or established writers, and our author guidelines will tell you everything you need to know about submitting your work to us.

Before you submit an article, please read the guidelines carefully. Unfortunately, we are unable to accept or review articles that do not adhere to the guidelines.

The Editor reserves the right to revise material or to return it to the author for amendments before accepting it for publication. We also reserve the right to amend material during production in accordance with house style and the demands of space and layout. Copyright of original articles published in MIDIRS belongs to MIDIRS.

For informal inquiries, questions or support with your submission please contact the MIDIRS Editor: Sara Webb at: [email protected] .

Find out more about writing original articles for MIDIRS Midwifery Digest below:

Advice on writing for MIDIRS

Listen to our very first podcast episode on writing for publication here . Read the transcript here .

A journal article should be written in a different style from that of an academic essay.  Aim for a clear, readable and accessible style. If this is the first time you have submitted an article to a journal it may help to ask a colleague or tutor to read it.

As you write, ask yourself:

  • Is my article relevant to midwives, student midwives, Maternity Support Workers (MSWs) or any health professional caring for women during pregnancy, birth and the postnatal period?
  • Does my article say something new?
  • What question(s) am I trying to answer?
  • Have I answered the question(s) accurately?
  • Have I made clear what is personal opinion and what is evidence/research-based fact?
  • Does the article flow in a logical progression?
  • Could I improve it by rewriting or moving certain paragraphs?
  • Have I helped the reader through the article with regular (short) subheadings?
  • Is my language and level of argument appropriate for the broad readership?
  • Are all the references complete and correct?

Please check your writing carefully for accuracy and ambiguity. A final edit, prior to submission, is essential to check spelling and remove any unnecessary words or phrases. You may find it helpful to look at past issues of MIDIRS to get an idea of the journal’s overall style and focus. The editorial team reserves the right to edit any article. Your article will be sent to you to check in its final form shortly before publication.

For informal inquiries, questions or support with your submission please contact the MIDIRS Editor: Sara Webb at [email protected]

Download the advice on writing for MIDIRS here.

Article types

Advancing Clinical Practice  - (Reflective Practice/ Work experience / Service evaluation / Clinical Governance & Safety)

We welcome contributions about clinical practice, such as reflection on practice, personal experiences, service evaluation and clinical governance/safety.  We are particularly interested in current issues, new developments, controversial topics, and would like articles that share experiences to help others advance their practice and/or challenge clinical practice.

Guidelines - Advancing Clinical Practice

• Maximum of 2500 words including in-text references and the reference list. • 100-word summary of the article, positioned at the start of the paper. • Statement of permissions obtained if appropriate • Reference list positioned at the end – maximum of 20 references . • Maximum of three tables/illustrations

Research – Primary (audits / RCTs / Cohort studies) or Secondary (Literature reviews / Systematic reviews / Modified systematic reviews)

We welcome submissions on primary and secondary research. We are keen to encourage submissions from any research undertaken as part of a higher education course, such as a dissertation or essay. Occasionally, the larger pieces of work may need to be split into two related papers.

Research articles are a maximum 3500 words  including in-text references, tables/figures and the reference list.

Guideline - Primary Research (audits / RCTs / Cohort studies)

• Abstract - 350 word maximum o Objective o Methods o Results o Conclusion • Main paper o Introduction State the objectives of the work and provide an adequate background, avoiding a detailed literature survey or a summary of the results. o Methods A brief but clear outline of the methodology, making clear the study setting, the sample, the hypothesis (where relevant) and the reason for the chosen method. Please provide information of ethical approvals granted and particular ethical considerations in your study. Please provide details of funding, if appropriate. o Results Results should be clear and concise. Results/findings consistent with your chosen methodology. Tables and graphs may be used – maximum of three in total . o Discussion Relate your findings to focus their relevance to midwifery practice. Also include a brief statement of limitations of the research, and implications for practice and future research. o Conclusion A concise conclusion to include implications for future practice/research. • Statement of permissions obtained if appropriate. • Reference list - maximum of 25 references.

Guideline - Secondary Research (Literature reviews / Systematic reviews / Modified systematic reviews)

• Abstract - 350 word maximum o Objective o Methods o Results o Conclusion • Main paper o Introduction State the objectives of the work and provide an adequate background, avoiding a detailed literature survey or a summary of the results. o Methods A brief but clear outline of the methodology, to include search strategy, inclusion/exclusion criteria, study selection, quality appraisal, reflexivity (if applicable), data extraction and analysis methods. Please provide details of funding, if appropriate. o Results/Findings Results should be clear and consistent with your chosen methodology. Tables and graphs may be used – maximum of three in total. o Discussion Relate your findings to focus their relevance to midwifery practice. Also include a brief statement of limitations of the research, and implications for practice and future research. o Conclusion A concise conclusion to include implications for future practice/research. • Statement of permissions obtained if appropriate. • Reference list - maximum of 25 references.

Viewpoint/Discussion pieces

We welcome shorter reflective pieces that will encourage reflection and discussion. These articles may be clinical, descriptive, narrative or reflective pieces. We are keen for pieces that look at historical practices and experiences and how they relate to current services/guidelines, or for comparison of clinical practices across countries.

Viewpoint/Discussion pieces are a maximum of 1000 words  including in-text references and the reference list.

For inclusion with your submission: • 100-word summary of the article, positioned at the start of the paper. • Main body of article. Tables/illustrations can be included - maximum of three tables/illustrations in total • Statement of permissions obtained if appropriate. • Reference list - maximum of 25 references .

De-mystifying Research!

To encourage advancement, understanding and adoption of research into daily midwifery practice, MIDIRS welcome pieces that discuss and critique a particular published piece of research.  These will help the reader gain a greater understanding of how to critique research, while also gaining knowledge about the specific research study being discussed. 

