Tuesday, December 25, 2007

VBAC homebirth

This is a wonderful story of a woman who had two previous hospital births resulting in caesarean birth who chose to birth at home for her third child. She tells her story very eloquently in this video. She understands that she needed to be upright and mobile and to have faith in her own bodies ability and in the care and support of her midwife. This is the story of her personal journey.

If you are considering a VBAC it is important that you understand why you needed a caesarean previously. You need to be well informed of the risks of all your birth options before you decide what is best for you and your baby. You might need to talk to more than one care giver before you can truly make an informed decision. Check out the Childbirth Connections information about the risks associated with various birth options.

Saturday, December 22, 2007

Celebrating 2000 hits on my blog

I am celebrating having had 2000 hits on my blog. Not bad since I just started this in September.

Thanks to everyone who has visited my site. Thanks especially to those who have left comments. I hope you have found something that has been helpful to you. If you have a different opinion, or if you want to agree and add something to what I have said, please leave a comment. Also if you have a question, I will respond and will answer if I can.

You will see a stat counter at the bottom of this page. It tells me how many hits I have had. I can also find out how long people look at my blog and if they have come back more than once. What I particularly enjoy about collecting these statistics is finding out where people have come from. It gives me quite a buzz to see that I have had visitors from all over the world. It would be really great to have a conversation about midwifery and childbirth with you so please comment. I would love to know how things are in your country. We can learn so much from each other and perhaps make a difference to how women experience the wonderful life changing event of childbirth.

Merry Christmas (or whatever festivity you celebrate)and Happy New Year to everyone

Thursday, December 20, 2007

Information for mothers and would be mothers

Are you worried and confused about birth? The Childbirth Connection web site offers really good unbiased evidence based information to help you to get a better understanding of some of the things that might be confusing you. They have produced a booklet, which is free online entitled "What every woman needs to know about cesarean section". You have to register with the site to be able to download but registration does not cost you anything and does not seem to come with any extras that you might not want. Well worth having a look. Whether you are planning to have a cesarean section or not this is important information that you do need to know.

Homebirth video

I have just read a posting and watched a video of this midwife's own birth. Rather than putting the video in here I am posting a link to the entry in her blog. It is her story and her video and needs to be seen as such. Please go and look and read.

She talks of the birth as a difficult struggle. I doubt that it would have been less of a struggle in a hospital setting and may not have ended as happily. She is a brave woman to share her true feelings about this birth and I applaud her for doing so. Do you want to share your thoughts about this?

Wednesday, December 19, 2007

Midwives Rock

Although this an advertisement for Texas midwives I just love it and had to put it on here. Midwives Rock!!!

Sustaining rural midwifery practice

When considering the issues of sustainability my colleague Sarah Stewart has been blogging about issues for midwives in sustaining practice. She has identified discontent amongst some midwives about the annual recertification process in New Zealand which has only been in place for the last three years. She also questions how midwives are supported and sees mentoring, particularly E-mentoring as a possible support for midwives to help to sustain them and enable them to continue in practice. She also mentions communities of practice as a possible support for midwives.

I was a rural Lead Maternity Care (LMC) midwife for around 15 years, from the start of our modern midwifery autonomy in New Zealand until I changed direction a little and ventured into the education field around 4 years ago. I still do a little rural LMC midwifery as a rural locum. I provide holiday relief or backup to several rural practices in my region and nearby. I have just completed my Master in Midwifery degree and my research looked at how midwives informed practice, finding that communities of practice had a strong influence on information sharing and supporting rural midwifery practice.

During my 15 years as a rural LMC I never had regular days off. I took days off when I had a quiet day but was still on call. I had holidays when I could and some years did not have a holiday at all. When I did take a holiday it was always for at least one month. I found it took me at leas two weeks to get my head out of the job and relax and probably took me at least twice as long as that to settle back into the job when I came back. This was during the years that my children were growing up and at times it was probably pretty tough on them and on my husband. None the less I loved the job and still do. It is my love of midwifery that sustains me most I think.

What I did not love was the continual battle that I felt I was fighting. When I worked with colleagues who shared my beliefs about childbirth I felt much more supported in my practice. Too often I felt that I continually had to justify my profession and myself with the world. With GPs who stated that homebirth was unsafe, with facility management who, rather than supporting often seemed to be trying to undermine what I was trying to achieve. With the media and public, whenever something happened in childbirth somewhere in the country and every midwife seemed to be blamed and had to justify there existence. This was not my usual experience but when it did happen it was very tiring and took most of my energy and enthusiasm for the job.

So my thoughts on how to sustain midwifery practice would be to make sure that you work with other midwives who share your beliefs about birth and work in a similar way to you. Let go and don’t believe you have to be all things to all people. It is women who are having babies not us. We should be able to prepare women so that they can do the job with or without us, as long as we know that our colleagues will support them as we would. Make sure you make the connections with other midwives who can sustain you and will share their knowledge with you as you will with them. Try to establish links with other midwives who can provide a locum service for you to have a break when you need it. If you do not have colleagues like this in close proximity to you then use online sources such as this to make connections with them and communicate regularly. Never lose that belief that this is a really important, satisfying, wonderful job that you do.

I am truly interested in what others think about this. How can we sustain midwives in practice? Our communities need midwives, how can we fill that need when it is not there or support midwives to continue in practice when it is there?

Sunday, December 16, 2007

Sarah Buckley on gentle birth and birth hormones

Dr Sarah Buckley from Australia has also investigated and written extensively on the influence of birth hormones. This is an open source article "Pain in labour" from the Birth International Website which explains the influence of birth hormones also discussed by Michel Odent in my previous posting.

