MID 320: Assessment 2 Written Essay and Critical Reflection

Related learning outcomes

1. Conceptualise perinatal psychosocial health, from a salutogenic, women 's-strengths-based  perspective.

1. Review women's perinatal psychosocial health within a trauma-informed framework, with a focus on integrating the links between social vulnerability, trauma and perinatal substance use disorder.

1. Critically reflect on personal beliefs/attitudes that may impact midwifery care of a woman adversely impacted by the social determinants that predispose her to pre-existing and emerging psychosocial challenges.

1. Investigate, at an introductory level, contemporary information related to support of a woman experiencing a pre-existing and/or emerging mental illness, including the life-threatening

 conditions of suicidal ideation and psychosis.

1. Critically reflect on the midwife's role in reducing the incidence and impact of family violence, including the importance of the midwife caring for herself and mitigating own personal risk.

This assessment prepares students to apply the ACM Referral Guidelines in real-world scenarios involving psychosocial complexity. It builds skills in clinical decision-making, trauma-informed care, and appropriate referral, while encouraging reflection on personal values, professional responsibility, and self-care as a midwife.

Overview

The ACM Referral Guidelines (2021) outline when, why, and how a midwife should consult, refer, or transfer care across various clinical and psychosocial contexts. This includes mental illness, substance use, family violence, and other psychosocial risks that impact perinatal wellbeing. In this task, you will apply the ACM Referral Guidelines to a complex psychosocial scenario and critically explore how referral decisions align with midwifery values, trauma-informed care, and the midwife’s role in promoting woman-centred, strengths-based practice.

Case Studies Choose one of the following case studies Nina Nina is a 24-year-old woman in her second pregnancy. She recently separated from her partner after experiencing escalating emotional and verbal abuse during her first trimester. She has a history of childhood trauma and was diagnosed with moderate depression at 19, which worsened after the birth of her first child. Nina is now 28 weeks pregnant and couch-surfing with her toddler. She was referred to midwifery continuity care via a local youth mental health service. Nina is deeply ashamed of her situation and reluctant to disclose her living arrangement to other health professionals. She reports frequent insomnia, lack of appetite, and intrusive thoughts about “being better off gone.” Nina wants to keep the baby and raise both children herself but fears that Child Protection will be involved if she shares her situation openly. She smokes occasionally to manage stress but does not use other substances. OR Sofia Sofia is a 32-year-old woman in her third pregnancy. She presents late to antenatal care (at 30 weeks), after relocating due to escalating physical and emotional violence from her partner. Sofia has a history of methamphetamine use, mostly in the context of coercive control by her partner. She has not used since moving into temporary crisis accommodation in a new town, but fears that if she discloses her past use or current mental distress, her baby will be removed. Sofia reports nightmares, hypervigilance, and difficulty concentrating. She is overwhelmed by the demands of starting over with two young children and fears she is “damaged” from past drug use. You are the midwife working in a local perinatal outreach service and notice signs of high anxiety in Sofia, and you gently begin to build rapport. Sofia shows insight and motivation, but remains fearful of udgement, service involvement, and retraumatisation.

Task

You are to read and choose one of the two case studies and write a 2,000-word essay that includes:

PART 1: Midwifery Assessment and Referral Plan (1200-1400 words)

• Identify psychosocial concerns requiring referral, consultation or ongoing collaboration that your chosen woman may be undergoing
• For each identified issue:

1. Outline your midwifery assessment and clinical reasoning
2. State the referral category using the ACM Referral Guidelines (e.g. consult, refer, transfer)
3. Identify who you would refer/consult with (e.g. GP, mental health team, etc.)
4. Justify your decision using:
5. The ACM Referral Guidelines
6. Trauma-informed, strengths-based, and culturally safe midwifery principles
7. Relevant national or local policies, guidelines, or supports
8. Relevant peer-reviewed articles

Critical Reflection 

Using the Bass Model of Reflection, reflect on how your personal values or beliefs might affect your referral decisions or ability to hold space for psychosocial complexity When writing the reflection, consider the following questions to help you frame your response:

• The role of the midwife in navigating risk without judgment
• What personal values, emotions, or assumptions might arise for you in situations involving psychosocial vulnerability, and how can you remain professionally accountable?

