I'm no madwife! Just a little Cuckoo

Curriculum Developing

2011-12-17T12:10:00.000+11:00

Briefly over the past 18 months I have mentioned that I am a curriculum developer for the midwifery course run by Griffith University in Queensland.

I haven't blogged about it much because I already spend hours and hours researching, learning, writing and creating for these modules. I am afraid that blogging has gone on the back burner especially when I fall behind on the deadline.

You may have gathered from my last post I went for an interview to attempt to realise my career dream/ambition of becoming a midwifery lecturer. I was asked at interview how it was that I started to develop a module of the curriculum for the online environment.

I need to outline what it is I am actually developing because many other universities simply think that writing a one hour tutorial is online educational development of a course. These tutorials simply consist of an introduction to a subject, a reference to a suitable chapter reading in a book and then a series of 20-40 questions on that chapter reading. The following week the students get the answers to the questions.

Griffith University online curriculum development is becoming a complete supportive framework for students learning and is designed to be 'blended' with other forms of learning. A warning to everyone the online development of topics is not a substitute for textbooks or additional reading it is designed to complement it.

By the end of this year/ beginning of next I will be responsible for the development of 1/5th of the midwifery course curriculum. Each module consists of up to 13 topics in some cases and needs to be much, much more than just an online textbook. It needs to inspire, inform, evaluate that the students can seek out new life and new civilisations, oops wrong phrasing, but they need to be able to seek out the information, be able to apply it and evaluate what they have written. The online environment must also be conducive to building a supportive peer group network, promote collaboration and provide a supportive framework for establishing lifelong professional learning.

All that aside having the opportunity to develop this curriculum has given me the opportunity to grow so much professionally and built so much on my professional knowledge I am beginning to feel quite emotional about my personal growth.

The last few days I have been exploring women who are pregnant and have special needs. It has opened my eyes to the prejudices they face, the judgmental attitudes and their search to be validated as women with the ability to have a reproductive life.

I am in essence on a learning journey of my own as a develop these topics for student midwives.

Back Breaking Portfolio

2011-11-28T10:54:00.001+11:00

As you will all know I am a fan of e-portfolio's. I have become a greater fan as of last friday and my experience of carrying around my paper version for 12hrs.

I am not in the mood today to share why I needed to lug around my paper portfolio on Friday just yet but I want to share with you why it is important that we all get on board with e-portfolio's as a matter of urgency.

As a family we took a trip to Melbourne on Thursday afternoon. I had to pack for the family and my separate beautiful classic brown leather briefcase containing my professional portfolio, a note pad with maps and information and a few pens as basics, oh and yep a spare pair of tights.

I was tortured 5mins after getting off the train in Melbourne. The briefcase was weighing very very heavily on my shoulder. On the walk to the apartment I had to stop the girls every few mins whilst I swapped shoulders.

The following morning I set off to fly to Brisbane. I was up at 6am my neck and shoulders already giving me pain from carrying the briefcase the night before. I also had to be dressed smartly and wear my high heels. It was a very long day, in very warm heat.

I returned back to Melbourne at 8pm. My back, neck and shoulders were in absolute agony. I have since done a breakdown of the weight I was carrying:

Leather briefcase - 1Kg
Ipad & notes - 1.5Kg
Professional Portfolio - 4Kg !!!!!!!!!

I cannot believe that my portfolio weighs so much! I resolve never to carry it around again. I will supply anyone who asks a link to my e-portfolio and if they ask why I will certainly explain that I believe a paper portfolio is not sustainable or healthy to be carrying around.

I also dread to think what it would cost in postage to send to my professional body to review. It is time now to get on board and have a major rethink. We need to push e-portfolio's as sustainable, more creative and more effective means of reflection on professional midwifery practice.

Addressing a Learning Need

2011-11-23T14:29:00.001+11:00

Elluminate Live! - 2010 K12 ONLINE LIVE EVENTS, originally uploaded by Wesley Fryer.

In an earlier post I described how I had undertaken a VARK questionnaire to assess my learning style. The purpose of identifying my learning style is to also identify my teaching style. It also enabled me to identify a professional learning need.

I identified that I scored evenly across all aspects which meant that I have a multimodal learning preference but that my poorest score was in auditory learning. This means that I don`t necessarily like learning in pairs, groups, explaining ideas or discussions. I became more aware that as an online learner I am less likely to take an active part in discussions in Elluminate, preferring to take a back seat and listen to what is going on.

As a potential midwifery lecturer this could have proven to be a drawback as I need to be comfortable with all methods of curriculum delivery to provide 'instructor modelling'.

I therefore identified this as a professional learning need. I then needed to investigate how I could meet this learning need.

The Virtual International Day of the Midwife afforded me an opportunity to challenge myself and create a presentation to be given through Elluminate to a faceless audience.

I have since given two presentations to this conference in 2010 & 2011. I have become more confident with my skills in this area. I now feel more confident to meet the needs of students in an online classroom environment.

Cultural Safety and Reflection - A hand in hand process

2011-11-17T09:48:00.001+11:00

In writing and developing curriculum online modules for the Bachelor of Midwifery program run at Griffith University in Queensland I have really begun to find my feet and develop a formula for the format.

I have a number of beliefs that I try and inject into each module.

Midwifery Curriculum should aim to create the basis of a commitment to the creation of lifelong learners. The curriculum should aim to develop the necessary skills within each student to be able to seek out, understand and apply evidence and knowledge to their midwifery practice.
Reflection should be built into each learning module especially in the final year. The student needs to be able to understand why they are studying the module, how they need to incorporate it into their practice and the importance and relevance.
Cultural safety also needs to be part of every module.

Cultural Safety

“the effective midwifery care of women from other cultures by amidwife who has undertaken a process of reflection on her owncultural identity and recognises the impact of her culture on herpractice”
NZCOM Midwives Handbook for practice. New Zealand College ofMidwives. (2002) Christchurch. p.41
(Cited in ACM Bmid Standards, 2006)

I don't believe that cultural safety is just about the colour of a person's skin or a person's ethnic background. There are all kinds of different cultures for example:

Class culture
male/female culture
teen culture
religious culture
medical culture
midwifery culture
nursing culture

Which is why reflection on one's own culture is essential. Until you are aware of how your own beliefs, experiences and actions influence the care you provide you will never be deemed as 'culturally safe' by the person receiving the care you are giving.

The first step to becoming 'culturally safe' is developing a cultural awareness. This is the beginning step. In this step it is important to develop the ability to recognise that there are differences in people's rituals, beliefs and practices.

The second step is to develop cultural sensitivity. In this step there is a need to begin a process of self-exploration. Reflection is an important process in this step as you reflect on your own life experiences and realities. You then need to recognise how these relate to the impact they may have on others. This is the stage the students should be at by the end of their Bachelor of Midwifery course.

The final step is to become a culturally safe practitioner. The important aspect of this step is that as a practitioner you cannot determine yourself or declare that you are a "culturally safe practitioner'. Cultural safety can only be determined by the woman who is receiving the service. The only way we can gauge 'cultural safety' is by receiving feedback from women. The New Zealand midwifery standards review process undertaken by all midwives is particularly good at working in partnership with women, all case loading midwives have to provide a feedback form to every single women they look after. The feedback forms are sent back to the college and then returned to the midwife concerned. The midwife then gives them to the consumer representative to read at her review.

As a course developer I feel it is my responsibility to incorporate these aspects into each module I create so that these aspects become second nature to the future midwives we are creating.

Invitation to participate

2011-11-12T11:59:00.001+11:00

Invitationto participate in a research project:

Howdo men in Australia feel after supporting women through labour and birth?

This research study aims to identify the factors impacting on men’sexperience of supporting women through labour and birth. This study is beingundertaken by Pamela Harnden as part of the Primary Health Care Evaluation andDevelopment (PHCRED) research training program with the Rural Health AcademicCentre, University of Melbourne in Shepparton.

You have been invited to participate in the study as you have beenidentified as a man who has supported your wife/partner through the labour andbirth of your first child. Your input in this research is highly valuable inorder to gain insight into the factors on men’s experience of supporting womenthrough labour and birth.

The study involves completing an online questionnaire that is likelyto take you 20 minutes to complete. It contains a number of questionsconcerning your background, employment situation, involvement in labour andbirth, participation during labour and birth, level of support you experiencedand the emotional effects of labour and birth on your relationship with yourwife/partner and newborn baby. To access the questionnaire, please click on thelink provided.

https://www.surveymonkey.com/s/JV9BYZR

By completing the questionnaire you are indicating your consentto participate in the project.

You are not required to give your name or other identifying detailsand all information collected from you will be treated in confidence and onlybe made available to the research team. Participation in this research isentirely voluntary and you may withdraw from the study at any time.

The results of the project may contribute to an increasedunderstanding of factors impacting on men during labour and birth in Australia.The results will be submitted for publication in relevant journals andpresented at conferences in order to improve the understanding of men’s needsduring the labour and birth of their first baby. The original data will bestored in secure locked facilities for a minimum of 5 years after publication.The total confidentiality of data may in some circumstances be affected bylegal limitations; however no data is individually identifiable.

This study has been approved by the EthicsCommittee of the University of Melbourne (HREC number :1034377.1). If you haveany concerns about the conduct of this project please contact the ExecutiveOfficer, Human Research Ethics, The University of Melbourne, ph: 03 83442073,fax: 03 93476739.

Croakey blog posting

2011-11-12T09:35:00.001+11:00

Here is a link to a blog post I spotted on Croakey

It has the headline,
"Concerns continue about unsafe home birth practices: Dr Andrew Pesce"

I have left a comment because I don't like the general tone of the post.

Here is my response,

The issue that this doesn’t address is one of informed choice. I would like to remind people of the RANZCOG guidelines for standards of maternity care in Australia and New Zealand,
“1.5 Women who have been fully informed regarding a recommended course of action, and the potential consequences of not pursuing such management, should have their decisions respected if they decline.”p.6

I would also like to remind people of the following from the National Guidance on collaborative maternity care document published by the Australian Government NHMRC,
“Documentation should include clear and consistent records of: information provided to the woman and indications that the messages have been understood, informed consent, responsibility and accountability for decisions, and the woman’s understanding of risk and her responsibility for her own choices and decisions about care, especially if these decisions are in conflict with professional
advice (in such circumstances it must be clearly documented that the woman has accepted a certain level of risk).
A woman decides who she involves in this decision-making process, be it a health professional, partner, doula, her extended family, friends or community, and should be free to consider their advice without being pressured, coerced, induced or forced into care that is not what she desires (McLean and Petersen 1996).Women have the right to decline care or advice if they choose, or to withdraw consent at any time. Therefore, if a woman declines care or advice based on the information provided, her choice must be respected (UNESCO 2005). Importantly, women should not be ‘abandoned’ because of their choice (FPA Health and Read 2006, Faunce 2008; NHMRC consultations 2009).” p.14

The ACM therefore are the only organisation that sought to deny these rights to women and actively encouraged midwives to refuse to attend a woman in labour by issuing this ‘interim home birth statement’. I also stress it was an INTERIM statement which has now been voted on my the membership to be withdrawn. I would remind any midwife that under the law as it stands should a woman have consulted her at any time during her pregnancy that a therapeutic relationship has been established and should she then refuse to attend that woman in labour she could be prosecuted.
The real issue is that where informed consent has taken place there is no protection for the midwife she looses on all counts. Can be prosecuted should she refuse to attend, prosecuted if she attends and struck off. I love that you wish to portray us as ‘demons’ but please stick to the real issues and quit with all the professional personal attacks.

Ethics Approval

2011-11-11T15:54:00.001+11:00

I have finally gained ethics approval for my study

Create your free online surveys with SurveyMonkey, the world's leading questionnaire tool.

So you want to be a midwife?

2011-11-03T14:48:00.001+11:00

I have been asked several times to give advice to women who want to become midwives.

My first question to them is always,

"Why do you want to become a midwife?"

The answers always seem to be the same,

because I helped deliver my cousins baby
because I like babies
because I had a great midwife for my pregnancies and I want to be just like her
because it must be a wonderful, pleasurable job and want to bring lots of lovely babies into the world.

So really what I wanted to do was to give some top tips to anyone who is thinking of midwifery as a career and a profession.

I want to point out before we start that midwifery is a vocation.

Top Tips

Never ever utter the word 'delivery' again in relation to BIRTHING. Women BIRTH they are not pizza they are NOT DELIVERED.

Scrub that word from your vocabulary. In actual fact now I am so obsessed by this use of the word that whenever we are having take out pizza and I tell my husband that it is being 'delivered' he asks are you sure it isn't being 'birthed' by the delivery man!

2. Midwives have a philosophy of care visit as many as you can and read them.

New Zealand College of Midwives Philosophy of care

International Confederation of Midwives

Birthspirit Holistic Midwifery Services

3. Once you have read these philosophies examine your own strengths and see what you have to offer pregnant women and how you can uphold these philosophies.

4. Talk to midwives and student midwives

Student Midwife.net

5. Consider how your own background and beliefs will potentially influence the relationships you build with women in your care. This is the beginning step in becoming a culturally safe practitioner.

6. Consider and read about the political and social challenges that midwives face in the country in which you will be working.

7. Consider how you would cope emotionally caring for a woman who's baby has died, been lost in pregnancy or is facing her own life threatening challenge. The care we provide can kill and maim I cannot stress enough the responsibility you face as a practising midwife.

8. Do not underestimate the commitment you will have to make to your clinical work and studies whilst you are 'training'. Whatever amount of time you think you are going to be able to devote to your studies I suggest you double it.

9. Be prepared that this studying you undertake is in actual fact a lifelong commitment to remaining up to date with evidence and with your studies it will never get any easier.

10. Examine your marriage and your personal relationship. Ask yourself the following questions:

Do I have the right emotional support from my partner?
How will he cope with me being tired, irritable, upset when things get tough?
How will he cope with me spending long periods of time with my head in books, in front of the computer and doing clinical shifts and work?
How will he cope with me being called out in the middle of the night to attend one of my continuity of birth women that I am following?
How will he cope if I have to work a night shift New Years eve or a late shift on Christmas Day?
How much support do I have to maintain all the usual stuff at home as well as working and as well as studying?
How will he cope as I transform into a powerful, empowered, free thinking woman during my studies and after I qualify? I have actually seen colleagues marriages split after she qualified as a midwife because she was no longer the same person that their partners married.

So there are my top ten tips for anyone wishing to become a midwife.

New Presentation for my research.

2011-10-31T13:37:00.000+11:00

You will need to use Safari to view the presentation.

Screening for Type 2 diabetes in pregnancy

2011-10-22T11:17:00.001+11:00

Introduction

Thirty percent of Goulburn Valley Health’spregnant population have a Body Mass Index (BMI) > or >30 kg/ m²(1)putting them at 1.4 times the risk of type 2 diabetes(T2DM) (2). It is described as one of the most challenging public healthproblems of the 21st century (2) .

Symptoms of type 2 diabetes have insidious onset(3) with many people undiagnosed for years before clinical symptomsarise (4). A review of available literature suggests many women are diagnosedon their first antenatal visit(4) but are then “misdiagnosed” with gestational diabetes (4, 5).Gestationaldiabetes affects four percent of the obstetric population (6)but the degree of risk it poses to pregnancy outcomes iscontroversial. This controversy leads differences in management of diabetesduring pregnancy with calls for uniformity of approach to care (6) . It is also preventing the diagnosis of T2DM putting women andtheir babies at increased risk of serious outcomes to their pregnancies.