Michel Odent on gentle birth and birth hormones

These three videos follow on from each other and well worth watching right through if you can You will need to concentrate but well worth it.

Saturday, December 15, 2007

elective caesarean increases breathing difficulties for babies

A recent TV One Health news item speaks of the increased risks of breathing difficulties for babies with elective caesarean sections. Particularly when these are performed early, that is before 39 weeks.
This is information gathered from a large Danish study. They found a nearly fourfold increased risk of breathing difficulties in caesarean babies delivered at 37 weeks, a threefold increase at 38 weeks and a doubled risk at 39 weeks. Babies who have breathing difficulties usually need to be transferred to a special baby unit and are monitored in incubators with oxygen provided. This is another risk which has been identified for women who are choosing or being advised to have an elective caesarean section.

A French study published recently "Postpartum Maternal Mortality and Cesarean Delivery" reported that caesarean section increased the risk of the mother dying after having a baby more than threefold.

This growing evidence of the increased risks to mother and child of having a caesarean section as opposed to a vaginal birth are very concerning as rates of caesarean section continue to rise. Recently published figures from the United States report a 30% national rate of caesarean births. The most recently published national rate in New Zealand was 27% but it is very likely that it too is now 30% or higher.

Can we as a society afford this level of intervention in childbirth.Is this an issue for sustainability? Think of the resources that are involved in this level of intervention/

I am not suggesting that any mother or child be put at risk by withholding necessary medical care and intervention, but where does it stop. Clearly we are not reducing risks for women and children by increasing medical intervention. Instead we are raising risks to the health and wellbeing of the mother and her child.

Can we turn this around? Midwives we need to help and support women to have confidence in their bodies and ability to birth. We need to provide sensitive caring support and information to women. We need to have faith ourselves in the process of birth and to share our faith with women and those who will be supporting them during the birth of the child.

Sustainable babies

Photo from http://www.flickr.com/photos/worldofoddy/1171997881/

There are times in our lives when everyone wants to give a present to celebrate a special event. Times such as birthday's, Christmas, engagement, wedding and a baby's birth. We search around for an appropriate something to send to the important person. How many of these gifts then end up gathering dust in cupboards, advertised on "Trade Me" or "E-bay" or dumped in the rubbish? How many of these gifts are useful or good for any purpose?

I want to talk a little about gifts which are given for babies, but first I would like to share an old tradition that used to occur in Scotland when I was growing up in the 1950s.

I grew up in Scotland and life was full of superstitions and old traditions, for example when a bride left for the church she threw pennies out of the window of her vehicle for the local children. Everyone gathered around in anticipation and scurried to get their share. I think this was something to do with guaranteeing fertility in the marriage.

On first seeing a newborn baby it was necessary to cross the baby's palm with silver. When a new mother took her baby out in the pram for the first time people would come up and greet her and slip a coin or two into the pram. Those old Silver Cross Prams had a deep well which soon started to rattle with the money gathering in the bottom of the pram. This was often use to start a savings account for the new baby. When a new baby was expected family and friends started knitting or sewing however these arts are less common now.

Nowadays people often buy new babies a basket of goodies, full of lotions and powders and creams and shampoos. The manufacturers of these products outline how they benefit the babies skin and produce research to support their claims. We need to remember that they are trying to sell their product and the research has been conducted with this goal in mind. New born babies do not get dirty. They do not need all these lotions and potions. In my experience babies need, and love, to have a bath. All they need is warm water. After the bath a gentle massage with some pure almond oil, without any additives is relaxing and calming for the baby and is a nice way to care for the babies skin. Other oils such as olive oil can also be used but almond oil is less greasy. It is best to avoid using peanut oil because of the potential for allergy to this product.

Nappy wipes are a relatively recent addition to list of must haves for a new baby. Originally introduced as a handy way to clean the babies skin when out and about they now seem to be used universally at every nappy change. This is neither good nor necessary. A damp cloth with plain water will clean the babies nappy area just as effectively, reduces the babies exposure to chemicals and reduces waste in the environment. Women used to cut up old soft nappies or use muslin squares for this purpose.

The debate about cloth versus disposable nappies still seems to rage on. I think this is something that future generations will find very hard to understand. How could we possibly think it is OK to create this mountain of garbage so unnecessarily. What do you think about this? Why do so many parents feel that they have to use disposable nappies? Why not give a gift of cloth nappies, or maybe give a gift of an offer of help with washing these? If you are thinking about cloth nappies this is a lovely very simple little pattern for woolen overnaps. They need to be made out of pure wool but can be machine washed. The more felted the wool becomes the more waterproof the overnap is so old woolen overnaps are really desirable. Using these allows the babies skin to breath while still providing some protection from dampness. Babies nappies should be changed regularly as contact with ammonia from stale urine and bacteria from babies stools is a cause of nappy rash.

Baby Pilchers knitting pattern

Size 10 or 12 needles depending on your knitting
One ball double knitting wool does one pair, (large ball does two pairs)
Hank of natural does 3 pairs
Cast on 80 stitches
10 rows ribbing (holes half way)
(for larger size cast on 85-90 stitches).
Continue in plain knitting.
Knit two together on each plain row until one remains
Fold over band at top leaving space for cord
Sew up point in the middle leaving space for baby’s legs depending on the size of baby.

And then there is the gift of babies bottles, and sterilizers and formula. For a very few parents these might well be necessary. For most, help and support and positive encouragement to breast feed are better and healthier for the baby, and definitely better for the environment. Providing a meal or two for the new family, offers of help with shopping or housework might be much more useful gifts.

All about stuff. by Annie Leonard

This is a very well put together animated documentary about consumerism and sustainability. It has really made me think about my own life and what a true consumer I have become. It is a timely message too when we are entering the time of the year when consumerism reaches its zenith.