• How midwives can advocate for women’s autonomy, dignity, and continuity of care, even during referrals

• The importance of self-care and knowing your own professional limitations Suggested Structure: Presentation guidelines

Summary of Assessment Requirements

This assessment requires students to apply the ACM Referral Guidelines (2021) to a complex psychosocial case study involving either Nina or Sofia. The task is divided into two parts:

Part 1: Midwifery Assessment and Referral Plan (1200–1400 words)

• Identify psychosocial concerns requiring referral, consultation, or collaboration.

• Provide midwifery assessment and clinical reasoning for each issue.

• State the referral category (consult, refer, transfer) using ACM Guidelines.

• Identify appropriate referral/consultation services (e.g., GP, mental health team).

• Justify each referral using:

  • ACM Referral Guidelines

  • Trauma-informed, strengths-based, and culturally safe principles

  • National or local policies and peer-reviewed literature

Part 2: Critical Reflection 

• Use the Bass Model of Reflection to critically explore how personal values may influence referral decisions.

• Address:

  • Midwife’s role in risk navigation without judgment

  • Impact of personal values, emotions, or assumptions

  • Professional accountability and advocacy for woman-centred care

  • Self-care and awareness of limitations

The essay should integrate clinical reasoning, reflective practice, and professional midwifery values, supported with evidence.

Academic Mentor’s Step-by-Step Guidance

Step 1: Understanding the Case Study
The mentor first guided the student to carefully choose between Nina or Sofia and identify psychosocial complexities, such as trauma, substance use, family violence, mental illness, and housing insecurity.

Step 2: Linking to Learning Outcomes
The mentor helped the student align the task with learning outcomes: recognising psychosocial risks, applying trauma-informed care, understanding referral pathways, and reflecting on the midwife’s professional role.

Step 3: Structuring Part 1 (Assessment and Referral Plan)

• Identifying Concerns: The student listed issues such as depression, family violence, suicidal ideation, substance use, or housing instability.

• Midwifery Assessment: The mentor demonstrated how to use clinical reasoning frameworks to describe symptoms and interpret psychosocial risk factors.

• Referral Pathways: Using the ACM Referral Guidelines, the mentor guided the student in categorising concerns (consult, refer, transfer). For example, suicidal ideation requires immediate referral to a mental health team.

• Justification: The student supported each decision with guidelines, trauma-informed principles, and peer-reviewed articles.

Step 4: Structuring Part 2 (Critical Reflection)

• The mentor explained the Bass Model of Reflection (Describe, Reflect, Anticipate).

• Students were encouraged to reflect on how personal biases or assumptions might influence their decisions.

• The reflection also covered the importance of advocating for autonomy, dignity, and culturally safe care, while recognising the need for professional self-care.

Step 5: Writing Style and Referencing
The mentor emphasised the importance of academic writing, clear structure, concise explanations, and consistent use of APA referencing for policies, guidelines, and peer-reviewed evidence.

Final Outcome

By following this approach, the student produced:

• A well-structured referral plan addressing psychosocial complexities through evidence-based assessment and consultation.

• A critical reflection showing awareness of personal values, professional accountability, and trauma-informed strategies for woman-centred care.

• A strong connection to the required learning outcomes, particularly in applying ACM Referral Guidelines, trauma-informed practice, and reflective midwifery care.

Learning Objectives Covered:

• Understanding perinatal psychosocial health through strengths-based approaches.

• Applying trauma-informed frameworks to midwifery practice.

• Recognising the impact of social determinants on perinatal wellbeing.

• Supporting women with mental illness, substance use, or experiences of family violence.

• Reflecting on professional values, accountability, and self-care.

• Strengthening clinical decision-making skills using ACM Referral Guidelines.

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