Project

A new role for midwives

Wageningen’s midwives would like to have a more central role in the area of sexual health in Wageningen. The midwives noticed an increase in the number of pregnancies amongst teens in lower levels of education, and therefore they are motivated to become more active in this area.

What is the best way to improve education, guidance and care concerning sexual health of youth?


For that reason, they have initiated lessons about sexual health at a preparatory secondary vocational school, health education about birth control, placing IUD’s and a consultation hour for people who would like to become pregnant. This extension of the midwives’ professional responsibilities is in accordance with an amendment designated by order in council (AmVB). A new role for midwives fits with the vision of the Royal Dutch Organisation of Midwives (KNOV) and is encouraged by similar experiences of midwives in Amsterdam and Friesland who have organised sexual health lessons for schools in the region. There was also interest in the Swedish system, because Swedish midwives already have an extended role in promoting sexual health and giving birth control advice.

Aim

The aim of this study is to explore the strengths, weaknesses, opportunities and constraints of a new role for midwives. The following research questions were formulated:

  1. What are strengths/weaknesses and opportunities/constraints of sexual health education carried out by midwives for young people with lower education?
  2. What are strengths/weaknesses and opportunities/constraints of extending the professional responsibilities of midwives with regard to sexual health, and what does this mean for the responsibilities in primary health care and for society?

Method

The answers to the research questions are based on four sub-studies completed using literature research and information of the advisory board. The following sub-studies were carried out by students in Health and Society study programme in 2013 and 2014:

  • Exploring the vision of stakeholders with regard to the new role of midwives based on a literature study, stakeholder analysis and questionnaires.
  • A literature study about sexual health differences amongst youth and possibilities for the promotion of sexual health.
  • An inventory of existing experiences and learned lessons in Sweden, Amsterdam and Friesland based on semi-structured interviews.
  • An evaluation of three lessons about healthy pregnancy taught by a midwife at a preparatory secondary vocational school in Wageningen. The evaluation consisted of a written questionnaire completed by 48 pupils, interviews with the teacher and the midwife, a focus group session with 4 pupils, observation during the lessons and an analysis of reports about the lessons written by 24 pupils.

Results

There are a number of internal strengths and opportunities and external weaknesses and constraints for the new role of the midwife.

Internal strengths of midwives to educate young people on sexual health in schools are the midwives’ knowledge, authority and practical experience in the area of pregnancy and delivery; the midwives’ ability to associate with different groups of people and the fact that pupils take the lessons of midwives seriously.

Furthermore, the midwive is easily accessible and close-by to people. This means that midwives can specialise in prevention and health promotion. Internal weaknesses concern competencies and work pressure: Not all midwives have the required didactical skills, and the sexual education lessons come on top of their ordinary professional responsibilities, implying that they have less time for their primary tasks.

External opportunities include the fact that a great deal of health development is possible amongst young people with lower education, that prevention and health promotion at a young age contributes to general health and reduction of health care costs and that pupils have an interest in healthy pregnancy, childbirth and the work of the midwife.

The school is an important setting for sexual health education. It is an opportunity for schools to qualitatively improve sex education, for example by involving pupils and parents, and to embed the sexual education lessons. For example, lessons about healthy pregnancy are not currently part of the school’s curriculum or of the national sex education programme ‘Long Live Love’ (LLL4). Opportunities for improving care and for the community in  general are that the lessons of the midwives contribute to pupils being better able to locate and access care facilities, that organisations in the community work together and that prevention and care are better linked. To make the most of these opportunities also means addressing constraints. Pupils indicate they do not need education about subjects that they have already heard a lot about, such as smoking prevention and healthy eating. If sex education lessons are more embedded in school  policies, they become less dependent on the willingness of individual teachers. Lack of time to contact schools and to build relationships is an important constraint. In addition, not all stakeholders are initially positive about the new role of midwives.

Conclusion and recommendations

Sexual education by midwives in schools is a new and challenging endeavour. It fits with the competencies of midwives and is of additional value because it corresponds with an amendment designated by order in council (AmVB) and the request for prevention and health promotion. The new role of midwives is an opportunity to promote the sexual health of young people with lower education. The school is a good setting for this.

For the lessons in schools, it is recommended that midwives:

  • educate themselves in didactical skills for young people with lower education
  • prepare the lessons in collaboration with the schools (teachers, parents, pupils)
  • link with the needs of schools and pupils
  • take into account possible opposition at schools
  • think about the location of the lesson—in school or outside school
  • have teaching materials available
  • make a roster of midwives to be able to replace each other
  • make contact with schools and other organisations
  • begin with teaching—seeing promotes doing
  • evaluate the lesson in a simple manner (qualitatively and quantitatively)

For schools and stakeholders on the local level:

  • make lessons on healthy pregnancy part of the curriculum
  • involve parents and pupils
  • involve the midwife for a lesson about healthy pregnancy

The KNOV and other national organisations:

  • learn from foreign experiences with care professionals who provide sexual education
  • seek connection with LLL4 or another intervention
  • consider influencing law and regulations concerning sexual education in schools
  • support or provide training in didactical skills
  • provide teaching materials and a script
  • facilitate collaboration structures and networks
  • approach umbrella organisations
  • stimulate evaluation research of the school lessons
  • monitor and evaluate local initiatives