This video is quite large and can take a long time to load. If you have trouble you can follow this link and open it in different chapters

Saturday, December 8, 2007

It's official

My one minute of fame Photo isn't too good as it is a photo of a photo.

Tuesday, December 4, 2007

Where to birth and how long to wait before going home.

Where to birth? At home, in a primary birthing unit or in a hospital this is a question that many women have to consider during pregnancy. If choosing to birth in a facility, primary birthing unit or hospital, how long can they or should they stay before going home?

Photo from Sadalit's photostream http://www.flickr.com/photos/sadalit/123737076/

Research does little to help women decide when it is best to go home from a facility after birth. There has been quite a bit of research into early discharge, but the problem is that definition for early discharge varies so much. For some it means 2-3 hours after the birth of the baby and for others it means 1 or 2 days after birth of the baby. A Cochrane review of this topic found that the evidence was inconclusive but found that there was no evidence of adverse outcomes for the mother or baby with early discharge from a facility (Brown, Small, Faber, Krastev & Davis, 2002). If considering a home birth again the Cochrane review of this topic was inconclusive although they could find no evidence to state whether home or hospital was better for low risk women (Olsen & Jewell, 2007). A large American study found that there was less intervention when women planned to birth at home without any increased risks to the mother or her baby (Johnson & Daviss, 2005).

So what does this mean for women? If they have no health issues during pregnancy then women are less likely to have interference in the birth process if they plan to birth at home. Women have expressed increased satisfaction with birth when there is no intervention so it would tend to follow that satisfaction would also be greater with homebirth. The same is true if they birth in a unit which deals only with low risk births, (a primary birthing unit0. Of course if any problems arose then the woman would need to go to the hospital. Discharging from the hospital within hours of the birth also does not increase problems for women or their babies who are otherwise well.

There are two main issues here. One is being prepared for being at home, either early discharge or homebirth and the other is having the necessary support to be able to achieve this. One of the advantages of planning to birth at home is getting the support you will need prepared beforehand for this event. This might mean preparing meals before the baby is born so that there is no need to cook after or it might mean that a relative moves in with the new family. The woman will have prepared herself for early baby care, her midwife will cover the knowledge the woman and her partner need for those early days well before the baby is born. The home is ready for the new baby.

With hospital birth women often plan to stay in hospital for two or three days to learn how to care for baby and then go home. Many women seem to think that they will then pick up life as it was before, but this is not the case. They still need support as they learn how to become mothers and care for the new baby. It is not an instant process. We need to think of the first month after the baby is born as a continuation of the pregnancy-labour-birth process. It is a time when the woman's body is making enormous changes as well as the psychological adaption to new motherhood. The baby too is adapting to life outside the uterus and needs loving attention during this time. For the mother to be able to provide this to her baby she needs to be cared for and supported herself. Enormous changes and adaption occurs in the first month but there are those who would say that this continues, to a lesser degree, for at least first three months of the babies life. As a society we need to embrace the concept of mothering the new mother as she takes on her new role. It is an enormous life changing event and women need to be supported and nurtured as they adapt to this new identity.

Brown S, Small R, Faber B, Krastev A, Davis P. Early postnatal discharge from hospital for healthy mothers and term infants. Cochrane Database of Systematic Reviews 2002, Issue 3. Art. No.: CD002958. DOI: 10.1002/14651858.CD002958

Johnson KC. Daviss B. Outcomes of planned home births with certified professional midwives: large prospective study in North America. BMJ. 2005 Jun 18; 330(7505): 1416-9.

Olsen O. Jewell MD. Home versus hospital birth. [Journal Article, Research, Systematic Review] Cochrane Database of Systematic Reviews. 2007;(4): (CD000352)

A baby dies and change is sought.

My heart goes out to the couple in Wellington whose baby daughter died around 24 hours after she was born after Mum and baby had gone home 5 hours after their baby was born. This has been a frontline news item in New Zealand for the last 24 hours and it must be so hard for these parents who have not yet buried their baby. I hope that they are getting the support they so badly need at this time.

There has been strong criticism of Capital Coast DHB and its policy on early discharge as a possible contributing factor to this tragedy. Our new Health Minister, David Cunliffe, is demonstrating his vigor by suggesting that he may intervene in the management of Capital Coast Health. One network news discussed this tragedy in a very well balanced and thoughtful segment last night with Lorelei Mason providing a segment considering the lack of a primary birthing unit in Wellington and also in Dunedin. Norma Campbell the midwifery adviser from NZCOM explained that women no longer stay in facilities for 2 weeks after babies are born and this has not been the case for a considerable time. How long should women stay in a facility after birth? I am going to discuss this further in another post and would welcome your discussion on this point.

I am pleased that this debate has been opened up and the issue of primary birthing units is being highlighted. This may bring some long awaited action for both Wellington and Dunedin. It was also heartening to hear Lorlei describe the difference between a primary birthing unit which is situated within a secondary care facility and a stand alone primary birthing unit.

None the less we should not forget that this has come to the fore through one family’s personal tragedy. All who have been associated with this baby’s birth and death are suffering now, the friends and family of the couple and the midwife who provided their care. We all need to be aware that this is a far from normal situation, babies do not die because they go home within hours of birth. Before we start blaming we need to know what happened and why and we will not know this for some time yet. In the meantime I am thinking of this midwife and this family and hoping you all have strength and compassion for each other at this time.

Thursday, November 29, 2007

Necessity of attachment

This is video for early childhood workers but covers some of the points in the previous posts quite well.

Tuesday, November 27, 2007

More on brainwaves and human development

Following on from my previous posting Brainwaves and human development.
This is an excellent article Grey Matters from a seminar by Sir David Winkley which covers the points made here and much more.
I will now discuss this further and identify how this might influence my practice.