We also request submission of ‘Research guides’ that explain research and statistic methodologies in an easy to understand format.  These can be published in a series or as a one off piece.

Word count for these types of articles will be dependent on the content/topic. 

Please contact MIDIRS Editor, Sara Webb to discuss if you are interested in publishing such work: [email protected] .

Guideline/Report reviews

We encourage reviews of local, national and international guidelines/reports that have implications directly or indirectly for midwives.  Such commentaries will help our readers to understand what reports mean for midwifery practice and to place report recommendations into context.

Download the article types here.

Submission guidelines for MIDIRS

Author information: you will need to provide the following information:

Submitting Author • Preferred title • Name • Role • Workplace • Contact author email(This is usually the submitting author) • Twitter or Instagram handle (if applicable).

Co-Author(s) • Preferred title • Name • Role • Workplace

Main body article as described in the types of article, adhering to the following house style:

• Font and formatting: o Use Arial font, size 12. o Use 1.5 line spacing. o Headings and sub-headings in bold, further sub-headings in italic. o If you have included boxes of writing (possibly as extras or illustrative comments), please ensure these appear as text within the article (with borders, if you wish) rather than as separate items; this is to ensure they are easily accessible for our editorial team, but also so that the text is included in the word count. o When using abbreviations or acronyms in the text, always show the term or the name of the organisation in full the first time it is used in the text. For example: lower segment caesarean section (LSCS); National Institute for Health and Care Excellence (NICE). Thereafter, just use the abbreviation, ‘LSCS’, ‘NICE’ etc.

• References: o The chosen style for citing references is Harvard. Using this style, authors are named in the text with the publication year of their work shown in brackets after their name(s). o All references, regardless of the format they take, (whether they are journal articles, books, book chapters etc) should be listed alphabetically at the end of your paper. o Use authors’ initials as they appear in the article/publication but do not leave spaces between them. For foreign names, refer to Medline for the correct citation style. o Do not use commas between author names and initials in the reference list: Duff E (2003) not Duff, E (2003). o When referencing papers with different number of authors:

When referencing papers with different number of authors:

One author: 

In the text:    In a study by Duff (2003) it was concluded that…

In the reference list : Duff E (2003). Millennium development goals: where are the goalkeepers? MIDIRS Midwifery Digest 13(3):319-20.

Two authors: 

In the text:  When citing two authors, names should be linked by “&”:  In a study by Hey & Hurst (2003) it was concluded that…

In the reference list:  Hey M, Hurst K (2003). Antenatal screening: why do women refuse? RCM Midwives Journal 6(5):216-20.

Three authors or more: 

In the text:  Show the name of the first author only, and follow this by the phrase ‘et al’.  Thompson et al (1997) conclude that…

In the reference list:  All the authors names are included in the reference list.

  • The source (book, journal) should be shown in italics.
  • Journal titles should be shown in full, eg  Journal of Ultrasound in Medicine.

• Tables and graphs A maximum of three tables and/or graphs are allowed for all types of article. Each one is equivalent to 200 words so please remember this and include these into your total word count: eg, One table or graph = 250 words, one table and one graph/ two tables = 500 words, etc.

• Images We welcome the addition of illustrations as they enhance articles. Please ensure that pictures, photos, diagrams, etc. are sent as VERY HIGH RESOLUTION jpegs or pdf attachments in addition to showing their placement in the article. Please clearly indicate in the text where the images are to be placed. Please ensure that the APPROPRIATE PERMISSIONS ARE OBTAINED and these are clearly stated next to the image.

• Illustrations Please provide good quality photographs (high res jpegs at a size of 1MB), diagrams or illustrations to go with your article. If you want to use or adapt illustrations from another source, it is your responsibility to obtain written permission to reproduce the material and to credit it accordingly. Photographs need the permission of both the photographer and all subjects within the pictures. Please submit all photos, diagrams and other illustrations as high res jpegs or pdfs separately, clearly highlighting where in the article it should go.

Confidentiality

Please be aware of issues of confidentiality. You may require permission from individuals/institutions discussed in your article. We reserve the right to anonymise where appropriate before publication.

All material is accepted for publication as an original article on the understanding that it has not been published before and is not due for publication elsewhere. The copyright of all material accepted for publication lies with the Publisher, MIDIRS. Whilst welcoming all contributions MIDIRS does not offer payment for unsolicited articles.

Promotion of products or services

We cannot include references to private companies, products or services. If you are writing as owner or employee of a company, brand names etc. will be changed to be more generic. Where a further resources section is included, this is designed to provide sources of information to the reader, not to list or promote products, companies or even particular books. Charities can appear, at our discretion, within the further resources, but only alongside a variety of alternatives, usually based in the NHS or equivalent.

Download the submission guidelines for MIDIRS here.

Tips for making your article come to life

We recently supported the Bangladesh Midwifery Society on how to write for an academic publication. 

Listen to the our very first podcast episode on writing for publication here .

Copyright information about sharing your MIDIRS Digest article

In order for you to share your publication please see below:

1. Academic institute repository   

MIDIRS publications can be deposited in your academic library repository after a three-month embargo period from the date of publication. Your institute librarian can email us to request this deposit:  [email protected]  

2. Personal/organisational sharing 

Immediate sharing – front page  

Upload an image of the front page of your article on a website/social media together with a link to the MIDIRS Midwifery Digest page on our website.  

T hree-month embargo – full article  

If you wish to share the full article this is subject to a three-month embargo from the date of publication. Please attach the following link statement: MIDIRS retains the copyright of this article  

Download the copyright information about sharing your MIDIRS Digest article.

