Creating Culturally Competent Midwives for Rural Virginia

There is a lack of access to quality maternity care in rural Virginia. The state's infant mortality rate is 7.4/1,000, and in some medically underserved areas (MUAs), the rate is as high as 30/1,000 live births. A Governor's Work Group on Rural Obstetric Care in 2004 reported that Virginia's system of obstetric care in rural areas is unraveling. This is related to many factors including the lack of trained midwives in rural areas, especially midwives that understand the cultural issues impacting these women. Old Dominion University (ODU), in collaboration with Shenandoah University, has developed a Midwifery Initiative that addresses the provision of culturally competent nurse midwives to rural underserved areas. This paper will describe the standardized patient (SP) program developed as part of the Midwifery Initiative to improve the cultural competency of midwifery students. The goal of the SP programs was to prepare midwives to address the needs of the diverse patients in the rural communities. The faculty at ODU, in collaboration with staff in the skills lab at Eastern Virginia Medical School, developed the cases and trained actors to portray them. The standardized patients were then transported five hours to Shenandoah University to provide the educational experience to the midwifery students. The evaluation of the program suggested the encounters had a tremendous impact on making the students aware of issues faced by many diverse midwifery patients. The midwifery students were able to address cultural issues in a non-threatening environment where they were able to receive feedback on their performance.