Babies are born with some pre-existing neurological connections, which expand rapidly through interaction with people and the environment. Babies are born with the ability to see at a distance from the mothers breast to her face. Nathan suggested this proves that the infant is born with the need to interact with others. He said that 30% of neurological development occurs through independent learning and the other 70% is through interaction with people. Babies are born with an affinity for the human face. They are drawn to face shapes and even have a preference to look and two circles representing eyes.

Learning occurs with the development of neurological pathways and myelination of these pathways. This process is enabled in the presence of endorphins and is disabled by the presence of cortisol. There are several things which promote an endorphin response. Anything which makes the child happy will promote endorphins, certain types of food, notably breastmilk produce an endorphin response. Singing, holding, massage etc promote this type of response. In addition to establish a neurological pathway the item being learned needs to be repeated at least 90 times. If a cortisol response is experienced during learning the connection will be destroyed and the pathway has to be developed again from the beginning.

Cortisol response is produced by stress. Not meeting the needs of the child creates a stress response and therefore reduces the child's ability to learn. Leaving a child to cry will create this type of response.

Photo Asleep in the sling
Babies need to be close to their parents, early sensitive and responsive care promotes future language development as described in this article and in this posting . There are critical periods which have been identified for different aspects of human development. attachment and bonding are important in children under one year. Children who do not have their needs met in this time will have more difficulty in forming warm and loving relationships.

Photo: Maya wrap baby sling.

Nathan pointed out that we can still learn some things later however they will be learned in a different way and are not naturally acquired skills. He likened this to learning another language later in life, no matter how fluent the language is always spoken with a foreign accent, unlike native speakers.

If exposure is not provided within the critical period neurological pathways can not be developed . For example a child might be born with congenital cataracts. If this is recognised and surgery is performed within the critical period of around 3 months the child will develop normal sight. If this does not happen until later the child will be permanently blind as the neurological pathways have not been developed during the critical period.

The body always has some endorphins and some cortisols in circulation. It is the balance of these that is important. If a child is learning something and is scolded, this may be enough raise the cortisol level and destroy the learning connections being developed. Rather than correcting the child it is better to model the correct way of doing the skill, as it is through repetition and modeling that new skills are learned.

Photo: Breast is best

I is also difficult to 'unlearn' an established behaviour. If an adult is quiting smoking the learned behaviour of smoking is very strong. They may have been progressing well and developing new neurological pathways for this new non smoking behaviour. If they then have one cigarette all the new pathways are destroyed and the previous smoker pathways are immediately reinforced. This illustrates the difficulty of overwriting previous learned behaviour.

Lessons from this for me as a midwife are;
*More evidence about the importance and benefits of breast feeding.
*Babies need to have their needs met.
*Leaving a baby to cry is not teaching it anything, rather it is impairing learning.
*We all learn best when we have more endorphins circulating in our circulation.
*In the classroom promoting a happy and jovial atmosphere will facilitate the learning experience.
*For adults things that promote endorphins are, exercise, music and laughter amongst other things.
*Modeling the correct way to do things will result in better learning than correcting errors.
*We all need opportunities to repeat new skills many times before we reach the "Ah ha" moment when all the connections are made and we finally have the skill fixed in our learned experience.

Monday, November 26, 2007

Sunday, November 25, 2007

Brainwaves and human development

Today I attended an interesting lecture presented by Nathan Mikaere-Wallis. Nathan was presenting the latest information from the Brainwave trust. The information in this presentation was relevant to my role as a midwife and supporting women with parenting skills. It also is relevant to my role a midwifery lecturer and finally it has potential to influence my own personal learning. Following is my interpretation of the important points I remember.(I have tried several times to embed video in this post but it continually messes up the format of my entire blog. I have tried everything I can think of to overcome this but nothing worked. If anyone has any idea why this is happening can you please leave me a comment to let me know, thanks).

Since the 1990s knowledge of brain activity has grown in leaps and bounds due to the ability to identify brain activity while undertaking tasks with the use of technology. This has confirmed some beliefs about brain development and caused revaluation of other beliefs.

The brain stem controls reflexive needs such as breathing and heart rate. The cerebellum controls functions associated with movement, however it appears that the cerebellum my have more association with higher brain activity than had previously been thought. As humans we share three basic needs with other mammals.These are the need for survival, to procreate and to care for our young. these basic instincts are controlled in the Limbic system.

Human babies are born with some neurological pathways already in place, however many fewer than is the case for other mammals. This allows us to develop pathways after birth and adapt to our environment.

This occurs in response to a stimulus where branches reach out to each other and connections, or synapses occur.

Over the first three years of life these neurological pathways are established. Connections are made in response to stimuli. For these to become established the stimulus needs to be repeated about 90 times. Each time it is repeated the connection is strengthened with a layer of myelin sheath, an fatty insulating layer. One of the functions of breastmilk is to provide this the necessary omega fatty acids for this sheath. The stronger the sheath the stronger the connection.

Connections are created in the presence of Endorphins .
If the connections are being made and there is stress or fright Cortisol is produced. This produces the flight or fight response and causes any neural connections being made at the time to be destroyed to allow the individuals survival mechanism to kick in. Destruction of the myelin causes destruction of the neural connection.

Once a child is three year old she has the most neurological connections she will ever have. At that time the brain starts to select the connections which are being used to their potential and the others are lost.

The cerebral cortex is the centre of reasoning but this does not reach its maximum capacity until around 26 years (hence the risk taking behaviour of youth).

I have more to write on this but it is late. I am tired, I will add more or might edit this tomorrow.