Prevalence

Overweight and obesity are common in theobstetric population (7) thirty percent of Goulburn Valley’s pregnant population areconfirmed as obese (1) . The prevalence ofundiagnosed diabetes in the rural population in the state of Victoria, in onestudy was found to be 26.3%(8) . In this study 1454 men and women aged 25 years and older wererandomly selected from six rural towns and assessed for diabetes This studydemonstrated that the prevalence of diabetes had doubled in the last 15 years.The study doesn’t distinguish between T2DM and type 1 diabetes mellitus but itis unlikely that a person can remain undiagnosed with type 1 diabetes mellitusfor any length of time. T2DM is nolonger confined to the older population. It is suggested that the prevalence ofT2DM is on the increase in the young, non pregnant population (9). This can lead us to wonder about the true prevelance in thepregnant population. A recent survey of 180 births in Australia reported thatfifty five percent occurred in women with type 2 diabetes (10).

The risks of T2DM in pregnancy

In the past physicians and women have thought of T2DM as a lower risk condition thantype 1 diabetes (11, 12) .This thought has been carried through to the management of T2DM in pregnantwomen.

MATERNAL RISKS OF T2DM	EARLY PREGNANCY RISK	LATE PREGNANCY RISK	NEONATAL RISK	CHILDHOOD RISK
Hypertension in pregnancy(5, 7, 13)	Miscarriage	Preterm birth(7)	Death in the 1^st year of life (5, 13)	Impaired glucose tolerance (14)
Diabetic retinopathy(3, 15)	Congenital Malformations (4, 11, 12, 16) (Cardiac & Muscoskeletal abnormalities)	Stillbirth (11, 13, 16)
Cardiovascular events (17)
nephropathy(17)

Looking at the table above it would bereasonable to agree with Melamed and Hod in their review of perinatal mortalityin pregestational diabetes,when they state that the management of T2DM shouldbe the same as type 1 diabetes (12) .

At risk groups

There has yet to be an agreement as towhether all pregnant women should be screened for T2DM at the first antenatalvisit or whether screening should be confined to those who are at particularrisk.

Women that should be considered ‘at risk’of undiagnosed type 2 diabetes are those with a BMI >30kg/m2 (18, 19).

Screening method

The choice of screening method in pregnancyis a problem; the oral glucose tolerance test (OGTT) is defined as the ‘goldstandard’ test by the World Health Organisation (WHO) (20) however, it is not easily tolerated by women in early pregnancy dueto nausea and vomiting. Borch-Johnsen ofthe diabetes centre Copenhagen argues there is no ‘gold standard’ and differenttests identify different subjects (21) .The WHO is currently reviewing the possibility of using the HbA1cblood test yet the HbA1c test as a diagnostic tool for type 2 diabetes in pregnancy is questionable.

Arguments against the HbA1c

Measurement of HbA1c is not yet standardized around the world and has significant biological variation in non-diabetic subjects. There is currently insufficient evidence to enable a judgment to be made regard to its performance as a screening test.
Not commonly used amongst the ordinary population as a screening test
Affected by anaemia – therefore affected by physiology of pregnancy
What level should be used
HbA1c level is significantly lower in early and in late pregnancy
More expensive
Already determined to be inappropriate for gestational diabetes
HbA1c results differ in different ethnicities
Uniformity of laboratory testing is required

Arguments for the HbA1c

less affected by stress
no fasting
More sensitive
Not affected by diet
One blood test
Less time consuming
Better index of overall glycaemic exposure and risk for longterm complications

Evidence of HbA1c use in pregnancy

Level setting at 5.3
Erythocyte turnover repeat the test every 3-4 wks
HbA1c cannot be used to predict fetal size and birth weight

Discussion

Detection of type 2 diabetes in pregnancyis worthwhile because there is a need to differentiate between women sufferingfrom undiagnosed type 2 diabetes and women with gestational diabetes. Women who’s pregnancies are complicated bytype 2 diabetes are suffering a more severe disease associated withlongstanding glucose intolerance with the risk of major malformations in thedeveloping fetus due to uncontrolled hypergycaemia. The risk of uncontrolled hyperglycaemia isgreater in those women who are yet to be diagnosed but who will be enteringtheir first trimester of pregnancy. Diabetes diagnosed in early pregnancy hasgraver consequences and needs to be addressed as soon as possible (22) .

· Primary caesarean section ratecould be reduced.

· Education and lifestylemanagement plans can be put in place to prevent the development of thecomplications of type 2 diabetes.

Conclusion:

Screening for type 2 diabetes in pregnancyshould be considered in women who are high risk.

Women already pregnant and considered to beat high risk of undiagnosed type 2 diabetes need to be offered earlierappointments at antenatal booking clinics with a midwife who specialises indiabetes.

What needs urgent consideration is whetheropportunistic screening of women in the primary care setting should take placefor women considered at increased risk of undiagnosed T2DM. Another option maybe exploring the cost effectiveness of offering a midwife led preconceptionclinic to screen for T2DM in high risk women planning to become pregnant.

Further research is needed to look at HbA1cas a diagnostic tool for undiagnosed type two diabetes in early pregnancy withfollow up of women tested through their pregnancies looking at foetal growth,birth outcome and birth weight. The women tested should then be followed upfollowing pregnancy to confirm or deny type 2 diabetes at 3 months post partum.

References

1. TealeG. Assessment of Goulburn Valley Health's population. 2011.

2. AusDiab. The Australian Diabetes,Obesity and Lifestyle Study. 2005.

3. Gillett MJ. International ExpertCommittee report on the role of the A1c assay in the diagnosis of diabetes:Diabetes Care 2009; 32(7): 1327-1334. Clin Biochem Rev. 2009 Nov;30(4):197-200.

4. Jovanovic L. Definition, size ofthe problem, screening and diagnostic criteria: Who should be screened, costeffectiveness and feasibility of screening. International Journal of Gyecologyand Obstetrics. [Journal atricle]. 2009;104:S17-S9.

5. Lapolla A, Dalfra MG, Fedele D. Pregnancycomplicated by type 2 diabetes: An emerging problem. Diabetes Research andClinical Practice 2007(80).

6. Metzger B, Coustan D, Dyer A,Hadden D, Hod M, Lowe L, et al. New findings in gestational diabetes - the HAPOStudy. Diabetes Voice. 2009;54.

7. Callaway LK, Prins JB, Chang AM,McIntyre HD. The prevalence and impact of overweight and obesity in anAustralian obstetric population. Med J Aust. 2006 Jan 16;184(2):56-9.

8. Simmons D, Mackenzie A, Eaton S,Shaw J, Zimmet P. Prevalence of diabetes in rural Victoria. Diabetes Researchand Clinical Practice. 2005;70.

9. Leary J, Pettitt DJ, Jovanovic L.Gestational diabetes guidelines in a HAPO world. Best Pract Res Clin EndocrinolMetab. 2010 Aug;24(4):673-85.

10. McElduff A, Ross GP, Lagstrom JA, ChampionB, Flack JR, Lau SM, et al. Pregestational diabetes and pregnancy: anAustralian experience. Diabetes Care. 2005 May;28(5):1260-1.

11. Temple R, Murphy H. Type 2 diabetesin pregnancy - An increasing problem. Best Pract Res Clin Endocrinol Metab. 2010Aug;24(4):591-603.

12. Melamed N, Hod M. Perinatal mortalityin pregestational diabetes. Int J Gynaecol Obstet. 2009 Mar;104 Suppl 1:S20-4.

13. Dunne F, Brydon P, Smith K, Gee H.Pregnancy in women with Type 2 diabetes: 12 years outcome data 1990-2002. DiabetMed. 2003 Sep;20(9):734-8.

14. Harder T, Rodekamp E, Schellong K,Dudenhausen JW, Plagemann A. Birth Weight and Subsequent Risk of Type 2Diabetes: A Meta-Analysis. American Journal of Epidemiology. 2006;165(8).

15. Rasmussen KL, Laugesen CS, RingholmL, Vestgaard M, Damm P, Mathiesen ER. Progression of diabetic retinopathyduring pregnancy in women with type 2 diabetes. Diabetologia. 2010Jun;53(6):1076-83.

16. Clausen TD, Mathiesen E, Ekbom P,Hellmuth E, Mandrup-Poulsen T, Damm P. Poor pregnancy outcome in women withtype 2 diabetes. Diabetes Care. 2005 Feb;28(2):323-8.

17. Waugh N, Scotland G, McNamee P,Gillett M, Brennan A, Goyder E, et al. Screening for type 2 diabetes:literature review and economic modelling. Health Technology Assessment. [literaturereview]. 2007;11(17).

18. Organisation WH. Diabetes. 2011 [cited 2011 06/03/2011]; Fact SheetNo312].

19. Kopelman PG. Obesity as a medicalproblem. Nature. 2000 Apr 6;404(6778):635-43.

20. Organisation WH. Definition andDiagnosis of Diabetes Mellitus and Intermediate Hyperglycaemia: InternationalDiabetes Federation2006.

21. Davies P, Chellamuthu P, Patel V. Howto diagnose diabetes? Practicalities and Comments on the WHO ProvisionalRecommendation in Favour of HbA1c. The British Journal of Diabetes &Vascular Disease. 2010;10(261).

22. panelIAoDaPSGC. International Association of Diabetes and Pregnancy Study GroupsRecommendations on the Diagnosis and Classification of Hyperglycaemia inPregnancy. Diabetes Care. 2010;33(3).

Articulating the difficult

2011-10-18T15:21:00.000+11:00

I have often found it hard to find the right words to articulate what it is about autonomous midwifery practice I miss the most.
It was very easy to list the reasons why I left it. Today I received an email from a friend who manages to write it up beautifully.
I want to share her thoughts with you.

"Having come in from semi rural LMC work and moved to a city tertiary hospital I have so many questions, at times they are almost overwhelming.

I left a workplace where I could instantly find anything I needed, a place where I could slip into a consultant paediatricians or obstetricians office and ask a question (any question, even question their practice or decision on a case), get an urgent appointment for any of the women I cared for, or have a cry if need be. If I required help in the middle of the night, a phone call got not only my backup, but whoever I needed and I never had to worry if the help that came was competent to the task before them (nor did I get more help than I needed). I was on first name basis with most GP's and half the CYPS social workers, all the hospital social workers and could rely on the staff at ultrasound and the lab to phone me direct with any results, not to mention bail me out if I forgot to send in a form (I am only human).

I left a thriving LMC practice, autonomy, a place where I had earned a degree of respect in the community, and among colleagues with regard to my midwifery skills & knowledge. I left a role which I believe (when done with enthusiasm and passion), has the greatest opportunity of any health profession, to alter health outcomes not just for women and their infants but for whole communities - what other health professional is free (without cost) to the people using it, results in health professionals being invited into the homes of relatively healthy young people; from a complete cross section of society; over such an extended period (conception-6wks postnatal); with the opportunity to promote health and wellbeing?

I traded (sometimes I think my soul) for days off, regular hours, a regular (fixed) income, sick leave, holiday pay, tax at source and the ability to have the occasional glass of wine with dinner."

Men, pregnancy, birth and transition to fatherhood

2011-10-05T18:18:00.001+11:00

For the first-time expectant father, antenatal maternalattachment represents his first experience of his partner’s developing a new“emotional involvement” with a third party.
Counselling of the couple by midwives may assist the male to be more accepting of sharing and to develop a morepositive relationship with both the baby and his partner.
The ideal opportunity for this to take place is at the first antenatal booking visit. First impressions count and to shut the partner out at this stage may set the relationship for father/midwife off on a negative footing.

The antenatal period is recognised as an opportunistic timefor intervention with prospective fathers because it is a time when:

Men are uniquely available physically and emotionally

They may be more motivated, especially when the pregnancy is planned

Men may be more receptive to health messages

This may appeal to their 'protective' nature and they may be responsive to research indicators of good health.

Domestic abuse and other negative behaviours by men can be challenged

Midwives are currently screening women during pregnancy for domestic violence in Australia and New Zealand. What is unclear is what impact this screening is having on the rates of domestic violence.

Men may become more involved in care of the newborn

Once again encouragement is the key. Participation and partnership is essential.

The patterns of behaviour established in pregnancy may continue after the birth

At this point in time I have been unable to locate the evidence in relation to this.

Mothers childbirth experiences will be improved

Certainly the evidence exisits that suggests that women have greater satisfaction with their birth experience when their partners are present and supporting them.

There is a growing body of research evidence from around theworld that a father’s involvement in childbirth has a significant impact ontheir partner, birth events and birth outcomes.

We can acknowledge that there are also same sex partnersinvolved in pregnancy, birth and the postnatal period but there is very littleevidence of their experiences. Much of the research evidence is looking at themale perspective of birthing.

Researchers have disagreed about what it means to beinvolved in fatherhood. Lamb et al first identified the man’s involvement as amultidimensional concept, that includes:

engagement,
availability
responsibility (1).

Many researchers define men's involvement in pregnancy outcomes as activities or practices by theman and a couple anticipating birth that ideally lead to an optimal pregnancyoutcome.

Barriers to paternalinvolvement

Work/life balance is important for expectant fathers.Governments often acknowledge the need for reform of tax; welfare and childsupport polices to encourage family formation and father involvement. It isalready acknowledged that paid parental leave could significantly strengthenpaternal involvement in the postnatal period. The Australian government hascommitted to providing two weeks paid parental leave for fathers from July2012.

Once the Paid Parental Leave Bill hadbeen introduced into Parliament, the Bill was referred to the Senate CommunityAffairs Committee. The Australian Human Rights Commission made a submission andCommissioner Broderick appeared before this Committee.  While the national PPLscheme is a welcome first step, Commissioner Broderick will continue to lobbyfor improvements, including:

• Superannuationon paid leave

• A minimumof two weeks paid leave for fathers and other supporting parents

• Overtime a full year of paid parental leave that can be shared between parents, toensure that children receive the care they need at this important early stage

• Withinthe full year of paid parental leave, a minimum of four weeks paid leave forfathers and supporting parents, available on a ‘use it or lose it’ basis, toenable them to be involved in caring during the first year of their child’slife

• Leave paid atthe rate of at least two thirds of income, so that more families can afford totake the leave.

You can read more at this web site:

http://www.hreoc.gov.au/sex_discrimination/programs/paidwork_familyresp.html

I recently emailed LNP leader Tony Abbott after his outspoken views. I stressed the importance of men being available to their partners at the birth. I also stressed the importance to father/child bonding if he is present at the birth.
I received a brief acknowledgement that failed to acknowledge any of my points and he failed to outline the oppositions position on the subject.

Promoting PaternalInvolvement

In the past men have not had a role during pregnancy andchildbirth. Today, an it is estimated that 95% of fathers in the U.K. nowattend the birth (2). It has taken a number of yearsfor men in Australia to become commonplace in the birthing room (3). Today, there are nopublished figures on the percentage of men who attend labour and birth inAustralia but in 2009 there were 295,000 births registered, 65% of thoseoccurred in a nuptial relationship, 35% occurred in an ex-nuptial relationshipand just 3% of those births leave the fathers details unnamed (4).

Pregnancy offers many opportunities for men to be offeredhealth education. Like pregnant women, expectant fathers are particularly opento information, advice, and support during pregnancy and are more likely tochange their health behaviours (5).
Antenatal education programsspecific to men are needed to enhance expectant fathers’ involvement inpregnancy and parenting. The development of a specialist antenatal class in Sydney by one antenatal educator for men has been successful but does this go far enough? There may be a need for a series of specialist male classes for them to attend.
The quality of involvement of an expectant father inthe post-natal months may be dependent on his level of involvement during thepregnancy.

