Objective: to identify factors which affect the learning of clinical skills by student midwives.
Design: ethnographic, grounded theory.
Setting: a large urban maternity hospital and its community area in the south of England.
Participants: student midwives, midwives, midwifery managers and teachers.
Data collection: by observation in clinical settings and interviews.
Key conclusions: observation, indirect learning and trial and error were the strategies used by midwives and students in order to obtain competency in clinical skills. However, anxiety, because of inadequate instruction and supervision and poor communication, interfered with learning and students felt ill prepared to function as midwives.
Implications for practice: clinical midwives need to be educated to facilitate the transfer of theoretical learning into clinical practice, and teachers need to re-learn the experience of being a clinical midwife.