Article Submission

This website is intended for healthcare professionals

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Borton T: McGraw Hill; 1970

Broderick S, Cochrane RLondon: Radcliffe; 2012

Cacciatore J, Rådestad I, Frøen J Effects of contact with stillborn babies on maternal anxiety and depression. Birth. 2008; 35:(4)313-20

Cox E, Briggs S Disaster Nursing: new frontiers for critical care. Critical Care Nurse. 2004; 24:(3)16-22

Davies R New understandings of parental grief: Literature review. J Adv Nurs. 2004; 46:(5)506-13

Driscoll JLondon: Elsevier; 2007

Flenady V, Middleton P, Smith GC, Duke W, Erwich JJ, Yee Khong T Stillbirths: the way forward in high-income countries. The Lancet. 2011; 377:(9778)1703-17

Gardosi J, Giddings S, Clifford S, Wood L, Francis A Association between reduced stillbirth rates in england and regional uptake of accreditation training in customised fetal growth assessment. BMJ Open. 2013; 3:(12)1-10

Gibbs GOxford: Oxford Further Education Unit; 1988

Gissler M, Alexander S, Macfarlane A, Small R, Stray-Pedersen B, Zeitlin J, Zimbeck M, Gangon A Stillbirths and infant deaths among migrants in industrialized countries. Acta Obstetricia et Gynecologica Scandinavica. 2009; 88:(2)134-48

2010. http://uk-sands.org/sites/default/files/SANDS-BEREAVEMENT-CARE-REPORT-FINAL.pdf (accessed 21 March 2014)

Jasper M, Rosser M, Mooney GLondon: John Wiley & Sons; 2013

Kenworthy D, Kirkham MLondon: Radcliff; 2011

McDonald SD, Murphy K, Beyene J, Ohlsson A Perinatal outcomes of singleton pregnancies achieved by in vitro fertilization: a systematic review and meta-analysis. J Obstet Gynaecol Can. 2005; 27:(5)449-59

Mullan Z, Horton R Bringing stillbirths out of the shadows. The Lancet. 2011; 377:(9774)1291-2

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O'Carroll M, Park ARJLondon: Elsevier; 2007

Reid B ‘But we're doing it Already!’ Exploring a response to the concept of reflective practice in order to improve its facilitation, 4th ed.. In: Bulman C, Schutz S Oxford: John Wiley and Sons; 1993

Säflund K, Sjögren B, Wredling R The role of caregivers after a stillbirth: views and experiences of parents. Birth. 2004; 31:(2)132-7

Statham H, Sobmou W, Green JM When a baby has an abnormality; a study of parents' experiences.Cambridge: University of Cambridge; 2001

Trulsson O, Radestad I The silent child—mothers' experiences before, during and after stillbirth. Birth. 2004; 31:(189)

Van Manen M Linking ways of knowing with ways of being practical. Curriculum Inquiry. 1977; 6:205-28

Stillbirth: A reflective case study

Sarah Stott

Midwife, Whiston Hospital, Liverpool

View articles

Stillbirth rates both in the UK and worldwide are extremely high. This reflective case study is centred on my first experience at caring for a bereaved couple who lost their baby boy, stillborn, at 27 weeks gestation. Whilst causes of stillbirth are often multi-factorial and unexplained, this reflection aims to explore how midwives can adopt simple measures to care for bereaved parents and how they can support themselves. Although research has focused on how improvements in research and training have contributed to a decline in stillbirth rates, this reflection also gives particular emphasis to the emotional aspects of bereavement care.

This reflective paper seeks to explore some of the issues surrounding bereavement care and the importance of sensitive and individualised care when dealing with bereaved parents. Reflection is a key concept of learning within the health and social care professions that allows us to look at our practice and understand it within the context in which it occurs ( O'Carroll and Park, 2007 ). Without reflection, midwifery care can become automatic, thereby disregarding the concept of individualised care, which is outlined in the Nursing and Midwifery Council (NMC) code of conduct (2008) . Reid (1993) described a process of reviewing experience under headings such as description, feelings, evaluation and analysis, which consequently informs and changes practice. A variety of reflective models currently exist, which involve this systematic process ( Van Manen, 1977 ; Gibbs, 1988 ; Driscoll, 2007 ). This reflective case study will adopt Borton's (1970) developmental framework, which incorporates all the core skills of reflection from these current models, yet its simplicity is useful for those inexperienced in undertaking deeper reflection ( Jasper et al, 2013 ). Through Borton's (1970) framework, the practitioner describes (what), analyses (so what) and synthesises (now what) their experience. All names have been changed to protect confidentiality, in accordance with NMC (2008) guidelines.

Amanda, a 43-year-old para 5 was admitted to hospital for medical induction of labour in view of a 27-week intrauterine fetal death. At handover for a late shift, I was asked whether I would be willing to care for Amanda, which would enable me to gain experience in this field. I had not had much exposure to bereavement care during my time as a student midwife, therefore I felt unprepared to deal with it. Instead, my training largely involved ‘catching’ babies so that I could be signed off as competent in facilitating ‘normal’ birth. Nevertheless, I reluctantly volunteered, meanwhile experiencing feelings of panic and anxiety. I had never dealt with such a situation before. What would I say? What if I said the wrong thing?

A stillbirth, as defined by the Stillbirth (Definition) Act 1992, section 1(1), is:

‘Any ‘child’ expelled or issued forth from its mother after the 24th week of pregnancy that did not breathe or show any other signs of life.’