Many researchers recommend the following:

• The expansion of antenatal education programs toinclude promotion of men’s involvement in pregnancy and parenting

• The promotion of best practice models for improvingmen’s involvement in pregnancy and childbirth

• The promotion of father-friendly hospital/birth centresettings, practices and policies

• The establishment of additional resources that teachmen how to be responsible husbands and fathers, and to build strongerrelationships

• The promotion of early antenatal care that includes anintegral role for the expectant father

• The provision of services that welcome and empower theexpectant father, and develop education materials to help sustain paternalinvolvement after going home

Parental Involvementin Birth

In the current climate of maternity care men are often withtheir partners from the onset of labour. Maternity service care providers inAustralia offer fathers instruction and advice focused on supporting womenthrough labour and birth based on meeting the needs of their pregnant partnersduring labour.

Attendance of fathers at the birth of their babies has increased(2,6, 7).Men have reported differing motivations for their attendance (6, 8-10)and assume different roles during labour and birth (11).

There is growing research interest from around the worldabout father’s involvement in childbirth and how birth events impact on men’semotions, father-child bonding and adult relationships. Positive resultsinclude a strengthened new parent relationship(9,12)and a quicker establishment of an emotional bond with the newborn (9,13).However, following attendance at the birth it has also been found that men’semotional response is varied and supporting women through labour and birth forsome men has a negative impact. Some men complain of symptoms of posttraumaticdistress, depression, and anxiety and lower quality of life. (14-18).

Motivations

It has been demonstrated in other studies from around theworld, that most men are present during labour and birth at the wishes of bothpartners (9). However in another studyfrom the United States, Palkovitz (10) found that when questioned,some men stated they felt pressured to be present by their partners.

Feelings & experiences (Closer baby bonding)

Men who are present duringlabour and birth feel they have a closer emotional bond with their babies (9,13).Sapountzi-Krepia (9) in a study of Greek men,suggested that the men’s positive feelings towards their baby demonstrated acloser emotional bond. Bowen (13), found that the father’spresence at the birth, demonstrated more observable attachment behaviours andpositive language towards their babies.

Roles

Men assume different rolesduring labour and birth. Chapman (11) identified three main rolesin her interviews of twenty men from the San Francisco Bay area. The ‘birthcoach’ identified as a man who actively assisted his partner during and afterlabour contractions. The ‘team mate’ identified as responding to requests forphysical or emotional support or both. The ‘witness’, the largest of the threegroups identified as companions to provide emotional and moral support, presentto observe and witness the process of labour and birth.

Strengthened Relationship

Men’s presence at the births oftheir babies has been found to strengthen the couples’ relationship (9,12),with men expressing a feeling of having ‘solidified their relationship withtheir partners’(12)and by expressions of love and gratefulness following the birth engenderingpositive feelings of ‘closeness’ (9).

Emotional impact

Although participation in thebirth can result in men having positive feelings of pride and happiness(9) there are also reports ofnegative impacts. Nolan (14) identified in her U.K. surveysome men were distressed to see their partners in pain. Greenhalgh et al (17) in the U.K and Bradley et al (18) found men who reported postnatal depressive symptoms could beidentified as having experienced distress, fear and lack of confidence duringlabour and birth.

The transition to fatherhood

New mums often have theopportunity to learn the basics of newborn care in private: how to put on thenappy and how to dress them. When men are given the same opportunity they oftenare doing it for the first time under the watchful eyes of their wives andpartners. Receiving critique at this stage can destroy confidence in theirabilities and can sometimes result in the man withdrawing from vitalinteraction with their newborn baby.

Fathers often state that theyappreciate time alone with their babies to find out what works for them (19). In this environment they canprove to be capable caregivers. It also gives them time to enjoy what they viewas a miracle.

Often during this period oftransition a man will reflect upon his own father. They gain an appreciation oftheir fathers’ role and this can lead to the need to father differently withoutany clear idea of how to do so.

More research

Measurements of men’s involvement in pregnancy areunder-developed, as are methods for recruitment and retention of men,particularly Indigenous Australian men in research. Pathways to paternalinvolvement are poorly understood, as are the mechanisms linking paternalinvolvement to pregnancy outcomes. More intervention research is needed toidentify effective strategies for enhancing paternal involvement and pregnancyoutcomes. This is most important if the Australian government is to achieve its' targets in relation to 'closing the gap'. Where the following statistics for life expectancy exist:

Indigenous males live 11.5 years less
Indigenous females 10 years less
Infant mortality rate is 7.7-13.6%
maternal mortality is 21.5 deaths per 100,000 three times higher than non-Indigenous women.

Researchers recommend looking at the following:

• More research into parental involvement and pregnancyoutcome in Indigenous and lower socio economic groups who are know to suffermarked disparities in health and healthcare

• Greater funding for researchers to develop moreeffective methods for recruitment and retention of men in communities with highlevels of poor pregnancy outcomes for parental involvement and pregnancyoutcome

• Funding to be made available for researchers to conductstudies that advance the understanding of cultural variations in parentalinvolvement in pregnancy

• Further research into physiological and behaviouralchanges in expectant fathers

• Further research into fathers’ perspectives ofpregnancy and parenting

• Further funding and research into identifying effectiveclinical and population-based strategies for enhancing parental involvement andpregnancy outcome

Conclusion

Research has demonstrated that men are important to maternaland child health. We know that parental involvement can have a positiveinfluence on maternal health behaviours during pregnancy (20) and that further research isnecessary to develop our knowledge regarding the roles of the expectant fatherin pregnancy outcome. It is necessary to instil the understanding of equalparticipation of men and expectant fathers across all aspects of midwiferypractice and promote full paternal involvement in pregnancy to reduce andeliminate any racial and ethnic disparities in pregnancy outcomes in Australia.

REFERENCES:

1. Lamb ME, Pleck J, Charnov E, al. e. A biosocial perspectiveon paternal behavior and involvement. In: Lancaster JB, Altman J, Rossi A, al.e, editors. Parenting Across the Lifespan: Biosocial Dimensions. New York:Aldine de Gruyter; 1987. p. 111-42.

2. Somers-SmithMJ. A place for the partner? Expectations and experiences of support duringchildbirth. Midwifery. 1999 Jun;15(2):101-8.

3. Vernon D. Menat Birth. 2nd ed. Sydney: Finch Publishing; 2011.

4. BirthsAustralia [database on the Internet]2009 [cited 14/6/2011]. Available from: http://www.abs.gov.au/ausstats/abs@.nsf/Products/4D11AD4B275567B4CA2577CF000DEEC6?opendocument.

5. Lupton D,Barclay L. Constructing Fatherhood: Discourses and Therapies. London: SagePublications Ltd; 1997.

6. Madsen SA,Lind D, Munck H. Fathers' involvement with infants. Copenhagen: Hans ReitzelsForlag; 2002.

7. OrganisationWH. Fatherhood and Health outcomes in Europe. 2007 [cited 2011 16/7]; Available from: http://www.euro.who.int/document/e91129.pdf

8. Eriksson C,Salander P, Hamberg K. Men's experiences of intense fear related to childbirthinvestigated in a Swedish qualitative study. jmhg. 2007;4(4).

9. Sapountzi-KrepiaD, Lavdaniti M, Dimitriadou A, Psychogiou M, Sgantzos M, He HG, et al. Fathers'Feelings and Experience Related to their Wife/Partner's Delivery in NorthernGreece. The open nursing journal. 2010;4:48-54.

10. Palkovitz R.Changes in father-infant bonding beliefs across couples' first transition toparenthood. Maternal-child nursing journal. [Research Support, Non-U.S. Gov't].1992 Fall-Winter;20(3-4):141-54.

11. Chapman L.Searching: expectant fathers' experiences during labor and birth. J PerinatNeonatal Nurs. 1991 Mar;4(4):21-9.

12. David M, AslanG, Siedentopf JP, Kentenich H. Ethnic Turkish fathers in birth support roles ina Berlin labour and delivery room--motives, preparation and incidence in a10-year comparison. J Psychosom Obstet Gynaecol. 2009 Mar;30(1):5-10.

13. Bowen SM,Miller BC. Paternal attachment behavior as related to presence at delivery andpreparenthood classes: a pilot study. Nurs Res. 1980 Sep-Oct;29(5):307-11.

14. Nolan M.Caring for fathers in antenatal classes. Modern Midwife. 1994;4(2).

15. Veskrna L.peripartum depression - does it occur in fathers and does it matter? jmh.2010;7(4):10.

16. Ramchandani P,Stein A, Evans J, O'Connor TG, team As. Paternal depression in the postnatalperiod and child development: a prospective population study. The Lancet.2005;365:5.

17. Greenhalgh R,Slade P, Spiby H. Fathers' coping style, antenatal preparation, and experiencesof labor and the postpartum. Birth. 2000 Sep;27(3):177-84.

18. Bradley R,Slade P. A review of mental health problems in fathers following the birth of achild. Journal of Reproductive and Infant Psychology. 2010;29(1):19-42.

19. Jordan PL.Enhancing Understanding of the Transition to Fatherhood. ijce. 1990;22(2):3.

20. Teitler J.Father involvement, childhealth and maternal behaviour. . Children and YouthServices Review. 2001;23:22.

Health professionals and social media, black humor or disciplinary action?

2011-09-19T14:17:00.002+10:00

There have been a number of instances I have come across within social media circles that has demonstrated poor judgment on the part of those involved.
The story began with a GP lecturer witnessing a conversation in the public platform of twitter between two Dr's. I have seen a record of the conversation. It might seem to start out harmless enough, an unimaginative use of the word "madwife" to describe midwives, "labia ward" for labour ward but as the conversation moves further and further downhill I witnessed the use of such language I hate, "runts and cunts" to describe midwives and women on labour ward.
The GP lecturer decided to bravely challenge the behaviour in her blog post she describes how her challenge was received.
This blog post was then discussed on this Facebook page, The medical registrar where supposed professionals began to make personal verbal, abusive attacks on the GP lecturer. Abusive comments have also been left on her blog in the comments section and in response to a PATIENT who dared say that they were offended by the Dr's language! But isn't that why we are all here for the patients and the women?
The patient commented,
"I'm a bit shocked by some of the comments. As a taxpayer, healthcare patient and woman I am sickened by this language, and it has definitely brought the medical profession down in my eyes, particularly all the justification and minimizing going on after the fact. Respect for your fellow humans, people. If your profession is dehumanising you to the extent that you think language like this is OK, do something about the working conditions of your profession."

The response,
Oh, get the f*** over it, you professionally-offended self important waste of space. No-one has the right to not be offended."

Excuses of stress relieving "black humour" have been used in an attempt to gain some sort of acceptance of this abusive language. I am sorry but I did not see any sort of "black humour" on display in social media circles when the Welsh firefighters were attempting a stressful difficult rescue of 4 trapped miners.

I am also intrigued about the abusiveness of the personal attack on this GP who challenged these DR's. As adults we listen to news stories every day of teenagers being bullied through social networking sites and committing suicide. We tut and say shame on the bullies yet here are supposed grown up health professionals conducting personal abusive comments towards a fellow health professional. Well I am sorry but I for one don't think it is enough to just say, tut tut, shameful.

There are plenty of life threatening stressful jobs that see horrible things in life why do these Dr's think they are special enough to be able to use their demeaning language in the open on a social network that vulnerable patients can see and read?

I already have witnessed enough of it done to patients when they are under anaesthetic to such an extent that when I needed to have a procedure done that involved exposing my private parts to the world whist unconscious I suffered an emotional breakdown.

I would like to point out that it was not long ago that offensive secret message abbreviations were used in patients notes to make personal points about them. This was seen as being offensive when it became understood. I believe that this is the same thing and equally offensive.

Bullying in the health profession is rife in this blog post I document just a few instances that occurred to me. This is a further guest post on workplace bullying because wherever or whenever this is happening it is still bullying.

Time to remind everyone of their professional responsibilities, at least in the Southern hemisphere

The New Zealand Medical Council have a draft document discussing disruptive behaviour.

It states,

'Historically, disruptive behaviour has been tolerated by doctors because of the hierarchical nature of the medical profession."

It acknowledges that the Medical Council of New Zealand believe disruptive behaviour is unprofessional and that it expects doctors to act with, "honesty, integrity, probity, respect for colleagues and patients."

So what do they class as disruptive behaviour?

Sexual harassment
Racial, ethnic or sexist slurs
loud, rude comments
Intimidation or bullying
Abusive or offensive language
Persistent lateness in answering work calls
Throwing instruments
Offensive sarcasm or cynicism
Threats of violence or retribution or litigation
Demands for special treatment
Passive aggression

The Health and Disability Commissioner's Code of Rights makes reference to collaboration in Right 4(5) "Patients have the right to cooperation among providers to ensure quality and continuity of care."

The Medical Council of New Zealand also state that,

"Colleagues must always be treated fairly. In accordance with the law, you mustnot discriminate against them or let your views of colleagues’ lifestyle, culture,beliefs, race, colour, gender, sexuality, nationality, marital status or age prejudiceyour professional relationship with them. You must not undermine patients’ trust in the care or treatment they receive, ormake them doubt a colleague’s knowledge or skills, by making unnecessary orunsustainable comments about them."

The Australian medical council code of conduct states that,

4.2 Respect for medical colleagues and other health care professionals

Good patient care is enhanced when there is mutual respect and clear communicationbetween all health care professionals involved in the care of the patient. Good medicalpractice involves:

4.2.1 Communicating clearly, effectively, respectfully and promptly with otherdoctors and health care professionals caring for the patient.
4.2.2 Acknowledging and respecting the contribution of all health careprofessionals involved in the care of the patient.

4.4 Teamwork
Most doctors work closely with a wide range of health care professionals. The care ofpatients is improved when there is mutual respect and clear communication, as well asan understanding of the responsibilities, capacities, constraints and ethical codes ofeach other’s professions. Working in a team does not alter a doctor’s personalaccountability for professional conduct and the care provided. When working in ateam, good medical practice involves:

4.4.1 Understanding your particular role in the team and attending to theresponsibilities associated with that role.

4.4.2 Advocating for a clear delineation of roles and responsibilities, includingthat there is a recognised team leader or coordinator.

4.4.3 Communicating effectively with other team members.

4.4.4 Informing patients about the roles of team members.

4.4.5 Acting as a positive role model for team members.

4.4.6 Understanding the nature and consequences of bullying and harassment, andseeking to eliminate such behaviour in the workplace.

The GMC state that the duties of a doctor are to:Be honest and open and act with integrity

Act without delay if you have good reason to believe that you or a colleague may be putting patients at risk
Never discriminate unfairly against patients or colleagues
Never abuse your patients' trust in you or the public's trust in the profession.

I wish to remind midwives and student midwives that,
ANMC Midwives Code of Conduct states:

Statement 4
Midwives respect the dignity, culture, values and beliefs of each woman and her infant (s) in their care, and the woman's partner and family, and of colleagues.

Explanation

2. Midwives interact with colleagues in an honest and respectful manner.

5. Midwives refrain form expressing racist, sexist, homophobic, ageist and other prejudicial and discriminatory attitudes and behaviours toward each woman and her infant(s) in their care, partners, and families and colleagues. Midwives take appropriate action when observing any such prejudicial and discriminatory attitudes and behaviours.

Statement 9
Midwives maintain and build on the community's trust and confidence in the midwifery profession.

Explanation
1. The conduct of midwives maintains and builds public trust and confidence in the profession at all times.

