For the purposes of this part of the study clinical competence is used in relation to knowledge and skills as well as dexterity. The themes that emerged in this category were clustered under the following five headings:
i) Communication Skills
ii) Knowledge and ability to inspire confidence iii) Psycho-motor skills
iv) Infant Feeding v) Parent education
(i) Communication Skills
Good communication skills were seen as essential for effective care. A large number of women found that midwives and doctors were very good at explaining everything to them, but ten women were less satisfied on one or more occasion.
“I felt fobbed off by the doctors and midwives”
“... there was one stage when I would have like to have known what the midwife was doing...”
“...why didn’t they explain that the drip would not cause the problem I had last time...”
Listening skills were noted as the most variable communication skill difference between doctor and midwives. Midwives were usually described as being good listeners whereas there were complaints that:
“... the doctor did not listen to why I was scared....” “... midwives listen to you, the doctors don’t....”
“... the doctor would not listen to me... she had got it wrong but wouldn’t accept it...”
Of particular importance to a small number of women was the ability of midwives to discern what was needed by responding to non-verbal cues. Unfortunately one woman encountered a GP and another a community midwife who they felt lacked discernment and common sense and therefore these women said they:
“... held things back, I didn’t ask her anything...” “... did not tell him how I felt...”
Written communication
Making good records and reading the notes were significant omissions by a few doctors and midwives. Usually this caused irritation for the women and their partners or resulted in conflicting advice. In at least two instances failure to read notes caused unnecessary pain and delay in delivery.
Twenty-six women were particularly impressed with midwives’ knowledge of childbirth and felt they inspired confidence. They generally found midwives could answer all their questions, gave sound advice and really understood all about what it was like to be pregnant and have a baby. On occasions if the midwife could not answer the woman’s questions, she said that she would find out and come back to her. For the most part they did so very quickly. Women encountered disappointments with three midwives at the booking interview when they seemed to lack knowledge of some of the screening tests. However, two of these midwives redeemed themselves by following the women up and providing more information.
(iii) Psycho-motor skills
All carers were described by the majority of women as technically or highly competent. A few women were disappointed that although some midwives were “excellent at their
job”they “didn’t have a relationship with you as a person”. Women found that where staff were highly competent it instilled them with confidence. Where this was most appreciated was on labour ward and midwives were commended particularly for their gentleness and care when suturing.
(iv) Infant Feeding
Women who opted to feed their babies with artificial milk were reasonably satisfied with the help and advice they received. However some went home without knowing how to
prepare the feeds and one women found her community midwives so unhelpful about the different types of artificial milk that she rang her doctor’s receptionist for advice. When it came to breast feeding, there is an unfavourable comparison with even poor national statistics. That is, nationally about 25% of those who start to breast feed give up. In this study, of the 22 women who started breast feeding 9 women had given up altogether and 2 others were only giving the occasional breast feed at the time of the interview, 2-3 weeks postnatally. The reasons given for their difficulties are identified as follows:
• Inadequate help in hospital (3 women)
• Inadequate help in hospital and community (2 women)
• Inadequate help/help not for long enough in community (2 women) • Woman’s own decision in spite of good help (4 women)
In hospital women who gave up feeding said it was because the ward was busy and they did not get help when they needed it. Some women said advice was conflicting but other women said the varied advice helped them decide for themselves. When at home women who lacked continuity of midwife found advice confusing and 4 women were particularly critical of the health visitor, some of whom contradicted the midwife. Two health visitors apparently advised the women to give bottles of milk as they did not have enough breast milk. Two of the women who said they had sufficient help, but still gave up breast feeding, said it was too painful to put their baby to the breast . Of the other two women, one found breast feeding embarrassing and the other decided that as she had breast fed her first child she would “bottle feed this one so that others can help me”.
Those who experienced difficulty with breast feeding, but continued, found the hospital breast feeding expert invaluable and would have given up if she had not helped them. Those women who breast fed successfully were pleased with the help they received from both hospital and community midwives.
(v) Parent Education
Women that attended parent education classes found those held in the community and in the hospital to be excellent. Aquanatal classes were generally appreciated except by one women who felt the midwife in charge of her class was not really interested in the women as individuals. Most disappointments in relation to education was on the postnatal wards. Although at times the wards were extremely busy and short staffed, this was not always the case. Whereas a few women said how much they liked the non-interventionist approach and felt they could ask for help if necessary, nine women said they were not even shown basic baby care skills like putting on a nappy. One woman was worried about how to clean her baby boy’s genitalia but when she went home the community midwife demonstrated all the necessary skills.