Research has shown that almost 3 million babies worldwide are born stillborn every year ( Mullan and Horton, 2011 ). This means that every day, 11 sets of parents will suffer the pain and grief of having a stillborn baby. Despite cumulative advances in medical science and an ever developing health system ( Mullan and Horton, 2011 ), in the UK, the rate of unexplained stillbirths runs exceedingly higher, at approximately 1000 a year, than deaths from sudden infant death syndrome (SIDS), which is about 200 deaths per year ( Henley and Schott, 2010 ). Despite this wide variation, there appears to be little research conducted on why babies die unexpectedly in utero. It could be possible that the topic of stillbirth is often overlooked because of its profoundly emotive nature and complexity. While causes of stillbirth may be multifactorial, and sometimes unexplained, the highest associated modifiable factor is maternal obesity and overweight, comprising of a body mass index (BMI) above 25kg/m 2 ( Flenady et al, 2011 ).

Although a meta-analysis of 96 population-based studies by Gardosi et al (2013) observed an association between nulliparity and stillbirth, they also found a 60% increase in stillbirth risk for mothers with a parity equal to 3 or above. Gardosi and colleagues found no significant increase in the risk of stillbirth with older maternal age, however, it could be argued that this correlation was not found because congenital anomalies were excluded, which are known to be increased in older mothers. It could be argued that women of advanced childbearing age are more likely to experience infertility, therefore they may rely heavily on artificial reproductive techniques, however, the link between these and stillbirth risk is unknown ( McDonald et al, 2005 ). Substantial variations in stillbirth rates have also been found in relation to social status and ethnicity ( Gissler et al, 2009 ). This may be a result of poor accessibility to care, as well as language and cultural barriers from disadvantaged groups.

Stillbirth rates in the UK are among the highest in high income countries ( Flenady et al, 2011 ). Around one baby, out of every 200, at 22 weeks' gestation or more is stillborn. The reason for this rate remains unexplained, although a lack of awareness among health professionals has shown to be a large contributory factor ( Mullan and Horton, 2011 ). The care that families receive during this time is extremely important, yet it is influenced to a large extent by knowledge and education and the midwives' ability to provide individualised care. An analysis of mortality data collated between 2007 and 2012, found that a high uptake of accreditation training and evidence-based protocols in customised fetal growth assessment, contributed to a steep decline in stillbirth rates ( Gardosi et al, 2013 ). Nevertheless, while this is the gold standard for most midwives, it is difficult to implement when faced with a rising birth rate, increased case complexity and minimal staffing, as well as a disparity of training and local restrictions imposed by financial constraints ( Henley and Schott, 2010 ). A survey of 77 maternity units found that regular training in bereavement care was only present in less than half of the units and that, in the majority of these units, training was only optional because of pressures on staff time, training costs and the sensitivity of the subject matter ( Henley and Schott, 2010 ). Despite this, midwives are still expected to interact supportively with bereaved parents ( Cox and Briggs, 2004 ).

Specialist bereavement midwives play an invaluable role in supporting both parents and staff, however, the specialist midwife in our unit was off duty for this particular shift. Therefore, my role as a midwife was crucial in supporting and advocating for Amanda and her partner John. Luckily, as it was a quiet shift, I had the support of my shift leader who has many years of experience in bereavement care.

I first obtained an in-depth handover from the midwife who had been caring for Amanda, before I introduced myself to her and her partner, John. I was informed that a scan 3 days previously had shown a hydropic fetus with a large bowel atresia and an absent fetal heart. Shortly after, I went to see Amanda who was being cared for in one of our specialist bereavement rooms at the far end of the labour ward. The provision of these dedicated rooms has a fundamental impact on couples' experiences ( Henley and Schott, 2010 ). During introductions, my palms began to sweat and my heart beat faster as I struggled to choose the right words to say. Did I need to say anything? I had this feeling in the forefront of my mind that nothing I said could make them feel better, but that saying the wrong thing could have a massive impact on their emotional wellbeing and subsequent mental health. Having a stillborn baby has been associated with an increase in anxiety, depression, suicidal ideation, as well as substance use and marital conflict, which can persist for many years ( Cacciatore et al, 2008 ). Consequently, I felt helpless, unable to offer any form of comfort. Säflund et al (2004) found that midwives felt the need to distance themselves from bereaved parents because they felt unable to deal with the enormity of the parent's feelings of loss. I was so used to caring for women with healthy, term pregnancies and, having been present at well over a hundred births, the expected and automatic cry of a healthy baby. In healthy pregnancies and births, I would speak with couples about parenting, feeding and tending to their babies, and their expectations, yet in bereaved parents these conversations do not exist. Instead I was caring for a woman and her partner who were submerged in grief and sorrow, these parents may experience feelings of guilt as a result of the expectation of a healthy baby. They will not feel the same excitement, joy and euphoria of bringing a new life into the world.

One concern I had was the documentation, which is ever increasing due to prospect of litigation. Failure to fill in the correct form, or sending it to the wrong place will lead to an official reprimand or managerial intervention, and this presents as a genuine fear ( Kenworthy and Kirkham, 2011 ). There are forms to be filled out surrounding the birth as well as the stillbirth certificate that is a statutory obligation after 24 weeks' gestation ( Henley and Schott, 2010 ). It is understandable that feelings of anxiety and stress can impact on the accidental omission of essential paperwork ( Kenworthy and Kirkham, 2011 ). There is information that is only collected by obtaining tissue samples, such as those for cytogenics investigation, as well as a need to prepare the baby for viewing and organising mementos. I feel strongly that had I not had support from my colleagues, the burden of the documentation would have impacted negatively on my provision of care to Amanda and John. This is disconcerting at a time when we may need to console the woman and her family and provide extra support.