2. The lawful and unethical actions of midwives in their personal lives risk adversely affecting both their own and the profession's good reputation and standing in the eyes of the public. If the good standing of either individual midwives or the profession were to diminish, this might jeopardise the inherent trust between the midwifery profession and the woman, as well as the community more generally, necessary for effective relationships and the effective delivery of midwifery care.

3. Midwives consider the ethical interests of the midwifery profession when exercising their right to freedom of speech and participating in public, political and academic debate, including publication.

Personally I believe these health professionals are not behaving in accordance with their code of conduct if they partake in this online supposed "black humour". It is interesting to note that apparently some of the English Dr's don't respect their governing body the GMC.

"Just tell us what we need to know"

2011-09-13T18:01:00.000+10:00

My personal philosophy when it comes to educating student midwives involves the following commitments:

the creation of lifelong learners
the creation of a community of online learning that provides support to each other
that the education of potential midwives is about pregnant women it is NOT about the student midwives.

I want to remind student midwives that midwifery courses are designed about creating midwives that are competent and safe for pregnant women and their babies. Therefore the course whichever you chose, is actually NOT about YOU it is about the women and babies that will eventually put their lives in your hands.

You have the potential position of power and trust. As an educator I need to be sure you understand that. when I design courses I am measuring a number of elements, that include your ability to:

gather information
the ability to confirm your gathering of information
confirm your use of knowledge
make use of knowledge
to analyse knowledge
to put together knowledge
to judge the outcome or evaluate care provided
that you can judge the outcome

Perils and the pitfalls of rural medicine

2011-09-07T11:35:00.000+10:00

Background

Rural communities are experiencing difficulties recruiting and retaining general practitioners. Often one of the reasons given for GP's not staying in their role in the rural community is that they are pushed by their partners/spouses to move back to metropolitan areas.

Rural GP work has particular challenges that are not only faced by the GP themselves but by their spouses which can include the crossing of personal boundaries and inability to maintain their own privacy. It is sometimes like being married to a 'Z' list celebrity.

As a wife of a rural GP for 10 years and also as a case loading NZ midwife in a rural community I have often faced these challenges which include:

Coming across people in the street or social settings who like to tell you that he is a wonderful Dr, wonderful listener.

Now whilst I am immensely proud of my husband and I know he is a great Dr, he is also just a man. At home he does all the usual manly annoying things. Sometimes i have had to suppress the urge to shout, "but he is just a man! He is not some sort of Demi God!"

Coming across strangers in the supermarket who like to say, "oh you're Dr Harnden's wife aren't you. I saw him yesterday about my haemorrhoids he sorted me out, wonderful man"

Actually he doesn't and never has come home from work discussing the people and things he has seen at the surgery. That would breach confidentiality. I don't want to look at members of the community in the supermarket and be thinking of those haemorrhoids or sexual abuse or any other medical condition thanks.

Another comment is also "I've tried to get to see that husband of yours but he is too busy do you think you could have a word with him?"

I am not his receptionist. The problem with my type of personality is that I tend to carry this with me and then I find I am asking hubby when he comes home from work to give them a ring which in turn then invades our family time together.

Sitting in a local cafe enjoying a coffee with the kids and someone sits themselves down and begins what sounds like a medical consultation.

This raises huge issues of boundaries, confidentiality and invasion of privacy.

These are just a few examples I can think of many many more.

Personal Experience

Here in Australia I faced the challenge once again. My husband is currently away in Canberra presenting at a conference. At 9pm my mobile phone rang, a patients husband was on the end of the phone and preceded to tell me that his wife was in hospital, carrying on to explain her medical condition. She was going to be discharged the following day, "the hospital have done nothing for her" were his words and he wanted me to arrange for her to be seen by my husband the following day.

I had to politely explain that he is away in Canberra and that I have nothing to do with the medical clinic, I have no access to his appointment book and although I sympathised with his frustration he really needed to phone the clinic on the landline the following morning.

I am more than equipped to deal with these issues because of my professional background but it still left me unsettled for the rest of the evening on a number of levels. I felt anxious about her predicament and her suffering. I also felt a little resentful that the call had invaded my home life and worried about how I had represented myself and my husband on the telephone. Where do I stand when I'm asked for advice on the telephone? Especially in this climate of mandatory reporting here in Australia? Shit, actually the more I think about it the more I know I could have even been compromised severely in a professional capacity yet it was them that have invaded my privacy. I am a midwife anything that I said to her partner on the telephone could be misrepresented to the Nursing and Midwifery board and in this current climate I could face being struck off as having given advice that was out of my scope of practice. Yet I have never, ever invited such calls.

I am more than a little nervous because they also know where we live. What do I do if they turn up on the doorstep?

Much needed research

I would like to conduct some research into the thoughts and feelings of partners and spouses of rural GP's who have moved back to metropolitain areas. Maybe if we can provide more supportive measures to them it may improve GP retention in these vulnerable communities.

An idiot and her research project

2011-08-23T17:11:00.000+10:00

Last December I was accepted into the PHCRED program run by Melbourne University. The purpose of the program is to take a primary health care practitioner who is without previous research experience through a research project. Support is provided through regular tutorials, project supervision and a grant of approximately $4,000. The project should ideally be completed within 12 months and although there is no formal qualification at the end of it, it is hoped that you may achieve a publication from the project.

I should have been blogging about my experience as I was going along but I have been bogged down with curriculum development for Griffith University, suffering gall stones, having surgery and attempting to settle down into an alien anti midwife culture.

The pressure to submit to ethics has increased over the last couple of weeks as I am now a little behind on my project. My peers in the program, already having achieved ethics approval, are now beginning to collect data for their research.

The problem is that although I began a literature search at the beginning of the year it has produced a number of pitfalls. I also spent a great deal of time searching for a validated tool that had already been used that I could replicate and adapt for the Australian context.

As the picture suggests I aim to investigate men's experience of supporting women through labour and birth in the Australian context.

What I would like to share with you is an 'idiots guide to a research project' and provide you with some handy hints and tips that have given me my 'ahah' moments these past two weeks.

Writing my biggest stumbling block

Three years ago I decided to commence post graduate study with Otago Polytechnic with the career ambition of becoming a midwifery lecturer. I completed eight post graduate papers and it took me two years to gain a post graduate midwifery diploma with merit. I maintained a B average. However during one of my papers I attempted to change my style of writing in an attempt to sound very studious and clever. This was a huge mistake and provided me with feedback which has had a powerful hindering effect ever since. After that paper I was told I couldn't 'write'.
I never have had a difficulty with writing before I gained a good grade at English and English literature O level at school. I had never before been criticised about my sentence structure or language.
This is a burden and anxiety I have carried into my PHCRED project. The difference is I am now an 'honorary research fellow' with Melbourne University and MUST write in a scientific manner.

I am of the opinion SCIENCE and MIDWIFERY don't mix. It is like oil and water. I have frustrated my project supervisor, a bestselling author, with my emotive style of writing. She in turn has made me feel like I suffer some sort of disability when it comes to writing in a scientific way. All in all there have been more moments of despair so far than there has been highlights. Culturally science and midwifery aren't an easy mix. This has been identified by the pioneer of culturally appropriate care giver, Ramsden in her thesis on cultural safety where she quotes an author Johnstone who warns that, “researchers who are brave enough to write about their own emotions risk being ridiculed, dismissed and marginalised” (1999, p. 26).

Guide to language
The first of my tips on the 'idiots guide to scientific writing' is to examine and identify words used in articles that you may be reading.
I now read an article or report and highlighter in hand colour in specific words. I was told 'describe' was a bad word to use and wasn't scientific. I now have stuck to the side of my computer a thesaurus list of words to use whenever I have the urge to write 'the study describes'.

If you are drawing from the results section of a paper then the acceptable words to use are:
Reported
Found
show(ed)
conclude(d)
indicate (d)
Results
identify(s)
Present(ed)
Findings demonstrate

If you are commentating from the discussion part of a research paper then use the words:
Suggest
so and so, state(s)

This is just number one of my tip for today!

References

Ramsden, I. (1999, March). Nursing research in New Zealand: We do have something to say. Tino rangatiratanga for nursing, through research. Paper presented to the New Zealand Nurses Organisation Conference, Palmerston North, New Zealand.

Maybe a chink of light?

2011-08-17T12:15:00.000+10:00

Today I presenting to a group of medical students from Melbourne University who are about to embark on their rural placements.

Why do I do this? Because I want to be involved in teaching and at the moment I have been invited to be a part of the medical students rural placements.

The learning objectives of the rural health module are:

To understand the impact of local context for rural people on their journey through illness and the healthcare system.
In terms of Aboriginal health to:

understand the social determinants of Aboriginal health outcomes and how history impacts on Aboriginal People's current health and wellbeing
develop an obligation to address the gap between Aboriginal and non-Aboriginal health outcomes at a personal, professional, institutional and community level.

To understand the expertise and experience of rural health practitioners, particularly in relation to six key themes.

The six key themes that underpin rural and remote healthcare are:

Patient access to care
Overlapping relationships
Cultural safety & cultural security
Generalist health care
Community-based models of health care
Interprofessional team practice

The Case
This is the case that was designed to examine and challenge the students to consider these six key themes:

You are a doctor in a small Victorian town of 3 500 people. Local facilities include a small cottage hospital with nurse led A&E assessment unit, to which you provide back up. There is also a birthing unit there, in which 500 births a year occur.

You are having lunch in your favorite café. The manager approaches you, she has found out you are one of the local town doctors having seen your VISA card details.

She approaches you saying that “She has heard you are really nice and a good GP obstetrician." She is 8 weeks pregnant and says she wants a home birth this time, saying her GP was dismissive of her request.

Discussion:

Overlapping boundaries

Confidentiality

Potential conflict with the other GP

Need to maintain professional approach even when your confidentiality is breached in a public setting

You see Mrs S 2 days later in your clinic.

She is requesting a home birth.

She is G3 P2.

Past Obstetric history

1. full term birth Emergency C Section for failure to progress in labour. BW 3.4kg, no peri or post natal problems

2. Full term normal vaginal birth. BW 3.87kg no post natal or peri natal problems.

She is a non smoker

She owns the local coffee shop.

She is very unhappy with her previous birth experiences. The midwives and doctors referred to these as deliveries which really upset her.

She says she only had a C section due to the fact that her doctor was very tired and it looked as though she would have her baby at 5am.

She also says the local birthing unit is impersonal, she wants 1 on 1 care during childbirth and to know the people looking after her in labour. She also wants birth attendants who respect her wishes.

This is her final pregnancy and she wants her mum, sister, husband and children to be present which the hospital will not allow.

She is medically fit & healthy

She does not drink alcohol.

Discussion

Involve respect for patient’s views

Need to explore risks vs benefits of home birth

Possible criticism of a professional colleague ?do they have a problem, could involve conflict

?Criticism of local hospital policy

Where do you draw the line here?

Rights of patient to choose place of birth

Risks of refusal ie free birthing loss of reputation in community

Referral pathways to midwives/ home birth doctors

You referred this woman to a colleague who birthed at home successfully.

She comes back asking you to look after her family as you listened to her concerns.

This lady originates form the Cook Islands.

The place of birth and role of family is sacrosanct to her values & is thankful you supported her in this.

What other cultural aspects around birth are you aware of?

Facilitating learning around evolving themes

The key to this mornings session was to be prepared as a facilitator of learning to adapt and evolve in response to the themes thrown up by this discussion. I did not rigidly stick to the script and in fact a 30min discussion turned into an hour.

My previous interactions with Australian medical students have been in stark contrast to my contact with New Zealand medical students. New Zealand medical students I have tutored have been warm and responsive individuals in contrast to, until today, feeling the arrogance and superior attitude of the Australian medical students. It was because of this attitude I was slightly nervous about the presentation this morning.

The medical students today I found were very interested and motivated to contribute to the discussion about this case. I discovered that we set of down a track and explored many of the issues facing rural pregnant women today. I was able to draw on my knowledge of the National Guidance on Collaborative Maternity Care document published by the Australian Government.

It also gave us the opportunity to explore the issues around mandatory reporting and the potential effects and also how it may be used as a weapon as well as protecting the public.

Chink of light

The chink of light that came out of the session for me was the medical students themselves stating that there needs to be a change. The change to more women centred care and less fighting between health care professionals in relation to pregnancy and birth. They wanted to see the culture changed at student level and expressed a wish to be more exposed to midwifery philosophy of care.

Morning of surgery

2011-07-25T09:18:00.001+10:00

It is 9.00am I will be admitted to hospital at 11.00am for removal of my gall bladder. Yes I am nervous.

I am nervous because I hate surrendering control of my care to others. I wonder what type of nursing care I will get?

I hate being on that theatre trolley wondering about how my dignity is being preserved once I am rendered unconscious.

I am reminded of a time I tried hypnosis for weightloss. It wasn't successful because apparently I am difficult to hypnotize and don't surrender myself to lack of control at all!

Maybe that's the midwife in me!

Honestly I really don't care if my nurse has a degree or a diploma or if she is good at creating a computerized care plan. I only care that

1. I feel safe
2. My dignity is preserved
3. That I am kept clean
4. That I am able to get to the toilet
5. That I am not fluid overloaded like last time
6. That I don't suffer too much post op pain
7. That the staff are friendly and caring

And please please most of all I hope I have a nice night nurse for a change!

- Posted using BlogPress from my iPad

Let's teach Social Media

2011-07-21T14:11:00.000+10:00

I have been thinking of how to develop a Social Media course for health professionals and I thought I would put a few of my thoughts into a power point presentation.

I am mum, the job's never done

2011-07-20T10:56:00.000+10:00

I am a mum; the job’s never done

I am a mum the job’s never done.

Where’s my time card, the clock out clock?

Let me find that darn timesheet

Oh yeah I forgot I’m a mum the job’s never done.

I am a mum the job’s never done

The toilet needs flushing

The weight of responsibility is crushing

Oh yeah I forgot I’m a mum the job’s never done.

I am a uh uh mum the jobs are never done

I place things in the bin

Cutting my finger on a tin

Oh yeah I’m immune to blood, I’m a mum the job’s never done

I am a mum the job’s never done

Yeah postman delivery guy

It’s lunchtime and I’m still in my pj’s

Can’t you see I’m a mum? My job’s never DONE

I am a *sigh* mum the job’s never done

“Muuuuuummmm the dog’s pooed in the laundry again”

I am dog poo mum

My job is never done

I’m a mum a desperate in need of coffee type of mum the job’s never done

There’s a gorgeous muddy-handed artwork piece on the wall

I am not cruiser, casual coffee drinking mum

I’m scrubbin’ wall mum, the job’s never done

I’m in need of a sexy make over mum but the job’s never done

I have a great scent of detox, antiseptic scent of floor cleaner

I am not J-Lo scented sex goddess

I am floor scrubbin’ mum is this job ever done?

I am a mum, I am glad the Job’s never done

I wouldn’t swap those bedtime hugs for any perfume in the world

Nor the phrase “I love you” from cherub innocent mouths of offspring

I am mum, loved mum, best in the world mum, so glad the job’s never done mum.

Back to Brisbane

2011-07-19T11:07:00.002+10:00

Australian Nursing and Midwifery Guidelines on using Social Media

Last week I attended the Primary Health Care Conference in Brisbane.

The official opening remarks to the conference were given by The Hon Mark Butler MP, Minister for Mental Health and Ageing. It was impressive that he managed to sneak in a reference to the carbon tax within the first 10 seconds of his opening remarks but I resisted the urge to heckle him!

He did mention he was on twitter every other sentence, however he is not a MP who interacts in the social media framework he just uses it to promote government policy and himself! I will soon be unfollowing this minister as I like to follow those who use the space to share comments, connect and learn from each other.