Tuesday, November 13, 2007

Learning communities online.

This post is in response to a blogpost by Sarah Stewart. We have recently been investigating how to use online resources to provide students with a sense of connection and a sense of being a learning community. I think this is what the facilitating online learning communities course we have been working on is all about really. Learning is definitely enhanced through community interaction and I think face to face will always be optimal,how can we help people feel that sense of connection and shared learning when they cannot physically be together in the same space. Do you think we have that sense of community in our facilitating online course? I think it has happened to a degree, but perhaps the sense of a learning community might be greater when the learning goals are also shared to a greater extent. Our course participants have come form a variety of practice areas representing a variety of professional groups and have been participating in the course for a variety of reasons, so perhaps it is quite astonishing that we have managed to achieve a sense of community at all. When we are working with distance students who are working together to learn specific skills towards a shared learning goal perhaps there will be a greater opportunity to develop an online sense of community. I wonder what others feel about this?

Sunday, November 4, 2007

Teaching or facilitating learning

Regarding facilitation and teaching. I am still trying to get my head around this topic . I have written the following to clarify for myself what my thoughts are. I would love some comments if anyone feels they have anything to add or any comments they would like to make.

I am working with adult learners. Women enter the Bachelor of Midwifery program with a variety of life experiences and most have some prior knowledge of what it means to be a midwife. Some have personal lived experience of their own or close friends or families birthing experiences. So we are not starting with a blank slate but building on previous knowledge and experience.

As with most professions knowledge in midwifery is constantly changing and growing. Some things we 'knew' in the recent past we now know not to be the case. Midwives cannot learn all that there is to being a midwife and then stand still. Learning is continuous, developing new skills, further developing skills which have been gained previously or identifying new evidence for practice decisions. I believe our greatest role is to stimulate curiosity, and provide students with the ability to continue their learning journey as professionals in the field. Students learn through inquiry and investigation, not through lecturers delivering material or being repositories of knowledge. If lecturers have all the answers, where do you go when this knowledge font is no longer there? I believe that this is the skill of facilitation, supporting and guiding others through a learning experience while making sure they have access to the necessary resources to accomplish their task. My thoughts on what can be learned in this way are changing all the time.

We have just completed our first year integration week where students work together in groups, researching material around a clinical scenario and then presenting this to the class at the end of the week. As lecturers we facilitate their learning through this process, meeting with them each day, offering suggestions for material they might want to check, making sure they keep focussed on the necessary aspects of the task. The learning that occurs during this week is enormous. Much greater than all the lectures I could deliver. I wonder how much more could be achieved if more of our course content was delivered in this way.

Having said that there are some things that just have to be taught, students will not learn the correct technique for taking a blood pressure, dressing a wound, maneuvers for assisting with a birth if they are not taught how to do so. Or am I wrong, could they also learn this through facilitated group work? As with my students, I am on life's learning journey and my thoughts on these matters are constantly changing. I think the really important thing is that we reflect on what we are doing, evaluate it and gather evidence on the effectiveness of our facilitation or teaching. We will then have some basis to state that something works or does not work and identify what produces the best outcomes for those with whom we are working.

Thursday, November 1, 2007

Midirs webinar

I just checked out the midirs webinars. Midirs is a UK published midwifery digest. I have not manage to get the webinar software working properly yet however i was able to open a presentation in real player which was pretty good. I am surprised I have not been to this before as it is totally free and some interesting topics have been discussed including tongue tie, writing for publication, normal newborn behaviour etc.

It is really exciting to see this type of resource available for midwives I found the tongue tie presentation very interesting. I have not found it particularly easy to get the software loaded on my computer to view these properly and, until I do I will not be able to participate in a live webinar, however it was very easy to view the slides and auditory recording in real player.

My confidence in trying out these things has grown enormously with all the learning I have been doing recently. I would highly recommend these to any midwives who are reading this blog. I do think that the elluminate software is a bit easier to work with and also has more options for presenting accompanying material, but this may just be my beginning familiarity with elluminate.

Tuesday, October 30, 2007

Using blogs, wikis, elluminate and secondlife in midwifery education and professional development

I have already explored the use of blogs and wikis in previous postings, however my thoughts on the usefulness for these tools continues to grow as I use them more and learn through this use. Sarah discovered that it is possible to create a blog with multiple users at blogspot. A lecturer could establish a group blog for a group of students. Students can then be encouraged to blog about a topic they are investigating or reflections on learning activities they are engaged in. This would provide opportunities for informal learning and provide students with experience and tools which could benefit them in future midwifery practice and facilitate life long learning opportunities.

For midwives currently in practice group blogs might be a useful tool for sharing practice information and share experience and evidence for practice. Rural midwives might feel that this is particularly beneficial for them, providing opportunities for sharing not otherwise available.

Wikis have potential for groups to explore a particular topic in greater depth. A group of students or midwives could commence a wiki on a topic such as group B streptococcus perhaps. Each person can independently access the same document and add content or make changes where new evidence comes to light. This collaborative process could be used for developing group presentations or reaching consensus on treatment options.

Elluminate provides the opportunity for midwives or students to come together from a computer in their own home or a local source such as a library internet cafe or maternity facility. Synchronous discussion can occur through talking or text message. Also course material or powerpoint slides can be shown on a whiteboard online at the same time. Larger groups can also be broken off into smaller groups to brainstorm particular issues. A good internet connection is required however. Although this can be accessed through a dial up connection some material may take a very long time to load.