Throughout the shift, my priorities were to manage Amanda's pain and monitor both her vital signs and loss per vaginum, following 3-hourly administration of oral misoprostol. Following the second dose, she began to experience abdominal cramps which were somewhat relieved with intramuscular diamorphine, yet as the shift progressed her pain became more intense with increased regularity, and so she began to use Entonox frequently. I anticipated a quick birth due to Amanda's parity and previous precipitate labours, yet I did not say much, I felt like I did not need to. I mopped her brow, gave her sips of water and held her hand. This sensitive support is the most poignant aspect of bereavement care, forming many of the memories that parents will take home with them ( Henley and Schott, 2010 ). Towards the end of the shift, she ruptured her membranes and sighed in relief, expressing gratitude, thinking the worst was over. The whole situation felt so unjust, why should she be thanking us. I felt as though she was being punished in some way; questioning why she should have to endure labour with no joy or happiness at the end. With the next contraction, tears rolled down both her cheeks as the reality of the situation took hold of her. I felt so unprepared to deal with the situation, so vulnerable, but I could not let it show. I knew the upset I was feeling was so minor in comparison. Shortly after she birthed her baby. He was so peaceful and content, so still. His tiny fingers and toes, his bottom lip curled under like he too felt the sadness both his mother and father were experiencing. I gently wrapped him in a towel before asking Amanda and John whether they would like to see and hold him.

Parents often regard holding and seeing their baby as one of their most important memories and Statham et al (2001) found that, of 104 women interviewed, 81% felt they made the right decision to hold their stillborn baby. A further study on over 2000 women, found that fewer anxiety and depressive symptoms resulted if women were able to see and hold their babies following a singleton stillbirth after 20 weeks' gestation ( Cacciatore et al, 2008 ). To separate newly bereaved mothers from their dead babies in order to relieve them of the burden of holding and seeing their baby and taking any responsibility for them was the cultural norm in Britain until relatively recently (Broderick and Cochrane, 2013). We now see the error in this reasoning and know that women and their partners value this time to spend with their babies ( Statham 2001 ; Broderick and Cochrane, 2013). It has been argued that giving parents the opportunity to see and hold their stillborn baby can reduce the risk of depression and anxiety resulting from the traumatic experience (Hughes et al, 2001). Conversely, Statham (2001) found that 50% of women who chose not to hold their baby also felt they had made the right decision, whilst Trulsson and Radestad (2004) argue that forcing parents to see and hold their stillborn baby has potential to increase the risk of negative psychiatric sequelae. It is therefore important that women and their partners are treated as individuals and given the correct information to help them make informed choices—a recommendation further supported by the National Institute for Health and Care Excellence (NICE) (2007) .

‘Giving parents the opportunity to see and hold their stillborn baby can reduce the risk of depression and anxiety resulting from the traumatic experience’

Amanda was reluctant to hold her baby initially as she began to process the situation. Instead John took hold of him and closely studied his baby from head to toe. He then gradually revealed his hands and feet to Amanda before gently placing him in her arms. It was nothing a textbook could prepare you for, those shivers you feel down your spine as well as the lump in your throat as you hear a mothers' grieving sob, or the haunting silence that no guideline or policy talks about. It felt as though the world had come to a standstill. I gently took a step back to allow Amanda and John the precious time with their baby boy.

While caring for Amanda initially brought feelings of anguish and worry, I feel that it was a positive act that enabled me to confront my fears surrounding bereavement and pregnancy loss. Despite the distressing nature of the experience, the opportunity has helped me to develop my midwifery practice in order to incorporate aspects that are imperative to bereavement care. Women are coming into hospital, usually the labour ward, where there are babies and new mothers surrounding them, therefore it is important for us as professionals to prepare ourselves for the myriad of reactions that women and their families will present following pregnancy loss.

There is also an element of self-care that is not widely discussed in midwifery literature. It involves acknowledging that women should not be left alone to grieve, but also balancing this with the appreciation of the emotional burden to the midwife that is offering their support ( Kenworthy and Kirkham, 2011 ). Although some consider bereavement care as ‘part of the job’, midwives, irrespective of their professional status, will carry personal and undoubtedly painful experiences of bereavement themselves, which means support between colleagues is fundamental in order to make a positive difference to the care that women receive, and also to reduce feelings of isolation. This support may simply involve a 10-minute debrief in the midwives office, or an in-depth reflection, both of which I feel impacted positively on my ability to care for Amanda throughout this experience.

Through non-verbal communication, midwives can take cues from individual women and respond accordingly. Simply gauging women on an individual basis and bearing in mind that some will want to talk and others simply want a shoulder to cry on or a hand to hold. Furthermore, a ‘memory box’ made up of various mementos, such as hospital bands, a measuring tape, knitted blanket and photos may be offered. While some research has suggested these are unhelpful in helping parents to feel resolution following bereavement, Davies (2004) argues that they can be beneficial.

It is important to be honest and open with women in a sensitive manner without undermining their wishes or beliefs. She will remember her midwife and although she may feel that her midwife has dealt with many of women in her position, she should feel that every effort is being made to meet her individual needs. This could be achieved, in part, by referring to her baby by their name or sex, acknowledging them as a being, thus making it personal to that woman and her family. But most importantly of all, it involves being empathetic and compassionate. Simply, just letting them know you are there without having to say a word.

Conclusions

This reflective case study is centred on my experience as a midwife at caring for Amanda, and her partner John, following a stillbirth at 27 weeks' gestation. It focuses on the emotional aspects of care that are often overlooked, which during bereavement take precedent over the physical skills we easily take for granted. It highlights simple measures that can be adopted to support bereaved parents, while at the same time supporting colleagues. Stillbirth should not be a taboo subject, considering rates, both in the UK and worldwide, are at alarming levels. While a number of stillbirths are unpredictable and therefore unavoidable, pregnancy supervision for those women at risk should be increased and improvements in research and training considered. This is as well as acknowledging the importance of individualised care, sensitive communication and advocacy, all of which are fundamental principles which we are bound to by the NMC Code (2008) .