The greatest concern I have is with the review of health and medical research in Australia currently occurring. This is the link to the terms of reference for the review. The proposal involves creating centres of research excellence, all well and good until you examine the potential for abuse this creates in the competitive world of research. I am fearful it will create an elitist approach to research and old school boy network that will led to a chosen few being involved in research projects. This chosen few will abuse the system by disseminating the jobs connected to their research amongst their own buddies and it will be a case of who you know and suck up to that will be the biggest influence on whether you are involved in research or not.

The knock on effect for rural areas is the potential for rural researchers to be completely cut out of the loop. Rural health and rural research is not seen as dynamic and sexy enough. How can urban researchers understand the special needs and requirements of the rural community? It is offensive to the rural community of Australia that their needs are being totally ignored but I am not surprised, nothing surprises me anymore I just feel sad.

The main workshop I was interested in attending was presented by Melissa Sweet of Croakey. This presentation at this years Primary Health Care Research Conference aimed to gather thoughts on answering the question, how can primary health care harness the opportunities of the digital media age?

I was particularly drawn to this workshop because as a former New Zealand independent midwife; I am an avid social media user (my husband points out far too avid at times!). I have seen the slow growth of health care providers using social media networks to inform the public, share and support each other across a worldwide stage. I have also found that I am connected and have access to a wider variety of people, across many countries.
It has opened up my world, increased my knowledge and does not recognise the barriers of language and social class. I am going to steal Melissa’s phrase of, ‘citizen journalism’ to describe my social media space after attending this workshop.

I was shocked and surprised when I found my hand in the air volunteering to be scribe for the session so that the piece could be put on the blog. I even managed to crack a joke in a room packed full of professionals!

Melissa opened up the session with a general introduction to the world of twitter and instead of being asked to turn off our mobile phones we were actively encouraged to tweet from the session. Tweeting involves sharing 140 characters sound bite from your day, it is described as mini blogging. ‘Hash tags’ can connect tweets.
Tweeting from this session or the conference as a whole could be connected by adding the hash tag, #phcris. This enables twitter users to single out the subject of #phcris and gather all the information people are putting out about the conference.

There are a number of questions that as groups we attempted to address in this workshop.

· Is there a way organisations can approach social media in a positive way rather than a risk management way?

Many hospitals and health care providers block and ban the staff from using social media sites such as Facebook because they see them the potential for time wasting for staff. There has also been a focus on the few privacy issues that have arisen within the spaces. Maybe there is also a general reluctance to take the time out and investigate the benefits of information sharing with it all being placed in the ‘too hard basket’ of policy makers. It is also difficult for those who hold positions of influence to harness the potential for information sharing within these spaces if they themselves don’t understand how they can be used.

· Is there a way that we, as healthcare providers can be proactive rather than reactive in social media?

There has been a report written and released in June 2011 about how to use social media to improve healthcare quality. The mayo clinic is leading the way as an example. ABC open is working to keep people informed. Social media is described as now democratizing healthcare.

We were divided into 6 groups and to hopefully read what those groups discussed I suggest you keep an eye out on the croakey blog for the feedback I wrote (thats if it is good enough!)

Wrapping up

What I gained from this session and from what I have personal experience of is, that social media is a vast resource of information and ability to connect with people. Health care providers are in danger of being crippled by their own fear of the unknown and will be left behind in the wake. There are countless recent examples of how people have been left following disasters with social media as their only means of gaining information and connecting with the outside world. We cannot as responsible health care providers afford to be left behind, we need to be more proactive and get in with the in crowd.

1st Communion

2011-06-27T09:33:00.000+10:00

Sunday morning Chris and I looked on nervously as the girls took their 1st communion. As you can see Jemima is the one wearing a purple jumper. She out and out flatly refused to wear a white dress so I didn't get one for Jasmine.

This day has followed 3 painstaking months of 'tuition' for Chris and I. Tuition which Chris and I had to go through ourselves as children but now the rules have changed and the parents take the lessons!

I was very nervous and stressed because the event was so choreographed I was worried that I or the girls would end up in the wrong place at the wrong time. However an event took place which I could never even dreamed in my wildest nightmares.

We had to sit the Jasmine and Jemima on different pews, children towards the centre aisle. Chris and I sat one next to each of them hence Chris and I were in different pews. The children went up for communion first, received the host and walked down the side aisles, back up the centre aisles and into their pew. The adults then went up for communion.

I received the host, turned and walked towards the side aisle. As I turned into the side aisle I looked at Jemima to see her with her finger in the roof of her mouth scraping the host off the roof of her mouth. I had one of those go slow moments, everything seemed to be in slow motion I couldn't scream out "NOOOOOOOOOOO!!" Lest I attracted too much attention and I thought a flying tackle over the top of the pews might have seemed a little dramatic. But I couldn't get to her quick enough to stop her bringing the host out of her mouth half melted on her finger, look at it and then vigorously shake it off her finger on to the floor!! I just had to sink to my knees defeated, shamed into my pew and pray very earnestly that no one had seen it.

A surgeon, A midwife and a GP

2011-06-23T11:39:00.000+10:00

Recent health scare

Over the weekend I became really unwell with symptoms that I have been suffering from for a number of years but this was worse and lasted from Friday evening until the end of Tuesday. I have been looking back through my blog posts because there are a number of themes that led to be becoming so unwell. I also need to express my anger and disappointment at the fact that the last two years of suffering could have been avoided if a certain professional person had done his job properly.

Background

Roux-En-Y Gastric Bypass Surgery for weight loss

I began this blog Friday, October 24, 2008 two weeks post op of my gastric bypass surgery for weight loss.
My first experience of the excruciating pain that was going to dog me for the next two and a half years was at four days post op.
Four days post op I had an epidural removed and was thrust 2 panadol in exchange for the complete block and tramadol injections I had been having for the initial post op recovery. My body seemed to go into complete melt down approximately one hour after the epidural removal. I had severe epigastric pain which eventually spread all over my trunk leaving me leaning over the bed moaning, rocking and groaning as I tried to escape it. Despite a full load of Fentanyl given intravenously the pain was not relieved and I just had to ride it out.
As you can read in this post the following day of starting the blog, I was still feeling uncomfortable enough to need to take regular paracetamol. I blog about trying to teach my then 7 year old how to knit but having to abandon it because I am too sore.
The clear problems with communication with the post op nurse are described in this post. I am amazed now at how useful it is looking back through my blog and reading the difficulties I was having communicating with this nurse. I describe being cut off, how she didn't appear to be listening and despite the 30min allocated appointment length it was over and done with in 10-15mins! Please bear in mind I'd pain $25,000 for this surgery out of my hard earned midwifery caseloading money.
I didn't record my next major post op visit where I actually got to meet the consultant himself again. Pre op I had tried once to enter into a two way conversation and I was abruptly stopped. He held his hand up to my face and said, "my dear I do not say these things so you respond, I say these things so that you listen. You are not expected to talk back to me." Ominous sign you may think? Well at the time there were 10,000 gastric bypass surgeries going on in New Zealand and this particular consultant took care of at least half of them. I wanted someone who would definitely know what he was doing when he opened me up. So yes, I did put technical ability above bedside manner but perhaps to my cost. This pre op consultation style set me up for my post op consultation with him. A month following the initial surgery I had had a repeat session of the severe pain I had suffered day 4 post op. I was unable to get out of bed, moaning, groaning and my daughter had an anxious time calling her dad at the surgery to come home and see to mum. Chris my GP husband accompanied me to the post op visit with the consultant and he was amazed at my unusual lack of forthrightness and submissiveness in the visit. Near the end he felt he had to step in and say, "are you going to tell him about the pain?"
My pain was instantly dismissed as 'oesphageal spasm'. It was my fault, I was told I had obviously tried to undo his work by eating too fast and not taking proper care. The pain was there to remind me of this fact and I was reminded that he had saved me from diabetes, arthritis and had improved my life expectancy. So this set the tone for me really and for the next two and a half years every time I have had the pain I have thought, "Pamela it is your punishment, you have done something wrong, you have eaten incorrectly it is oesphageal spasm."
This tone was set really as whenever I visited the GP for follow up I played down the pain episodes, got around mentioning them and started to try and hide as many episodes from the family as possible. This has meant that for the last two and a half years I have been taking paracetamol regularly as many as 6-8 a day, everyday. Recently it got to the stage where I've been unable to leave the four hours between dosages and have taken 1.5mgs as an attempt at a 'loading dose' that anaesthetists sometimes prescribe instead of the recommended 1mg dose. I also found recently that if I took paracetamol with a glass of wine it had a better effect. Dangerous thinking alcohol doubles the effect of paracetamol on the liver.

Bloods

I was supposed to have half yearly blood tests to measure my full blood count, glucose, liver function and vitamin B12 levels. Without being too complicated I became fearful of the liver function tests. Liver function is measured mostly by (and I am not going to spell out the big words I am just going to use the initials), AST, ALT, GGT, Bilirubin, albumin and ALP. For a link to a really easy to read and understand guide to interpreting these tests click on the words above.


TABLE 1 Helpful Hints for Interpreting Liver Function Tests
Situation	Comments
Mildly elevated ALT level (less than 1.5 times normal)	ALT value could be normal for gender, ethnicity or body mass index.
	Consider muscle injury or myopathy.
Alcoholic hepatitis	Laboratory values can appear cholestatic, and symptoms can mimic cholecystitis.
	Minimal elevations of AST and ALT often occur.
AST level greater than 500 U per L	The AST elevation is unlikely to result from alcohol intake alone.
	In a heavy drinker, consider acetaminophen toxicity.
Common bile duct stone	Condition can simulate acute hepatitis.
	AST and ALT become elevated immediately, but elevation of AP and GGT is delayed.
Isolated elevation of GGT level	This situation may be induced by alcohol and aromatic medications, usually with no actual liver disease.
Isolated elevation of AP level (asymptomatic patient with normal GGT level)	Consider bone growth or injury, or primary biliary cirrhosis.
	AP level rises in late pregnancy.
Isolated elevation of unconjugated bilirubin level	Consider Gilbert syndrome or hemolysis.
Low albumin level	Low albumin is most often caused by acute or chronic inflammation, urinary loss, severe malnutrition or liver disease; it is sometimes caused by gastrointestinal loss (e.g., colitis or some uncommon small bowel disease).
	Normal values are lower in pregnancy.
Blood ammonia level	Blood ammonia values are not necessarily elevated in patients with hepatic encephalopathy.
	Determination of blood ammonia levels is most useful in patients with altered mental status of new onset or unknown origin.
ALT=alanine aminotransferase; AST=aspartate aminotransferase; AP=alkaline phosphatase; GGT=gamma-glutamyltransferase. At one point before coming to Australia my blood tests had been done and because I wasn't telling anyone about the pain I had received a lecture about how I was probably drinking too much alcohol and I pretty much felt like I'd been labelled some sort of alcoholic. This had a knock on effect I began to avoid all my check ups all together and I was refusing to have my blood tests. I felt like an opinion had been formed and everyone was going to believe I was a raging alcoholic. This last weekend This last weekend everything accumulated and erupted. Friday evening the old familiar feeling of the beginnings of the pain started. An indigestion spreading from the epigastric area , across my chest, under my ribs and a stabbing pain in the middle of my back. The epigastric pain crescendos into acute spasmodic rhythms not unlike labour contractions but felt in the chest. I started with my usual methods of pain relief. The warm bath, I had found it really useful in the past but in New Zealand we had a huge spa bath, very deep which supported my abdominal pain and allowed some relief. In Australia we have a very old shallow bath nowhere near deep enough. I tried my next option the hot water bottle. Usually I need it so hot that the skin blisters, great for distraction therapy but no good for long term pain relief (the skin doesn't respond well). I then gradually become more and more internalised much like I did when in labour, moaning, groaning, stopping my feet and rocking to try and relieve the pain. Unfortunately unlike previous episodes which have lasted 40mins to a maximum 8hours I was still suffering on Sunday afternoon at which point pain induced vomiting began. Chris finally put his foot down. I was still refusing hospital, A and E, sorry I have a general mistrust now of surgeons and nurses, and I didn't want to get to the hospital, have the pain stop and then feel like a complete dick for wasting every one's time. I just kept thinking, another 10 mins, it might stop in another 10 mins. Chris came home and said I have made an appointment for you at the Drs for tomorrow (Monday morning) at 09.45. And so, my week began. I saw the GP. I had to drive to the surgery with a bucket in the car so I could pull over and vomit. I had to lie down in the surgery. I was basically at my wits end, the pain had stopped but I was fearful of its return my reserves were spent. I was basically tired and tearful as well. 1st up were the blood tests following some IM stemetil I frailly took myself over to the lab. I was very scared at this point because I knew I had been taking too much paracetamol to try and cope with the pain. I thought my liver was beginning to fail. The blood tests came back, Chris came home and said scarily, "Congratulations you have some of the worst liver function test results I've ever seen". The grim look on his face said it all and I knew he was thinking of a worse case scenario. This just sent me into denial. He asked, "How do you feel about that?" I just busied myself in the kitchen trying to make dinner for the girls and said I didn't have time to think about it. That night I did though when the pain returned and I thought everyone was sleeping. I was cold and I thought it was that that had woken me but then I felt the familiar spasmodic rhythms again. This time though I had received dire warnings from Chris. I must stay away from the paracetamol and so I decided I would search the internet. I searched out the worse case scenario's liver cancer and cirrhosis and decided I might only have five years to live. Fitfully I finally managed to get the odd few minutes of sleep. So the next 48hours were pretty scary and I had a full range of emotions but mainly tried to keep them hidden from everyone. Tuesday I had a liver and gall bladder scan. The best case scenario outcome was gall stones. This is where I return to the origins of my anger. The consent for my original surgery included gall bladder removal because it is very very common to get gall stones following gastric bypass surgery. However he did not remove it. He never explained why but my surgery was running 2-3hrs late that day and I believe it influenced his decision. He wanted to be away on time, often in the private sector surgeons are charged extra if the run over their allotted theatre time because theatre staff need to be paid on call money or overtime. Unlike in the UK where we could charge the patient as we went along for services (I was a scrub nurse in a BUPA hospital prior to midwifery), I was on an upfront fixed fee in New Zealand. This means any extra costs incurred come out of the surgeons own pocket. Summary I believe if he had done the thorough job in the first place, I wouldn't have suffered. If the nurse and the surgeon had been effective communicators, which means effectively listening as well as talking, I might not have suffered. If I hadn't been made to feel judged or assumptions made about alcohol causing my raised blood results, I wouldn't have started to hide my symptoms. If everyone just cared a little more and did their jobs a little more effectively, I wouldn't have suffered this much.

Trying to find out what percentage of men in Australian support their wives/partners through labour and birth

2011-06-11T18:43:00.000+10:00

Create your free online surveys with SurveyMonkey, the world's leading questionnaire tool.

10 yrs Old!

2011-06-06T11:39:00.000+10:00

Every year the request has been, "can I have a birthday party?"

My reply has been, "When you are 10"

Jasmine was 10 years old last week the time had finally arrived.

She was restricted to inviting 5 friends. I am sorry but that is about the number I can handle in one sitting.

We devised a theme adapted from another party which my younger daughter attended recently, a 'spa' theme. This spa theme centred around facials, nail varnish and a foot spa experience. It was a great lesson in planning and assessing what goes well and what doesn't go well with this theme.

Build up planning.

I purchased a foot spa and massager, nail varnishes (multiple colours), hair pieces (vibrant colours), face packs and foot treatments.