I have been thinking a lot about second life today following my last experience there. I am not sure whether all of the things I have been considering would be possible. Perhaps those with greater knowledge could enlighten me. I believe that there are a number of uses for SL for midwives and midwifery students. I am about to fly to Auckland for a training day in real life. Midwives are traveling there from all over the country, this is logistically difficult to organise and very expensive. In second life these people would be able to come together. Powerpoint presentations could be delivered and discussed in real time. Participants can converse and share their thoughts and experience in real time. Experts could deliver real life video lectures through this medium. This must be more cost effective than getting everyone together form all over the country.
For undergraduate students there could be many learning applications for SL. Lectures could be delivered with real time discussion to follow. There is actually a physical presence to interact with. There is also an opportunity for scenario based learning . A particular scenario could be established. The students could be given information and could then make choices about the action they might take. This would lead the student to pass [teleport]to another part of the scenario where the consequences of their choices could be explored and further choices offered. Use of animations and graphics could make this very real and give a feel for the real life aspects of the issues which are explored.

The downside to all of this is getting everyone comfortable with using these web 2.0 tools and the time it would take to prepare and deliver some of these things, particularly the graphics etc for second life.

There are also many other applications such as you-tube videos which can present skills for students to view in their own time. Slide-share presentations which can either be viewed on the site or loaded onto blogs and many more tools which are sure to be used in the future.

I feel very privileged to have had the opportunity to explore and consider these various tools and resources through the facilitating online learning communities course. I would love to hear from midwives, students or fellow lecturers about how they feel about these resources. Do you think these could be useful to you? How do you feel you could use them?

Monday, October 29, 2007

No I am not really crazy I am just exploring learning communites

I realise that anyone reading my blog who does not know what I am interested in might find some of my postings about secondlife totally bizarre and consider that they have stumbled upon someone with a serious mental health disorder. So I think it's time I seriously consider what I am doing and why I am doing it. I am a midwife and a midwifery educator. I am considering how web2.0 technologies could assist me and my colleagues or students with learning.

I recently completed a thesis for a Masters Degree in Midwifery entitled "Wise women’s web: Rural midwifery communities”. This reports the findings of research I undertook to find out how rural and remote rural midwives inform practice, identify issues they my have and find out what they felt might support this. Being a bit of a lover of ready access to research and journals etc, I had thought that the midwives might want better access to online sources. I was a little surprised to find that what they really valued was the information that they shared amongst themselves, during their working activities or when they attended study. This should not have been a surprise because this was always important to me to in rural practice. On further research I found out more about communities of practice and their importance to the learning process. Originally discussed within the context of information technology (Wenger,2006)the importance of communities of practice has more recently been identified in the areas of health and education. Really this is giving a name and a structure to something which has been important in practice for a very long time. (Norris, Mason, Robson, Lefrere & Collier, 2003; Gabbay & Le May, 2004; Tolson et al., 2005).

Within my teaching practice I have also become aware of the importance of learning communities to the students I work with. As a postgraduate student it was also important to me that I was studying with others and could share and discuss aspects of the course and my understanding. Getting another perspective of material I had heard and interpreted myself opened up my thinking and helped me to identify other possibilities. I am currently engaged in a course called Online learning communities communities. In this course we have investigated how web2.0 technologies can assist in providing opportunities for communities of practice to grow and support learning for those involved. So I am interested in how these technologies might benefit both midwives in practice, particularly rural midwives and student midwives who are studying at a distance. This is something we will be moving into in the near future and, although part of the course will always be delivered face to face, a much greater proportion will be delivered online at a distance from the Polytech and from other students.

This is enough about why I am doing this in my next posting I will discuss how I believe these technologies could assist midwives and student midwives.
Norris, D. M., Mason, J., Robson, R., Lefrere, P., & Collier, G. (2003). A revolution in knowledge sharing.
Educause Review, 38 (5), 15-26.
Gabbay, J., & Le-May, A. (2004). Evidence based guidlines or collectively constructed "mindlines"? Ethnographic study of knowledge management in primary care. British medical journal, 329, 1013-1017.
Tolson, D., McAloon, M., Hotchkiss, R., & Schofield, I. (2005). Progressing evidence-based practice: an effective nursing model? Journal of advanced nursing, 50(2), 124-133.
Wenger, E. (2006). Communities of practice, a brief introduction. Retrieved 29th December 2006, from http://www.ewenger.com/theory/index.htm

SL video

Found these videos which are pretty simple.

second life again

I just have to say a little about last nights visit to SL. I accompanied Sarah in but initially was not part of the group finally got that sorted and found out how to accept invites and teleport. We went to the Rod Laver stadium and had a go a playing tennis but I didn't know how to make myself move once I took the role of player. Wandered a bit aimlessly and no one seemed to be talking. I was a bit too nervous to try talking, a bit worried about making a twit of myself I think, and not too sure what to talk about really. We went to IBM and saw quite a lot of good things, got a ride on a wee flying car. I accepted some gifts there but I don't know what happened to them, or what if anything I can do with them. I also managed to fill in a couple of online surveys. One highlight I have to say was flying over to a large yacht and having a brows around, it was very luxurious and a lot like the real thing I imagine.
Went to some Island where I had a go at playing a tin drum and wind surfing,then I followed a link to a halloween site. I lost everyone at this point. It got really weired I clicked on something that got me dancing and I couldn't stop. Mind you I was a pretty good dancer and the guitar music was really good. I literally lost my head. In the end I got out of there somehow, I can't remember how, by choosing to go back to the orientation area. When I was back there I met another newbie, from New York. We met by a cow and decided to see what it would do, we made it go Moo and then we sat on it together. Then I told him I had to go said goodbye and left.