‘There is a collective myth… that getting pregnant, staying pregnant, giving birth to a live baby… is simple, despite clear evidence that this is not the case’

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Last Updated 26/05/2021

In this guide

Requirement, meeting the requirement, resources and templates.

You must have prepared five written reflective accounts in the three year period since your registration was last renewed or you joined the register.

Each reflective account must be recorded on the approved form and must refer to:

  • an instance of your CPD, and/or
  • a piece of practice-related feedback you have received, and/or
  • an event or experience in your own professional practice

and how they relate to the Code .

We want to encourage nurses, midwives and nursing associates to reflect on their practice, so they can identify any improvements or changes to their practice as a result of what they have learnt.

Each of your five reflections can be about an instance of CPD, feedback or an event or experience from your work as a nurse, midwife or nursing associate – you can even write a reflection about a combination of these.

It's important to think about the Code when you write your reflections, and consider the role of the Code in your practice and professional development.

If you’re a midwife, you may find it helpful to use our reflective aid when thinking about your reflective accounts.

Recording your written reflective accounts

You must use the reflective accounts form  to record your written reflective accounts. 

These accounts don't need to be lengthy or academic-style pieces of writing. You can simply note down what you learnt, how it improved your practice, and how it relates to the Code.

You may choose to store the completed form either electronically or in paper format.

Be careful not to record any information which may identify another person. You may find the section on non-identifiable information in How to revalidate with the NMC  useful.

Reflective accounts form  (mandatory)

You must use this form to record your five written reflective accounts.

Examples of completed forms and templates

See pages 27-28 in our 'How to revalidate with the NMC' guidance for more details.

  • Last Updated: 26/05/2021

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how to write a reflective essay in midwifery

Teaching Connections

Advancing discussions about teaching, who’s afraid of academic writing a reflective essay on dispelling anxiety and fear in an academic writing course.

WONG Jock Onn Centre for English Language Communication (CELC)

Jock Onn considers how educators can apply an ethics of care in their teaching, as he takes us through survey findings on students’ perspectives towards academic writing, particularly the emotions they associate with this activity and the challenges they face.

Photo by Brooke Cagle on Unsplash.

Photo by Brooke Cagle on Unsplash

I had previously spent many semesters in my teaching practice developing methods that I thought would help students excel in academic writing. It did not matter to me at the time that student feedback told me that my coursework was demanding; I took it to mean that I was on the right track (Wong, 2023a). It was only in recent years that I realised the need to show more care in my teaching (Wong, 2023b). Last year, amazingly, for the first time, the word ‘care’ appeared in my student feedback. A student wrote, “Dr Wong displays care for his students…” Realising the importance of care, I decided to find out why students need care and conducted a simple Google survey (entitled “Attitudes Towards Academic Writing”) last semester with my three classes. I asked them to make known the emotions they associate with academic writing, write qualitative comments on their answers, and tell me what challenges they face. I received 41 responses, and the survey yielded some tentative but interesting findings.

The survey asked, “Which of the following emotions do you associate with academic writing?” As shown in Table 1, over 50% of the students associated academic writing with fear and anxiety. Slightly over a quarter associated it with a rather positive feeling (26.8%) and only a very small percentage (4.9%) associated it with something very positive. The fact that over half of the respondents associated academic writing with fear (53.7%) and anxiety (63.4%) was a surprise to me. Fortunately, less than 10% hated academic writing.

WongJO-Fig1

Students also gave qualitative comments on why they experienced fear and anxiety in academic writing. Some indicated that they had insufficient linguistic knowledge, including the vocabulary and skills to write academically. A few even claimed that they did not know what academic writing entails. Other respondents indicated a lack of confidence. For example, a student wrote that knowing that their work is being graded caused anxiety. Several students attributed their anxiety to uncertainty and a lack of confidence in academic writing. In some cases, fear or anxiety was a result of bad experiences in junior college (JC). A student recounted their JC experience, when they had to produce an essay in three hours, causing their brain and hand to hurt.

The survey further asked respondents to tick the problems they face in academic writing from a list. Table 2 shows that the top three problems students face in academic writing have to do with not knowing what constitutes academic writing, not having enough ideas, and sentence cohesion . More than half of the students said that they did not know how to write academically (58.5%) and did not have enough ideas for writing (51.2%). Also, over 30% of respondents had problems with the introduction (‘don’t know how to start’) (36.6%), and grammar (34.1%).

Table 2 Problems that students face (in decreasing order of importance)

WongJO_Fig2

Anxiety is said to be “one of the critical individual affective factors in the process of learning a second language or a foreign language” (He et al., 2021, p. 1). Presumably, the same could be said of the process of learning academic writing. Anxiety, as studies suggest, is linked to “avoidance of the feared situation and loss of motivation to perform”, which could adversely affect retention (England et al., 2017, p. 2/17). Student anxiety and fear can ultimately affect language performance (Soriano & Co, 2022, p. 450). Thus, dispelling anxiety and fear among students is a pedagogic imperative.   

To dispel anxiety and fear, one would benefit from understanding what they mean. I believe most of us do. However, two co-authors offer an interesting perspective. According to Kastrup and Mallow (2016), fear “deals with things of which there is good reason to be afraid”, whereas anxiety means “being scared of something that is not intrinsically fearful” (pp. 3-1). Although Kastrup and Mallow (2016) speak in the context of science, their definitions seem to make general sense. As educators, we recognise that while some student concerns are practical in nature (e.g., they do not know the rules), others seem to be psychological. The solution to practical concerns could be addressed in a more straightforward fashion by using sound teaching methods; however, psychological barriers may require a different approach.