Day before

The preparation included a massive, monumental clean up operation. I don't think the girls would have really noticed if the place was clean but it is always important in case the parents enter the house. Most of my food prep was also done the day before.

Menu

Decorated fair cakes.
I found an easy cup cake recipe:

125gms melted butter cooled
3/4 cup of milk
2 eggs
2 cups self raising flour
3/4 cup of sugar

And I added chocolate chips.

Mix flour and sugar together make a well in the middle.

Mix together cooled butter, eggs and milk

Add wet ingredients to dry ingredients and mix

Fill cake papers 3/4 full and bake for 8-10mins

I did buy ready made frosting, once the cakes were cool I piped the frosting on top and added a pre made decoration.

I also made sausage rolls, ham, cheeses and pineapple pinwheels.

But the real hit was melted chocolate in fondue set with marshmellows, strawberries, banana and pineapple chunks.

Party Plan

14.00 - Welcome drinks served in pink plastic champagne glasses, lemonade with a strawberry

Activity 1

Facemasks.

With facemasks applied I asked them to lie down in a circle with pieces of cucumber over their eyes they then had to share something with the group, a fact that their friends didn't already know about them.

I was asked by my daughter to leave the room at this point as she said that her friends might be inhibited with an adult present! She didn't realise her dad could hear from the office and so we learnt who her first crush is!

Giggles and hysterics made facial mask removing difficult and things threatened to get out of control.

Activity 2

Musical nail varnish

The plan was, that each girl would choose a different nail varnish and paint one colour on one nail. I would start the music and they would pass the nail varnish to the next person until the music stopped, then they would paint another nail. This should continue until all the nails are painted.

This didn't work out as planned.

Two of the girls just wanted one colour for their nails. Then once one hand was painted they obviously couldn't paint the other hands nails and there was dispute over which nail varnishes they wanted. It is also very difficult to do single handed, it is definitely a two adult job. I abandoned the idea as nail varnish was all over the table cloth and all over each girls hands.

The nail stickers were popular though.

Activity 3

Foot Spa

I recommend practicing with these before use! I didn't. I added the bubbly stuff and when they turned it on we were engulfed with soapy bubbles. The girls found it hysterically funny and started a bubble fight. I decided it wasn't worth intervening and so long as there was laughter I ran with it.

Activity 4

Making Body Glitter

A very simple process of buying Aloe Vera gel, glitter, plastic pots and wooden spatulas. Each girl got to choose their glitter and mix it in the plastic pots with Aloe Vera gel. They got to take it home and they got to put some on before going home. This was easy and they seemed to like it.

Activity 5

Adding hair pieces

I bought some brightly coloured hair pieces, let them choose their colours and added them to each girls hair. I did need to trim the hair pieces to the same length as their own hair.

For a two hour party this I found was enough activities as they wanted to play with the presents and do some hysterical running around. It was not a quiet, tranquil spa day but I really think that spa treatment businesses should consider this as an option to grow. I would have loved to have booked them all into a spa for the day, it would have been so much easier! Others may consider getting a team of adults together to 'man' the different stations and to help out.

Curriculum Development

2011-05-28T13:02:00.000+10:00

Online curriculum development for student midwives is challenging. Some days it can feel like you are wadding through treacle and other days an easy 5,000 words flow through your fingers onto a word document (rare moments, probably once in the last 9months!).

The last couple of months I have been challenged, creating two online modules simultaneously. I work collaboratively with a different tutor for each module and a web developer. My role is to develop the content.

The process begins when I look at the content of the module and I come up with ideas as to what I believe needs to be covered. I usually have an online skype meeting with each tutor then to see if my ideas fit in with what they believe should be covered and what has already been discussed at the university. It is vital at this stage that I have an idea of what has already been covered with the students to avoid repetition.

Once the subjects have been decided on I then begin a creative process of attempting to brainstorm some ideas of how it can be covered in a way that measures the learning outcomes of the module.

Last semester the course I developed involved very practical 'nursy' type tasks this meant step by step images needed to be found to support the text and make it more engaging.

This semester involves evaluating the students ability to plan and evaluate midwifery care. The idea for one of the modules was to create 'case notes' for students to immerse themselves in and describe and document their actions in response to the circumstances that were developing. I was very naive. I believed in no time at all I could reel off five cases creating the scenarios. Actually this is a very time consuming approach, interesting but time consuming. It involves plenty of digging into the depth of my creative mind.

The second module has evolved using two approaches. I have developed case scenario's for the students to plan care for but I also wanted them to gain experience EVALUATING midwifery care. The difficulty is how to evaluate midwifery care given without 'real' women that can demonstrate the effects of midwifery care. So I have asked the student midwives to assume the role of 'expert midwife witness' to some coroner cases. In these cases the coroner has called upon a midwife to evaluate the midwifery care provided and the midwife provides a report based on the questions asked. The students use the readings provided, reference their code of conduct and write a report to present at WIMBA sessions.

Some of the subjects have involved midwifery care given to women with complex problems this has meant there has been at times a wee bit of procrastination. Also like any writing I often am staring at the screen wondering where I am going with the story. It is at this point that I need to revisit the learning outcomes and what we are trying to achieve with the module.

Collaboration

Working in an online environment in a collaborative manner has its difficulties. Deciding on a tool to use which everyone can access and avoids multiple documents floating around is a good starting point. Last semester I tried email back and forth of a word document. The biggest drawback of this is following review comments, tracking changes and ending up with a full inbox of multiple copies of the same module. This can lead to confusion and I intensely dislike trying to read the document once multiple people have added their comments along the side.

This time the process began using google documents. I created a document for each module and added the collaborators. My intentions were that any of us could work on the document at any one time the changes would be there and there would be one complete document at the end of the process. There were a number of difficulties with this. Not all the collaborators were able to access and see the document. The biggest difficulty was that any collaborator could see if any work at all had been done on the document. This is not good for a bulk worker like me who procrastinates and thinks things over before actually committing to writing. I then suffered some difficulties when I tried to access the document via my laptop when on holiday and after a night of tears and tantrums I had to turn to dropbox to try and find a solution.

Dropbox still means that i work within a word document and then load it up. It definitely cuts back on documents in my inbox but I still don't feel entirely happy with this option.

If anyone has any other ideas feel free to let me know.

Conference Presenting

2011-05-08T09:29:00.001+10:00

This week has been yet another busy week. Part One

Virtual International Day of the Midwife

I have been doing a tiny bit of contributing towards helping Sarah Stewart organize this amazing free conference. Sarah does a fabulous job creating and organizing this online 24 hr event held on International Day of the Midwife. My contribution was small and I do wish I could have done more to help.
I decided during this event I would hold a discussion around the subject of student midwives learning in an online environment. This obviously is an area of interest to me as I work developing online content for student midwives at Griffith University in Queensland.
I didn't prepared a PowerPoint presentation for this slot. This I thought was slightly risky. I had a number of anxieties:

1. What if no one showed up?
This was a groundless worry a total of 32-35 people attended the session

2. What if no students showed up? After all the discussion was about their learning and I wanted to let them lead the session.
Another groundless worry the majority of those attending were student midwives

3. I had nothing even vaguely documented as a plan. All I had were vague thoughts in my head would anything flow?
In the end there did seem to be some sort of flow to the session and I seemed able to pick on threads of how students were feeling.

My personal drawbacks

I travelled to Brisbane as I was also presenting at the Passage to Motherhood conference and so I travelled with my iPad 2 and my netbook. The iPad doesn't support java and so couldn't support the Elluminate session. My netbook is small, light and convenient but it does have it's drawbacks for an elluminate session. I couldn't see the text box very well as it is tiny in my screen and so I couldn't keep up with the comments expressed there. Even if I could have kept up with the comments reading and keeping an eye on what is being written on the whiteboard and the text box is a challenge. If I had been at home in the office with my desktop this wouldn't have been a problem.

My highlights

Having Carole as a facilitator. She was brilliant, calm, explained how to use the tools exceptionally well to the audience and drew my attention to comments she felt were important. She was the perfect facilitator for this session. What I should have done (and I would have if I hadn't been so busy) was had a discussion with her in the days leading up to the session so I could have explained my thoughts and plans to her.

Enjoyed

I enjoyed the fact that it felt less didactic in the session, Carole and I seemed to work well together, the audience participated. All in all it felt like the session went how I wanted it to go and the ideas flowed well.

I want to thank everyone for turning up and participating and making it a useful session.
Of course a great big thanks should go to Sarah for putting on the event!

- Posted using BlogPress from my iPad

2011-05-04T14:52:00.001+10:00

Passage to motherhood

View more presentations from Pam H

Terminating

2011-04-23T18:18:00.001+10:00

Introduction

This is going to be a very difficult post to write. I continue in my role as curriculum developer for Griffith University and their online midwifery course. We are currently developing a subject around termination of pregnancy. I want the student midwives to develop an understanding of what it is like to terminate a pregnancy from the woman's point of view and so I turned to looking for blog posts on the subject. The difficulty is that most blog posts on the subject contain some sort of religious or political slant. So with a deep, deep breath I have decided to drawn on my own experience.

Deep dark secret

I have no idea who truly reads this blog. I have had some surprises but I have always thought of it being on the quiet side in comparison to most and I must admit I probably won't be publicizing this post. That is because abortion brings out some very judgemental opinions from people and of course some people who read this blog will form a judgement and never read it again. I may even get some hateful comments, I hope not but I must be prepared. It is the risk of these judgemental comments that mean many women who have an abortion will keep it as their own deep dark secret to be carried around, occasionally thought about when brought up in real life but mostly shelved compartmentalised in a little cardboard box of life's experiences. It is estimated that as many as 1 in 3 women will have an abortion in their lifetime (RANZCOG, 2005).

My life

My life has been very complex. I have made some very difficult decisions, some good, some bad but I always accept responsibility and move on. There is no point in mulling over things which have occurred holding yourself there, letting it affect the rest of your life. So, with this in mind I will describe my experience of terminating my pregnancy.

Circumstances

It was 17 years ago and I remember the events very clearly. I was in a supposed loving relationship, we were living together at the time in our new house on a financial knife edge. I had just qualified as a midwife and I needed to be interviewed for a job. Jobs were precious in the area where I trained as new midwives were qualifying every 8 weeks. I was also 8 months away from the big white fairytale wedding which had been already partially paid for and my dress was being fitted. My partner was the 'boss' in our relationship he decided when and where we did things and how our money was spent. He controlled our finances at that time to the point at which I began to loathe and dread the analytic, inquisitional pouring over the weekly bank statements. I was not privy to how much of our finances worked and even though I denied it at the time, I was 'controlled'. My ex husband would deny this because he had no insight into his behaviour but I was in the wrong relationship.

A positive pregnancy test

I needed a job, the pregnancy was not planned and as such it wasn't 'allowed'. I cried in the bathroom, came out and told my partner he immediately reacted in the way I anticipated. This wasn't planned so this wasn't allowed I would be terminating wouldn't I? I won't blame him. I was gutted. I wanted my big wedding. I wanted my midwife post. I wasn't ready for this. How would I tell my parents? How could I disappoint everyone? I continued to cry I am sure partly because of all the reasons I just gave above but partly as well because of what I was about to arrange. My partner rang the private Manchester Clinic but they would obviously only talk to me, I had to make the appointment. Tearfully the appointment was made.

Clinic Appointment

The clinic was situated in a suburb of Manchester. I felt like I needed a cloak over my head as I entered. Was everyone watching from the neighbouring houses? Maybe it would have been easier to enter the property under cover of darkness. I filled out the paperwork in the waiting room knowing that everyone else in the waiting room was there for the same reason. I remember vividly one young girl trying tearfully to fill in her paperwork, three times she walked out of the clinic claiming she couldn't do it until eventually a car drew up to the door and she was whisked away tyres squealing and boom box music pounding, vibrating down the driveway.
I was seen and questioned by two doctors which obviously fulfills the clinics legal responsibility that every woman is assessed as the reason for terminating my pregnancy was due to the pregnancy affecting my mental health.
I decided to opt for the overnight stay because if I was to have a day stay then my GP would need to be informed as he would need to provide care in the event of an emergency following the procedure.

The Day of the Procedure

I was admitted to the 'ward' The ward was full, I think around 8 beds. We were all prep'd for theatre. We didn't really look at each other or speak to each other. There was a blond girl next to me but there was also a girl who kept her bedside curtains closed during the whole stay. She was sobbing during the whole stay. She sobbed going to theatre, sobbed as she woke up from the anaesthetic and she sobbed all night until she was discharged the following day. That was the most difficult thing to listen too but we were all feeling a heavy weight of decision making. I thought constantly about my life and how this was something I would now need to live with for the rest of my life but I had nowhere to go and no one to call unless I went through with it. I felt trapped and now I had signed the forms I had no choice but to go through with it. Was this all my decision? Probably not but my life was all tied up with my husband to be, a mortgage that needed to be paid, a job I needed to have, I couldn't see any other way but swallow my doubts and go through with it.

I recall being taken to theatre and I recall going under the anaesthetic as if it were yesterday not 17yrs ago. I woke up from the anaesthetic remembering two staff trying to transfer me from a wheelchair onto a bed. I was probably 100kg at the time, I recall my bottom getting stuck in the wheelchair and the staff not being amused as I suffered the indignity of the transfer to the bed. The rest of the afternoon was a haze as I never cope with anaesthetic all that well. Every time I sat up I vomited. We were told to get ourselves to the dinning room at meal time. I tried but I vomited on the way. Gradually through the evening I began to recover and the rest of us began to talk to each other as we were joined in our sympathy for the girl from behind the curtains who couldn't stop sobbing. We were all suffering abdominal cramps but none of us dared ask for pain killers. None of us actually discussed why we were there either and carefully developed a fragile friendship without really sharing much.

Feeling Empty

I woke up the following morning and found myself feeling very sad. I clutched my stomach and suddenly felt very empty, like something was ripped from me. I once again swallowed these feelings and felt it was a justifiable punishment for what I had done. Little did I know that my actual punishment was to come. Prior to discharge the Dr and the nurse in charge do a ward round. They stood cold and hard at the end of your bed and I quote,

"We terminated your baby yesterday by sucking it out of your womb. Your baby was 7wks and is in a suction pot in our theatre. You are no longer pregnant. We suggest that if you are not going to return here you make suitable decisions and keep your legs together."

When the girl from behind the curtains was delivered of this speech we all took a collective deep breath as a howl of pure pain and emotion came from behind them.

I decided I had to take it on the chin. I wouldn't give them the satisfaction of knowing that they had hurt me it was obviously what I deserved.

I was collected by my partner at the time and rewarded with huge bars of chocloate and the words, "well done".

Well done wasn't quite what I was feeling but it was no good expressing how I felt because I didn't really know, I couldn't describe it. I felt guilt, shame and horror at what had gone on all wrapped up in some relief as well.

The next few weeks and months were hard. There were times I wanted to scream at everyone, "Have you any idea what I have been through?" But of course I couldn't. I couldn't because I was not to tell anyone it was a very bad thing I had done. Society demonises it. Politically, abortion is used to score votes from the conservative, pro life lobby. Feminists brandish it as a right for women to have choice over what happens in their own bodies. Some American states say it is harmful to the woman's psychological health to undergo the procedure and so it is illegal. Some very opnionated women state that if a woman is affected long term then she mustn't have really wanted it in the first place.

I carry a wound, I am not psychologically 'damaged' but I made a decision which I live with everyday. I stand by that decision, placed back in the same circumstances I cannot say that I would have made any other choice.

Today of course because I am married to a better person and I am in the right relationship I would never consider making the same choice. Thankfully things are different now.