In the IBM site there were meeting rooms, I can see that sitting around with a group of people who share a common interest and are unable to get together in any other way could be useful. I can see that there is an option to present people with online resources outside second life, such as the surveys I completed which could also be useful. I think there is a great deal of learning to do before we are all ready to be able to make use of this. Maybe we need a bit more help here.
I do believe that in time we could make good use of SL, when we are getting students coming through who are familiar with online tools such as this. Given the level of technophobia I see around me [as well as my own trepidation], I think that is a fair way off. I will wait until we have managed to have a group meeting where we have actually communicated before I draw any final conclusions though. I intend to check my students next year to find out what their level of knowledge is on online social networking tools.

If you are a midwife or midwifery student and have any experience of using second life to network with a community of midwives or students I would love to hear from you about how you are finding this and if it is really useful.
I wish I could load the photos I have but can't seem to work out how to get them from email into my blog. I could use some pointers there too.

Sunday, October 28, 2007

Using elluminate in learning times

An interesting tutorial on setting up elluminate through an open source professional development program called Learning Times.

Saturday, October 27, 2007

Maternity care in the UK

just found this interesting blog posting of an American woman's impression of maternity care in the UK. It doesn't sound so very different to what we have here really. Then you hear the other side of the story with this midwife who is feeling really weighed down and overworked. An interesting account here of a day in her working life. She also makes some inersting reflections on cost cutting in the NHS and the impact on her practice.

Online Elluminate meeting

Sarah Stewart is going to run two online meetings for midwives from around New Zealand and around the world.
The first is to discuss and share information about the New Zealand maternity service, and the second is to discuss research, particularly postgraduate midwifery research. Anyone is welcome to attend, I will be assisting Sarah. Sarah has put really clear instruction for how to access these meetings in her blog .
It would be fantastic to speak with people about these topics and see if we can support each other to make a difference for the midwifery profession and for women.

Structure of the midwifery service in New Zealand

When I have checked my statistics (see bottom of this page) I seem to have a few overseas visitors to my blog. I decided it might be good idea to post a diagram of my interpretation of the structure of midwifery services in New Zealand [see above]. I created this file in Gliffy. this is the first thing I have created in Gliffy, so it may look a little rough around the edges.

Now a small explanation of this diagram. I have also made an audio recording explaining the diagram [see above]

The Ministry of Health contract the Midwifery Council to regulate and oversee the midwifery profession in New Zealand. The Ministry of Health also contract District Health Boards to provide facility services for maternity care.

District Health Boards manage and disburse government funds to facilities which provide secondary, primary and rural maternity services to the public. These facilities employ midwives to provide core midwifery services (i.e. staff the facilities) and to provide lead maternity care (i.e. one on one or small team care to women throughout pregnancy birth and postnatal).

Midwives may also be self employed and be paid directly from the Ministry of Health. The Ministry of Health either pay these fees directly to the midwives or pay through a body contracted by the midwives to handle these payment (e.g. New Zealand College of Midwives [NZCOM] do this through the MMPO a subsidiary of NZCOM)

NZCOM is the professional organisation of midwives in New Zealand. It looks after the interests of midwives and the midwifery profession. NZCOM have developed standards of excellence for midwifery practice and consensus statements around aspects of maternity care, in consultation with the profession. They are subcontracted by the Midwifery council of New Zealand to provide the Standards Review Process which is a peer review process midwives must engage with as part of the recertification process.

Thursday, October 25, 2007

Rural GP Network Conference!

Please excuse me if I seem a little cynical or perhaps even a little paranoid.

My good colleague and I have just had three abstracts declined for this conference. The topic of the conference is "Doing it better: Working together". It seems however that there is a marked lack of interest in doing it better and working together with midwives, this is despite the fact that all three abstracts were very relevant to the conference theme. We have been told that the quality of abstracts was extremely high, although the conference organisers did have to put out a second call for abstracts and offered support and assistance to those who might be struggling!!!!

Further reflections on curatorial teaching and second life

This is in response to a posting by Yvonne. I have to say that reading others reflections on the issues we have been discussing, or the lectures we have had do help me to consider these things further. I initially felt that the idea of the lecturer as a curator, as presented by George Siemens was somewhat distant and detached from the students. As I consider others thoughts on this I am coming to see this as one of the roles that lecturers have. Lecturers need to present interesting material which students can explore further. Providing students with a variety of interesting resources provides them with some direction for individual exploration and consideration. Had there been some resources like this in second life for me to explore during my aimless wanderings the other day I may have had a different impression of the place.

Japanese midwives visit

During the last week we have had the privilege of hosting a group of Japanese midwife educators and postgraduate midwifery students at Otago Polytechnic. Our Head of School Sally Pairman had organised an fairly full program for them. It was really interesting to meet these women and hear about midwifery in Japan.It does seem to be very different to New Zealand. Doctors have to be present for births, some doctors take more of an upper hand in the care than others. Since the 1950s in Japan birth has moved form 90% homebirth to more than 99.8% hospital births and numbers of licensed (registered) midwives have halved. Numbers of all other health professionals have increased considerably over this same period of time. However the midwives commented on the Japanese government's concern about the lack of Obstetricians and the medical professions reluctance to train in this area of medical practice. Here is an interesting article which highlights this issue In Japan’s Rural Areas, Remote Obstetrics Fills the Gap . This article talks about doctors assessing labouring women through remote technology.

I brought the midwives to our lovely little rural unit in Balclutha
. The midwives there Vicky Cook, Christy Soper, and Nicky Cox (Holly McMillan was missing) shared their experience as rural midwives and impressed the Japanese group with their commitment, passion, care and expertise for the job they do.