My proposed way of addressing the psychological challenge is to replace the bad experiences with pleasant ones. As Cook (2021) puts it, teachers “must provide instructor presence by providing a positive education experience for students” and give them “a sense of belonging” (p. 136). The teacher can achieve this by creating a positive learning experience through an ethic of care (Noddings, 2012). The teacher can display “empathic concern” (Patel, 2023) by acknowledging student perspectives in class, using inclusive languages, encouraging open communication, and accommodating student needs (p. 64). The teacher can create “a safe learning environment” by establishing “rules of engagement” and encouraging students to “explain their answers” in class without labelling the answers as “wrong” or “incorrect” (Teo, 2023, p. 79). After all, “harsh criticisms” can impede learning (Soriano & Co, 2022, p. 452), whereas positive feedback can alleviate anxiety (He et al., 2021). A student recently gave feedback that I often asked them whether they understood what I had taught, and this suggests that checking for understanding regularly is reassuring. To this end, the teacher could use ungraded quizzes, which do not cause student anxiety (England et al., 2017). There are many other things a teacher could do in this vein to help address such psychological learning barriers (Harvard Medical School, 2017; Abigail, 2019).

To maximise student learning, the teacher plays a big role, a role much bigger than I had previously thought—the teacher has a responsibility to dispel fear and anxiety among students. I agree with Kastrup and Mallow (2016) that it is the teachers “who most affect the anxiety (or lack thereof) of the students” (pp. 3-12). I would now say that what makes an excellent teacher is not just the use of time-tested teaching methods but also a capacity to care (Wong, 2023b). Thus, for me, the obvious way forward is to ‘integrate care in higher education’ by ‘teaching with heart’ (Holles, 2023, p. 18).

Abigail, H. (2019, March 5). Tips to beat back writing anxiety . Retrieved from IUPUI University Writing Center Blog: https://liberalarts.iupui.edu/programs/uwc/tips-to-beat-back-writing-anxiety/

Cook, M. (2021). Students’ perceptions of interactions from instructor presence, cognitive presence, and social presence in online lessons. International Journal of TESOL Studies (Special Issue “ELT in the Time of the Coronavirus 2020”, Part 3), 3 (1), 134-161. https://doi.org/10.46451/ijts.2021.03.03

England, B. J., Brigati, J. R., & Schussler, E. E. (2017, August 3). Student anxiety in introductory biology classrooms: Perceptions about active learning and persistence in the major. PLoS One, 12 (8), e0182506. http://dx.doi.org/10.1371/journal.pone.0182506

Harvard Medical School. (2017, October 13). Write your anxieties away . Retrieved from Harvard Health Blog: https://www.health.harvard.edu/blog/write-your-anxieties-away-2017101312551

He, X., Zhou, D., & Zhang, X. (2021, July-September). An empirical study on Chinese University students’ English Language classroom anxiety with the idiodynamic approach. Sage Open, 11 (3), 1-14. https://doi.org/10.1177/21582440211037676

Holles, C. (2023). Faculty-student interaction and well-being: The call for care. International Journal of TESOL Studies, 5 (3), 7-20. https://doi.org/10.58304/ijts.20230302

Kastrup, H., & Mallow, J. V. (2016). Student Attitudes, Student Anxieties, and How to Address Them: A Handbook for Science Teachers. Morgan & Claypool Publishers. https://dx.doi.org/10.1088/978-1-6817-4265-6

Noddings, N. (2012). The caring relation in teaching. Oxford Review of Education, 38 (6), 771-81. http://dx.doi.org/10.1080/03054985.2012.745047

Patel, S. N. (2023). Empathetic and dialogic interactions: Modelling intellectual Empathy and communicating care. International Journal of TESOL Studies, 3 , 51-70. https://doi.org/10.58304/ijts.20230305

Soriano, R. M., & Co, A. G. (2022, March). Voices from within: Students’ lived experiences on English language anxiety. International Journal of Evaluation and Research in Education, 11 (1), 449-58. http://dx.doi.org/10.11591/ijere.v11i1.21898

Teo, C. (2023). Beyond academic grades: Reflections on my care for university students’ holistic development in Singapore. International Journal of TESOL Studies, 5 (3), 71-83. https://doi.org/10.58304/ijts.20230306

Wong, J. (2023a, March 29). When angels fall: The plight of an ambitious educator. Teaching Connections: Advancing Discussions about Teaching . Retrieved from https://blog.nus.edu.sg/teachingconnections/2023/03/29/when-angels-fall-the-plight-of-an-ambitious-educator/

Wong, J. (2023b). What completes an excellent teacher? Care in higher education English language teaching. International Journal of TESOL Studies2, 5 (3), 1-6. https://doi.org/10.58304/ijts.20230301

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COMMENTS

  1. Reflective Report On Experiences Working As A Midwife

    For this essay which is a reflective essay, I have chosen to write about a pregnant lady and, in order to protect her confidentiality, according to the Nursing and Midwifery's Code of Conduct (NMC 2008), I will refer to her as 'Zara'. In this reflection, I am going to use Gibbs (1988) reflective cycle. This encourages a clear description ...

  2. Reflection on Midwifery Placement

    Midwifery is a complex career, which in turn can cause mistakes especially for students who are on their first placement. In hindsight, I will be reflecting on my faults and successes based upon the auscultation of the fetal heart rate in two contrasting appointments. Although mistakes can be difficult to deal with and to acknowledge, it is ...

  3. Gibbs Cycle tutorial- Writing reflections for nursing and midwifery

    This tutorial explains what the Gibb's Cycle is, why we use it, and how to write reflective assignments effectively.

  4. British Journal Of Midwifery

    Abstract. Reflection is a process of learning through everyday experiences and forms an integral part of undergraduate and post-graduate higher education midwifery programmes. Students are encouraged to use a structured model of reflection to demonstrate their ability to reflect on their experiences during clinical practice.