Reference

RANZCOG. (2005). Termination of pregnancy, A resource for health professionals. Melbourne, Australia: The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.

Reflecting - Talking normal birth in Childbirth Education

2011-04-13T10:46:00.000+10:00

Reflecting
Donald Schön (1983) suggested that the capacity to reflect on action so as to engage in a process of continuous learning was one of the defining characteristics of professional practice.
As I have blogged before I am one of life's eternal 'reflectors'. I have been reflecting for sometime about an episode which occurred during an antenatal education session for Parents Centre in New Zealand.

Parents Centre New Zealand
Marie Bell gained her phD at the age of 84, her thesis is based on the pioneers of Parent's Centre who challenged the well- established and generally respected views of the policymakers of the 1950's. Under the leadership of Helen Brew, Parents Centre influenced many women to force a change around childbirth education and birth practices. Helen Brew was influenced by the book, Childbirth without fear, authored by Grantly Dick-read. Dick-read wrote about how adequate preparation for childbirth could reduce fear and pain in childbirth.

As now in Australia, childbirth in 1950's New Zealand was dominated by obstetrical and gynaecological boys who were heavyweights exerting total dominance over policy and conditions for women having babies. These heavyweights in obstetrics produced policies which served to give pain relief to every woman. Parents centre pioneers at that time believed that childbirth was a normal, natural event and that women were entitled to learn strategies to cope with the process without resorting to drugs.

As a childbirth educator
As a childbirth educator and as a midwife working within Parents Centre it wouldn't be difficult to assume that I would find it easy to promote childbirth as a normal, natural event to what I thought to be a well motivated, captive audience. My experience is rather different and I am left to wonder how far participants have moved from those early pioneers.

The hospital tour experience
I once took an antenatal group on a 'tour' of the local maternity unit. I always used this visit as part of 'teaching' using the visit to talk in context about issues that arise when birthing within an obstetric setting.
On this particular evening I was driving into the unit contemplating how I could use the session to promote normal childbirth. I was immensely proud of myself as I devised a cunning plan. I went into the unit and rearranged two of the birthing rooms.
In birthing room 1, I created minimal lighting, removed the bed, placed birthing balls, mats and cushions on the floor. I also had soft music playing and aromatherapy oils wafting through the air. It was a beautiful, comforting place promoting relaxation and a warm peaceful environment in which one could welcome a newborn.
In birthing room 2, I created a hard assed, brightly lit room with every cold piece of hard steel equipment I could muster on display.

I stepped back and surveyed my splendid work. I patted myself on the back.

Once all the group had arrived I divided them into two groups and gave them feedback forms. I sent each group into each room and we met up to give the feedback to the group as a whole. I was particularly interested in the feelings each room evoked.

The feedback
I was disappointed to find that they found the peaceful, darkened room scary and intimidating. They found the brightly lit room reassuring. When I asked them why this was, they said that they felt at least in that room every piece of equipment was available should they need it in an emergency.
This gave me some insight into the challenge we face as childbirth educators in promoting birth as a natural, normal experience. it does appear that the media have done a massively successful job at promoting how dangerous childbirth is.

I am left wondering where we go from here and how we can continue to hold on to the original philosophy and promote women to feel more empowered and confident in their abilities to birth in whatever setting they find themselves in.

Visiting Canberra.

2011-04-01T11:42:00.000+11:00

Canberra by the lake, early morning walk

On Tuesday I drove to Canberra from Shepparton to attend a research seminar. Frustratingly I had investigated all other forms of transport but I couldn't find anything that would make my journey any easier.

Thankfully though the road was very easy to drive. I survived the six hour drive intact and without incident. I just had one close hiccup in the city of Canberra where I nearly took the wrong road but thankfully my Trapster app on my iphone saved me from that disaster. It was also very reassuring as a person driving alone to have a voice periodically call out to you about 'dangerous intersections' and 'speed cameras'.

It was great to catch up with Professor of Midwifery, Dr Deborah Davis. She has been my tutor with Otago university on a couple of post graduate papers and we met a number of years ago at a Joan Donley Midwifery conference.

The seminar was enlightening on a number of fronts. Canberra University are very friendly, supportive and encouraging. I am also keenly aware that I need an advocate. My biggest moment of clarity was to finally understand why, when I mentioned I had a PGDip in Midwifery it means little to Australian University staff. It seems that when a general nurse qualifies here and does a midwifery program they qualify with a PGDip in Midwifery. My midwifery qualification was 19 years ago in a hospital based program of study an additional 18 months training to the 3 years general training. My PGDip is in addition to that and has taken me a further two years of study to obtain. The PGDip midwives here just do two more papers to obtain a Masters in the Australian system. So the main advantage of applying to Canberra to study is that I have someone on the staff who understands the study I have already undertaken in New Zealand and can advocate for me.

The research seminar itself was very, very interesting with presentations from a number of nurses, mental health nurses and midwives. They are all either in a phD program or in a masters program and shared their journey's through their projects.

We had a great evening meal out and I feel like I could have made some new friends.

I am often amazed actually at the similarities in research in each health discipline, nursing, midwifery and medicine because I have a foot in each camp. What I find is most disappointing is that there is very little collaborative work going on between them.

Today, I am tired. My brain isn't functioning as it should do and I appear to be needing more coffee than usual. I may reread this blog post and feel I wish to add more to it.

Filling in some blanks

2011-03-26T18:31:00.000+11:00

BEFORE

AFTER

Many thanks to http://shemeanswellbut.blogspot.com/2011/03/filling-in-some-blanks.html for tagging me in a blog post. This is a Fill in the Blanks Meme so here we go.....

I am....
me, a stroppy individual at times who takes great offence when midwives are insulted. I was recently described as being very 'forthright' in expressing my opinion and as my husband says I never seem to take a step backwards. If I am your friend I am fiercely loyal and will do anything for you.

The bravest thing I've ever done...
Well it is a very long and tortuous story but it was giving up on a custody battle with my son 11yrs ago because at the age of 5 he didn't want to be with me. He only wanted to be with his dad and my ex in laws. I was in too much of a mess and far too hurt to go through what would have become a very ugly battle. In some ways it was easier to walk away and in others it was the hardest thing I ever did. Not a day goes by when I don't wonder.

I feel prettiest when.....
Oh God I just don't know that the word pretty and I go together in the same sentence!

My favourite meal is......
Actually now it is anything that I can get down comfortably without feeling nauseous and which doesn't get stuck. My life used to revolve around food but now I could go a day without eating and often after I have eaten something I wish I hadn't.

The way to my heart is...
Make me laugh be a good person, stand up for what you believe in and be there when needed. Oh and be trustworthy.

I would like to be.....
At peace with myself, be a better mum, be a better wife, be a better researcher and maybe one day be a midwifery lecturer!

Hopefully this a better version of a Midwife/woman consultation

2011-03-10T14:40:00.001+11:00

Important aspects of this consultation as a 'journey' not a 'checklist'

1. Establishing a rapport with the woman

2. The consultation is woman led not midwife agenda led

3. Establishing what the woman's knowledge is about breech birth

4. Providing informed choice

5. Being supportive

6. Preparing to advocate for the woman's wishes

7. Demonstrating teamwork

2011-03-09T09:46:00.000+11:00

This was a video I made to illustrate a bad midwife consultation I once witnessed as a student midwife.

The key points to note are:

The use of language, "sweetie", "pet", "love", "naughty baby"
The lack of informed consent & explanation of the term 'breech'
The lack of empowerment of the woman
The lack of partnership with the woman and no shared decision making
The lack of offering to advocate for the woman and visit the obstetrician with her

Have a watch and see what you think.

An emotional week

2011-02-25T19:57:00.001+11:00

It's been an emotional turmoil of a week.

Tuesday was one of those, "I'll always remember where I was" kind of moments.
I as usual was sat in front of the computer. Twitter suddenly began to move very fast and I noticed a hashtag for #eqnz. I immediately brought up a column on tweetdeck and it was obviously serious as the stream was moving so fast it was impossible to read. Soon there were pictures coming through and as I saw them I was first horrified & shocked. My horror and shock soon turned to disbelief as I thought, "No those pictures can't be real someone is putting up made up pictures of buildings being demolished". I continued to believe that it must be some cruel hoax for a wee while as more and more conflicting and confusing reports were being posted on twitter. One minute the hospital was being evacuated and the cathedral had collapse then those reports were refuted by someone else. It was only when I turned on the TV did the full horror reveal itself to me. Just like 9/11 I sat glued to the TV for the rest of the afternoon unable to comprehend fully what was happening.

Overall it has all been too much. I was so relieved to hear my ex midwifery and good friend colleague who now lives in Christchurch was safe. I found I was tearful as I was told which surprised me. I thought living over in Australia would have made me immune to such feelings. I cannot even begin to imagine what it must be like to actually be in the middle of it.

This picture has now become synonymous with the quake and to believe you are wandering around a monument one moment and your life is gone in another is too tragic.

Being a new mum

2011-02-09T11:45:00.000+11:00

I have been busy. I am a new mum, to an 8wk old Cavalier King Charles Spaniel, named Bart.

Now, I am a midwife, I have been a midwife for approx 19yrs. I have gained amazing amounts of insight into being a new parent and I have given countless new mums advice on their newborns, dealt with their anxieties and answered their endless questions no matter how trivial they may seem to me, in a professional manner which gives confidence to new parents and makes sure that they in no way feel that I think their enquiry is trivial. I was a midwife when I became a mum and so I approached new baby motherhood in the same way as I did being a midwife. In other words I was confident most of the time and felt like I knew what I was doing.

Yet being a new mum to a puppy has introduced me to a new world of anxieties, tiredness and obsessions with puppy's bodily functions which has lead me to searching the internet and telephoning the vet search for reassurance that everything is okay. In other words I have gained amazing insight into what it is like to be a 'new mum'.

Bart is cute and gorgeous. We have had him now for two weeks. For the first few nights I put him in our bedroom.

Night Time Sleeping

Like any new mum, I don't do well with frequent disturbances of sleep. I tried to just put him in his little basket next to the bed. He didn't stay there, he wandered and cried in the dark when he got lost around the bedroom. So I tried the bean bag next to the bed, every time he moved I heard him and put him back down to sleep I also 'toileted' him 3hrly during the night. Going out into the Aussie darkness can be scary! There are strange noises and very large ants wondering around and I kept forgetting to put on my shoes which meant as he wandered off I was worried I would come across a spider or two. Night three I thought I cracked it, he slept from midnight to 6am and he did it for the following night, I was laughing! I was also patting myself on the back and boasting to another puppy owner who was getting no sleep how we had it sorted (just like mums at coffee groups do). I was very soon knocked back as the following night I was rudely awakened every 2hrs, Bart had diarrhoea. We had created a 'crate' out of two large packing boxes (we have plenty). This was due to research on the internet that recommended an actual dog crate for their own sense of space but rather than shutting him away I fashioned these two boxes together. So in the night when he wants to wee or poo he wakes up and cries to go out because dogs hate to soil their 'beds'.
I then became obsessed with his bowel functions, every time the girls took him out side during the day I found I was asking, "did he wee? Did he poo? What was his poo like?" Much like all new parents who find themselves discussing how many dirty nappies there have been during the day, I began to realise I was now doing the same thing.

Diarrhoea

Following that night of diarrhoea, I was very anxious about Bart's health, he has had one set of injections so I messaged hubby at work to see what he thought. He was obviously busy because he didn't get back to me immediately and of course I was so wrapped up in my anxiety I was looking for an immediate response and so I telephoned the vet. This is much like some of the phone calls I used o receive as a midwife. Bart was happy, bright and just as bouncy with no vomiting and my 'sensible' head said he is fine. Yet my 'anxious' head kept creeping in. The vet receptionist was slightly condescending and actually seemed to like delivering her lecture.
New puppies, when they go to a new home and have a change in diet often suffer diarrhoea. I needed to feed him very bland diet of chicken and if it didn't sort itself out in 24-48hrs then I could take him in to be checked over.
Well, actually it lasted 72hrs. I had 4 nights of 2hrly disturbance by the end of the weekend I felt like I was ready to hit my knees! It wasn't just a matter of getting up taking him out to do his business but because obviously his tummy was a bit sore he wasn't settling down again straight away and needed a tummy rub before he would fall asleep. One of the nights by 4.30 am I was so anxious, I actually put him in the bed with us ( much like most new breastfeeding mums do!).

Last night I actually found I was dreading night time, as I turned out the lights this feeling of depression came over me. How much sleep would I get?

Last night was a good night!

"Certified"!!!!

2011-01-28T14:19:00.000+11:00

won't rotate!

Yesterday I received my Post Graduate Diploma in Midwifery certificate. This certificate represents the last two years of study for me and took quite a bit of financial investment.

Post graduate study is a long, long road. I am eager to get onto a PhD program but because I don't have an undergraduate degree and I was 'traditionally' trained I have a long journey to 'prove' that I am capable and intelligent enough to be admitted into a program of study.

This is what I find most amusing about Universities, they are only interested in students who they know before commencement of a program of study will be capable of passing the grade. What does that say about the tutors? is it not a challenge to bring a student through a program of study and know that your input has given them the knowledge they want?

I am also confused at the suggestion that after 19 years in nursing and midwifery, I am somehow not intelligent enough to be able to complete a masters in research or PhD program. It makes me wonder how many perfectly capable nurses and midwives are there in the profession who have received the suggestion they are not good enough and so have felt immediately not worthwhile and dis empowered as a result?

It is challenging undertaking post graduate study but it is stimulating and rewarding. I don't know that it would have changed the way that I practised my midwifery but it has given me more knowledge and knowledge as we know is power!

Experimenting with my veges

2011-01-27T16:40:00.001+11:00

In New Zealand I enjoyed having a vegetable patch and I had really got to grips with producing my own potatoes, tomatoes, lettuce, courgettes, beetroot, turnip, swede (true to my irish roots I was particularly gifted with root vegetables). Since we moved into our new house I have begun to experiment this year to see what things grow and how they grow.

Above in the picture is the first of a yellow courgette and my first cucumber.

Growing well

We purchased two large pepper plants they cost $9.95 each. Peppers in the supermarket cost $4 each. I have harvested 6 green peppers so far which means I am at the moment breaking even but it looks like they are going to produce many more. I didn't have a great deal of success with peppers in New Zealand.

We purchased one aubergine plant, this definitely was a failure for me in New Zealand but here in Australia the plant is thriving with many flowers on it which should begin to bear produce.

My beetroot are looking a little hit and miss this is probably due to not giving them enough water when I first put them in.

Another huge success which I have never been able to do before is grow basil. it always seem to just disappear after I planted it but despite the barrel I put it in becoming flooded with water in the floods it has thrived in the humid conditions.

Below is my courgette plant.

Failure to thrive

My biggest disappointment has been the tomato plants. I put them in the barrel alongside the basil. The first heavy rains came, the barrel flooded and the tomato plants rotted. I purchased some more but it was late in the season and they are very lack lustre. I am trying to revive them with tomato feed but as we head later and later into the summer I fear that there will be no crop of homegrown tomatoes this year.

This is a lone green tomato which has come from 7 tomato plants. I usually enjoy an abundance of tomatoes and along with courgettes the girls love it when I make ratatouille.

I lost all my onion seedlings and leek plants in the floods they were swamped with water and have disappeared.

1st time experiment
I am trying for the first time to grow melon. There are some flowering buds on the three tiny plants so fingers crossed.

All in all I plan to do a little more planning for the forthcoming growing season through the winter.

We welcome a new addition

2011-01-27T10:21:00.000+11:00

We had a visit from a friend yesterday, she breeds King Charles Spaniels and she brought one of her boys with her he is 8wks old. Of course our hearts melted, the girls went mad with excitement and immediately named him Batholomew or Bart for short. I can't say that I was surprised that we ended up taking him, I was kind of half hoping it would happen.

So he spent his first day settling in, Homie is not too sure how to react and it is possible he is a little bit jealous and feeling a little put out at the moment but hopefully he will adjust.

I am reading up on puppy training but we didn't put him in the laundry as we first thought for the night, I put his bed in our room next to our bed. He only disturbed me at 3.30 and 5.30 I just kept lifting him back into his own bed.

App crazy crazy!!

2011-01-17T14:51:00.000+11:00

Image thanks to http://www.flickr.com/photos/rosenkrieger

I haven't really blogged about my purchase of an iphone. Now I feel motivated to do so and comment on a number of the 'apps' as they are called that can be downloaded to turn your phone into a real asset and 'can't bear to be without' lifestyle tool.

I am not a diary keeper, I often wish I had been and at one time it was a regular New Year resolution for me to start one. I would buy a nice clean blank diary, begin on the 1st January and by the 10th I was already neglecting it. Yet I do like to blog, I like tapping at the computer screen and I enjoy it when someone leaves a comment. it is a great supportive tool and I have found myself expanding into other parts of social media. I have an e portfolio, I have facebook, I am on twitter and I use social bookmarking sites.

What I have found in the 'app store' of itunes is Momento an app which will bring together all of my various entries on facebook, twitter, my blog, FLICKR, diigo and YouTube uploads into a daily diary entry. This I found quite exciting, I can also add to the entries if I wish to.

I have discovered today the ability to export it to my computer. When my phone is connected to my computer the entries are exported as a txt document and are saved in my documents file. I can then open them up and save them as PDF.

Overall I am quite excited about this app and look forward to discovering more ways of using it.

Nursing student expelled for Facebook photo - KansasCity.com

2011-01-05T13:02:00.000+11:00

Nursing student expelled for Facebook photo - KansasCity.com

I was intrigued by the story above. It gave the impression that a student nurse was expelled for posting a picture of herself smiling over the top of a placenta they were examining in a clinical education setting.

At first I thought, "how unfair!" but then I reflected and especially in the New Zealand context I realised that this just wasn't about posting a photograph but if you look at the said picture it suggests an apparent disrespect for an organ of the body.

I do believe however, that rather than expelling the students it would have been better to address this as an educational opportunity within a cultural setting. I also believe that education surrounding the placenta should take place within the culture of birthing and not be separated from it.

In many cultures and especially in Maori culture, the placenta, Whenua has special significance and so this picture could cause some offence as a potential source of disrespect.

I believe the university missed an opportunity and shirked their educational responsibility on this one and chosen instead the easy option of washing their hands.

Onwards and forwards into 2011

2011-01-02T11:05:00.001+11:00

There has obviously been a theme running through many blogs which I have been catching up with, one of aims for the coming year and new decade we have entered.
I resolved some time ago to no longer make resolutions as I break them very easily so I tend to just look to my hopes and aspirations.

1. Be a better mother and wife

This has to be my top priority. I want to be more tolerant and more patient with my girls and give them as much support and encouragement as possible. As a wife I want to listen more and be more supportive in the home environment.

2. Work objectives

I need to develop more focus and procrastinate less. I will be working in 5 roles and so I need discipline to complete all the objectives for all the roles. I will allow some time for social media but I will not be distracted by it. I will also give careful consideration to any further opportunities which come my way to ensure I have enough time to devote to it and to be more assertive in assessing whether it helps me to achieve my objectives rather than automatically saying yes.
I am getting a clearer idea of how to write academically and need to gain a regular rhythm of writing and reading and maintain that rhythm.

3. Domestically

I aim to do frequent small cleaning episodes as and when I see them rather than letting jobs pile up.

4. Organizing my social media

I love the apps on my iPhone and I have begun to organize it so that I can access my google reader from my phone to keep up to date with news and blogs that I follow.
I have saved a number of news items from google reader to inspire my blog writing.

5. Australian midwifery

I need to resolve to not get despondent about the difficulties facing midwives here in Australia. I do wonder if they actually know which direction they want to take their profession in the longterm. I hope that they can be more supportive of each other and stop the infighting and back stabbing. Let's call for unity and look to what we have in common rather than focusing on our differences and move forward to the benefit of women as a whole.

6. Emotional detachment

I must not become involved emotionally in Facebook opinion pages and argumentative blogs. I have tried the non impulsive approach but I tend to find that I 'stew' over what I have read and I feel worse. I shall try and just express a clear non emotional opinion and leave it at that.

7. Being more creative

I would like to explore a more creative side of me and look to completing some arty projects and accept that not all of them will be a success.

8. Continuing to look after my health.

I must remember the eating rules I must follow since my surgery. I must eat slowly and very small amounts of food. I also do resolve to drink less alcohol. I am concerned about the severe bout of abdominal pain I suffered recently which lasted 9hrs and left me uncomfortable for a number of days following it.

9. Be more confident in myself professionally.

I aim to not be intimidated by others and to be more assertive.

10. Make the most of each day

I think these 10 will be enough for the time being. I may need to do a monthly revision.

- Posted using BlogPress from my iPhone

Another year fades away

2011-01-01T11:41:00.000+11:00

As I sit in the office on this NewYears day of 2011 and I look out onto the pool I am given cause to reflect on how ones life can change in the course of just 12 short months.

At the beginning of 2010 I did a quick 9 day trip back to the UK, alone to see my brother following his heart bypass surgery. The journey was a challenge but I confess it was more comfortable sitting in business class with the lie flat beds. The sight of me running across Dubai airport to make my connecting flight must have been something to behold and I am sure that had I still been carrying about my person the extra 69Kg's that I have lost I wouldn't have made that flight.
Funnily enough it was snowing then in the UK too but thankfully not heavy enough to stop flights or cause too much chaos.

On my return to New Zealand hubby announced that he had applied for a job in Melbourne, Australia and I heard that I was being invited for an interview for a job in Gisbourne. A dilemma ensued as we were both offered posts in differing countries and we struggled with the decision as I had been trying to break into a more senior position in midwifery in New Zealand for quite sometime and I was feeling quite defeated by all the knock backs. It was these knock backs that had prompted Chris to look to Australia. He felt that his career and mine would be better served over the ditch. We did some deep soul searching and our decision was mainly influenced by what High school options there would be once the girls got older. This meant that another move to another country became the only option.

The packing began and the marketing of the house became a drudgery. We had numerous people interested in our house but all had properties themselves to sell. As we left New Zealand one family came up with the deposit and have moved in paying a nominal rent until one of their existing properties sell in Picton. They have 3 years to complete the sale or they have to move out and we keep the deposit and re market the house. This deal put us in a tighter financial situation than we had originally planned but we did just plan to rent a house once we got here.

Living in a rental property was more challenging than I thought it was going to be. I was constantly nagging the girls about dirty walls, having angst about property inspections and being told off constantly about not keeping the gardens tidy enough. Living in suburbia was more claustrophobic than I thought it was going to be and so we began to house hunt not long after we got here.
We tried to negotiate the same deal here in Australia that we had given the people living in our house in New Zealand but it takes creative thinking and they weren't that receptive to it. Hence we became even further financially stretched when we had to take out another mortgage. Money matters took a further hit when we moved out of our rental property before the end of the 6month lease agreement and the landlord took the keys back but demanded that we carry on paying the rent. Hence we were left paying 2 mortgages and rental on a property that we didn't live in any longer. We gave the girls dire warnings about only receiving the bare minimum for Christmas and nothing extravagant. They were fabulous and put Christmas hugs and family time at the top of their Santa lists.

Chris has had his challenges with his new post(s) with his job titles too long to fit on to his name badge! My career is developing some different twists and turns but definitely looks much more promising than in New Zealand.
Looking forward to 2011:

I shall be continuing to do some writing of online modules for Griffith University in Queensland, I feel privileged to have been asked to write two more modules.
I shall be doing some curriculum development work with Newcastle University in New South Wales
I am working as a research assistant with a Professor of Rural Medicine here in Shepparton undertaking a couple of research projects
I am now also an Honorary Research Fellow with Melbourne university whereby I will be undertaking my own research project with their full support and I shall be publishing it hopefully at the end of the year
There is also a possibility that I will be working on collecting information about chlamydia rates in rural Victoria but I have yet to have that project confirmed

So the aims for the year are clearly becoming mapped out and should lead to a hopefully a number of published papers.

My phd road probably won't start until 2012 but I have made a solid start in the field of research and after a number of years of being made to feel not good enough professionally, Australia has presented me with a number of valuable opportunities as soon as my feet hit the soil. I am never a person to turn down an opportunity and intend to run with them all and give Australia my best efforts!

Christmas 2010

2010-12-30T15:34:00.002+11:00

My First Project

2010-12-22T13:17:00.000+11:00

I am just getting to grips with the video editing software on my new Mac pro desktop computer. It is so easy to connect and upload video and photographs to flickr and YouTube all with just the press of a button.

1st day of the Summer School Holidays

2010-12-18T09:06:00.000+11:00

It is the beginning of the summer school holidays and as a mother I have survived the 1st half day! Chaos reigned at school pick up time, with parents dumping their cars in selfish, stupid places which caused a backlog of traffic outside of school along the road.
I promised the girls they could have two friends over each yesterday which didn't really work out as planned. I used this promise to extract good behavior from them ever since we moved into the house and I also wanted to see their school reports before I gave the final green light. This meant that they only got to make the invitations for their chosen friends two days before the end of term and Jemima went into a spin when she forgot to take hers to school. This meant that Jasmine just got to have one friend over and Jemima didn't get to have any friends. This resulted in a little sulking and a few tantrums but overall we all came through the afternoon rather unscathed.
I was very calm, explained things well and defused all arguments.
I attempted a Christmas artistic pizza, I cut pitta breads into Christmas tree shapes and topped them with pizza sauce, cheese and green pepper. I'm not sure any of them noticed but at least I tried!

I am grateful we have a pool.
Chris and I were talking yesterday and we haven't found so far there is too much upkeep involved in having a pool. After we moved in, I took a sample of the pool water to the local pool supply shop and they tested it. They gave me the appropriate chemicals to add along with clear instructions. All I have ever done since is dip a testing stick in every week, read the results and all has been great. Chris views his 'pool scooping' of all the leaves as therapy time. He wanders back and forth catching all the leaves in his net and seems to give a satisfying sigh when it is clear.
The girls and their friend yesterday had a great time swimming in the pool and creating a whirl pool in the spa. This meant there were no complaints of being bored and once they tired of that they were all happy to play a computer vet game on the laptop.

So roll on the next six weeks, I just can't believe it is Christmas next week!

Crisis in confidence

2010-12-16T19:12:00.000+11:00

Professionally since arriving in Australia my feet haven't touched the ground and I have hardly had time to draw breath but I am beginning to have a crisis in confidence.
For the last three years I have had the one professional aim, to become a midwifery tutor. I began my post graduate qualifications with this goal in mind.
I was unsuccessful in achieving this goal in New Zealand and indeed it soon became apparent that 'my face didn't fit' and I wasn't 'one of the girls' and my career was dying a death.
As my feet touched the soil here in Australia I was asked by Griffith University to write some of the online material for their student midwives. This was an opportunity which came to me via Sarah Stewart, my great friend, best supporter and fantastic mentor.
This has been a great challenge for me, around organizing my writing, deciding objectives, learning outcomes and sourcing learning material. All this was occurring as we were settling into a new country, finding a new home, having financial worries and moving house once again once we had purchased our new house.
I do realize that I am not a good academic writer but I am hoping to overcome this with the phcred program I have gained at Melbourne university. This is a program that takes you through a research program of your own supporting you with study days and support through the ethics process and gives you the title of honorary research fellow.
Yet back to my crisis, over the last couple of weeks I have begun to re evaluate whether I am actually good enough to be a midwifery tutor. I have the clinical experience, I love educating student midwives, I love passing on my experience and empowering students through learning but I am not sure that it is enough. I am not sure I am good enough. I am not sure this is the path for me. The politics of midwifery in Australia is in a dreadful state and the politics within the university setting seems even worse.
I know I have plenty on my plate at the moment. Not only am I trying to finish off the modules for Griffith, I have also started a research assistant post with Professor of medicine and Dean of the medical school. This means I will be involved with a couple of research projects as well as my own over the next year. This will give me a number of published papers in the not too distant future.
So I am slightly drifting at the moment without a clear direction or map of where I am heading. I have a feeling that I may face some rough seas and for now I may need to see where things take me.

woof here and woof there, here a woof, there a woof, everywhere a woof woof

2010-12-13T11:09:00.000+11:00

Meet Homie. We rescued him two weeks ago from Bendigo RSPCA. He is classed as a 'senior' dog as he is 9yrs old his owners surrendered him because they are moving interstate. Homie doesn't like to be in the sectioned off part of the yard he has already discovered that he can dig holes under the fence to get out. This has meant that I have had to walk him every morning before I go to work so that he can stay inside during the day.

The walking isn't a bad thing but I have developed the Aussie 'wave' wafting flies constantly out of my face. Why are Aussie flies like this? I am also covered in enormous mossie bites and even when I put on repellent before the walk they find a spot on me that hasn't been sprayed (ear).

Meet Abbey, she is a Labrador crossed with a poodle. We are also dog sitting for my boss, Professor of Medicine and Dean of the medical school, Dawn Dewitt. She has gone on holiday to the UK and America. Unfortunately Abbey developed kidney stones the night before her mums departure which meant a night at the vets. She was even more confused when we picked her up and brought her to a strange house.

The two dogs are tolerant of each other at the moment and just show signs of jealousy when one gets more attention that the other, this tends to result in a little growling and snapping at each other.

The girls are loving having two dogs but Abbey does insist in sleeping in our room which means I can hear her scratching and turning over in her sleep. I am sure I will become accustomed to it but for now I am extremely tired.

Wow Wow Wow things moving at the rate of knots!!

2010-11-30T10:40:00.000+11:00

Last week I started back into the outside workplace as a Research Assistant to a Professor of Medicine.
There are a number of differences which became apparent to me about moving back into the 'real' world of work as opposed to working in the 'virtual' world.
The real world advantages
Surprisingly, has real people in it! There are relationships to be established and conversations to be had. I am allocated an office and I have my own laptop paid for by the university. There is a stationary cupboard! I love stationary! I could spend all day in this cupboard living amongst the stationary. I also do a lot more walking, up and down the corridors, to get my coffee and the printer my laptop is attached to is the one furthest away from the office. I get to dress nicely and come home looking exactly the same way as I left the house. I am paid now to do literature searches and to critically analyze research, something I have always enjoyed doing.
The real world disadvantages
I need to shower every morning, wash my hair, put on make up. I have to drive to work. I need to fit more into a shorter working day. I am just working 'school' hours. 9-3pm which goes amazingly quickly especially when there is a meeting in the middle of that time. I am trying to keep the work for this project within the allotted 'work time' and resisting the urge to put 'extra' unpaid time in when I get home.
The virtual world advantages
I can start straight away in the mornings. There is no waiting for offices to open (I don't have a security card yet). I work in my pj's and often it is lunchtime before I look up and get dressed! I don't have to carry half my office around with me in a very heavy briefcase. There is no driving to work.
The Virtual world disadvantages
There is no 'real' people interaction but this can be substituted with social media. The work encroaches on my home life as I don't tend to 'leave it'. I have no excuse to dress up and make an effort with myself!