  5. Developing reflective capacities in midwifery students: Enhancing

    During the program all midwifery students are required to present written reflections across all years of their program. Whilst there were brief opportunities to do this on their clinical placement records, the primary sources of reflective writing were the COCE records, and one critical reflective essay in second year.

  6. Clinical supervisors' experiences of midwifery students' reflective

    Mann et al., 2009; Persson et al. 2018). Midwifery students have described reflective writing as a core component of learning (Bass et al., 2020). A literature review showed that reflective writing supports clinical reasoning skills, professional self-development and can facilitate learning (Bjerkvik & Hilli, 2019).

  7. (PDF) The use of reflection in midwifery practice to inform clinical

    Within the context of midwifery, reflective practice is a recent paradigm in midwifery education and fosters a systematic way of thinking about actions and responses to inform learning and ...

  8. Learning through reflection

    Reflection is a process of learning through everyday experiences and forms an integral part of undergraduate and post-graduate higher education midwifery programmes. Students are encouraged to use a structured model of reflection to demonstrate their ability to reflect on their experiences during clinical practice. These models of reflection will be discussed, and the use of reflective ...

  9. Midwifery students' experiences and expectations of using a model of

    Reflective practice is a core professional competency and the hallmark of an autonomous, evidence-based midwife practitioner committed to lifelong learning. Despite this professional imperative little is currently known about how the development of reflective capacity is facilitated with midwifery students.

  10. British Journal Of Midwifery

    Putting together five written reflections during a 3-year period is easily managed if you make a habit of writing a reflection, perhaps three alongside your new year resolutions each year, and two more can be written after a developmental activity or attendance at a study day or conference. The key is to consider what your contribution was.

  11. Reflective practice

    This book will build the reflective skills you need to succeed in your studies and to become a reflective practitioner. Learn the principles of reflective practice and how to apply them, enhancing your personal and professional development and ultimately the care you provide. Johns, C. (2022) Becoming a reflective practitioner. (6th ed.).

  12. PDF GUIDANCE SHEET REFLECTIVE PRACTICE

    However, your reflective discussion partner doesn't need to be on the same part of the register as you. For example, a nurse can have a reflective discussion with a midwife and vice versa. Any person on our register can be a reflective discussion partner as long as they meet the following: a) They must have an effective registration with the NMC.

  13. British Journal Of Midwifery

    A previous article in this series (Power et al, 2018) discussed 'Becoming a midwife', an innovative e-module that was introduced at the University of Northampton to support student midwives' employability, social awareness and preparedness for professional practice on qualification The e-module encouraged students to reflect on the knowledge and understanding gained through the module's ...

  14. Midwifery competence: Content in midwifery students׳ daily written

    The personal midwife supervisor is encouraged to write and sign comments to provide feedback to the student. The use of reflective writing was introduced to the midwifery programme as a means to support student learning. It is important for the development of the midwifery education programme that this innovation is evaluated.

  15. Reflective Practice

    Reflective Practice. Reflective practice is, in its simplest form, thinking about or reflecting midwifery practice. It is closely linked to the concept of learning from experience, in that you think about what you did, and what happened, and decide from that what you would do differently next time. Thinking about what has happened is part of ...

  16. Writing for Nursing and Midwifery Students

    Combining the theory and practice of academic writing, this book helps you to master the basics of writing at university. It equips you with the skills needed to examine cognitive processes such as reflection and critical thinking and includes essential information on referencing your work correctly and avoiding plagiarism. A comprehensive writing toolkit for students of nursing, midwifery ...

  17. Write for MIDIRS Midwifery Digest

    A journal article should be written in a different style from that of an academic essay. Aim for a clear, readable and accessible style. ... (Reflective Practice/ Work experience / Service evaluation / Clinical Governance & Safety) ... We recently supported the Bangladesh Midwifery Society on how to write for an academic publication. ...

  18. Reflection on Midwifery Placement

    Midwifery is a complex career, which in turn can cause mistakes especially for students who are on their first placement. In hindsight, I will be reflecting on my faults and successes based upon the auscultation of the fetal heart rate in two contrasting appointments. Although mistakes can be difficult to deal with and to acknowledge, it is ...

  19. Reflective Report On Experiences Working As A Midwife

    For this essay which is a reflective essay, I have chosen to write about a pregnant lady and, in order to protect her confidentiality, according to the Nursing and Midwifery's Code of Conduct (NMC 2008), I will refer to her as 'Zara'. In this reflection, I am going to use Gibbs (1988) reflective cycle.

  20. Stillbirth: A reflective case study

    Abstract. Stillbirth rates both in the UK and worldwide are extremely high. This reflective case study is centred on my first experience at caring for a bereaved couple who lost their baby boy, stillborn, at 27 weeks gestation. Whilst causes of stillbirth are often multi-factorial and unexplained, this reflection aims to explore how midwives ...

  21. Written reflective accounts

    You must use the reflective accounts form to record your written reflective accounts. These accounts don't need to be lengthy or academic-style pieces of writing. You can simply note down what you learnt, how it improved your practice, and how it relates to the Code. You may choose to store the completed form either electronically or in paper ...

  22. Sample Essay Using Gibbs' Reflective Model

    This essay aims to critically reflect on an encounter with a service user in a health care setting. The Gibbs' Reflective Cycle will be used as this is a popular model of reflection. Reflection is associated with learning from experience. It is viewed as an important approach for professionals who embrace lifelong learning (Jasper, 2013).

  23. Who's Afraid of Academic Writing? A Reflective Essay on Dispelling

    Table 2 shows that the top three problems students face in academic writing have to do with not knowing what constitutes academic writing, not having enough ideas, and sentence cohesion. More than half of the students said that they did not know how to write academically (58.5%) and did not have enough ideas for writing (51.2%).