During their brief stay we formed quite a bond with these midwives and hope to catch up with some of them again in Glasgow in 2008 at the International Confederation of Midwives congress

Adventure? in second life

I wish I had a photo. I took a couple while I was in SL but do not know where they have gone.
I discovered on Wednesday that SL will work with Vista now so set off on my journey. I arrived on Orientation Island and met a young lady there. She was from New York and was in SL to make friends as part of a class she is doing. We had a wee chat and flew around together for a wee while then went our separate ways. We signed each other up as friends. While we were talking a strange shadowy creature came up to me and seemed to be touching various parts of my virtual body, I ignored it. I explored a little, got on a vehicle and ran over a few rats. Wandered around the island and looked at some videos, then teleported to an area with shops. I found amongst other things that I could buy female anatomical parts. One has to ask the question why???? Went to various other places fairly aimlessly. I tried to talk to some people but they mostly ignored me. Some just stood and stared at me. I did learn how to dance, again I am left asking why would I want to virtually dance? Went to money Island but you can't make money if you come from New Zealand, only UK, USA, Australia can fill in surveys to do this.

It was a very strange experience. I wasted an awful lot of time doing very little. I was not able to join our group on Thursday as I was transporting our Japanese guests to Balclutha. I think it may be useful to go to SL with others or to go if you have some idea of useful things to do, otherwise I really wouldn't bother. Still I did develop some skill at moving around which is seems from the posting on our group blog,"Our first venture into second life" is fairly important to get the most out of the experience. Perhaps it was not such a waste of time after all then?

Wednesday, October 24, 2007

Setting up an elluminate session

Today Leigh helped Sarah to set up a meeting on Elluminate for Monday when her daughter is going to share her expertise with Facebook. I sat in on this and Leigh asked one of us to prepare a video of this process. So here it is. It seems pretty simple really, I just hope I have got it right. I am sure Leigh will let me know if not.

Another busy week

What a week. The weather has been wild. Yesterday the gales were so strong trucks were blown off the road, causing the road to be closed and making my long trip home a little longer.

I have been away doing some locum midwifery again over last weekend. Staying in my camper van and traveling around some of the most beautiful countryside in the world while doing postnatal visits. My last night I had a transfer to the base hospital which meant I was up most of the night. I am not as resillient as i used to be and I am still feeling the effects of this.

Meanwhile at Polytech we have some japanned midwives visiting which has been very interesting. I am taking them in a minibus to visit the maternity facility in Balclutha tomorrow, so hoping the weather is kind.
Japan Photo Gallery

Wednesday, October 17, 2007

Fear, risk and supporting normal birth in midwifery practice.

I am writing this in response to a posting by Sarah Stewart. She has written an honest and insightful posting on how midwives cope with fear and risk. She considers the impact on practice when other midwives are involved in litigation. It seems to be especially difficult at these times to support women, or to maintain a midwifery identity considering birth as a normal and empowering life event. I am sure many midwives will identify with the situations she describes.

I too have struggled and debated the concept of risk and how we as midwives can promote normal childbirth and support women to birth without intervention, as we know the majority of women are able to do. Spiraling caesarean section rates force all midwives to look at their practice and consider what their contribution is to this phenomenon. For me, when I am considering risk, I try to turn it around. I consider the fact that almost always, no matter what the risk, it is much more likely that everything will be fine than the possibility that the risk, whatever it is, will eventuate and result in an adverse outcome. Sometimes the risks are so high that there is no question about the need for intervention, for example, placenta praevia or transverse or oblique lie at term. At other times the risks are very low, for example the risk of uterine rupture following previous caesarean when labour is spontaneous. Conflicting evidence about the chance of adverse outcomes makes decisions difficult for women and midwives need to support them to understand and make rationale decisions. If we approach risk in this way I believe women are more likely to have confidence in themselves and in us. Confident that they can birth their babies without intervention, but also confident that we will be watchful and will advise them if things are deviating from the expected path.
Our job, as midwives, is to acknowledge risk but not get it out of proportion. We need to assure women that we are aware of and vigilant to the possibilities of problems occurring which may require intervention. This is after all why women need the care midwives. We not only need to support women and assure them that all is well and that they can succeed in birthing a baby, we also need to be aware of what can go wrong and have the ability to deal with the situation in an emergency situation, or refer on to specialists when there is a necessity to do so. If this were not so women would birth without any support at all.

Rural midwives wikispace

I did some more work on the rural midwives wikispace last night. It was a bit frustrating working on it as my computer has been misbehaving. I was playing with the widgets option and managed to add my igoogle movie and a survey to this site. I tried to add my GBS slideshare show but couldn't get into the slidshare website. i don't know if this was my computer or theirs. I also managed to arrange the space as a series of pages with a navigation tool down the side. This looks a lot better than one big page. I feel it is probably at a point now where midwives might find it a little interesting and feel they could make some suggestions for content or even start to work on it a little. I might try to make another wee movie to demonstrated how edits can be made and how discussion comments can be left. I just need to get this out into the midwifery community somehow now. I have started inviting one or two people to the site but do not have email addresses for many. Any ideas for getting this out to people?

Monday, October 15, 2007

reflections on Derek Chirnsides 10 minute lecture

This is my interpetation of the 10 minute lecture delivered by Derek.
The words used here and interpretation are my own. Derek began by saying that online learning is
Learner centred
It needs the world wide web

He provided a map of how students progress through his course. They begin by story telling together and, as they gain confidence and knowledge of the topic they venture out into online sources and shared resources. At the end of the course they return and once again share stories. Derek says that story telling is very important part of the learning journey that the students make during the course.

Stories help to build the community which is based around the people on the course.
Students participate in 3 levels of reflection;
Blogs ( they either come with an existing blog or are assisted to start one)
Open journal (which is open only to the course participants)
Closed journal (which is only between the lecturer and the student).
The discussion which followed this lecture centered very much on this area, of closed and open access to blogs and journals, with very different points of view being expressed. My understanding of some of the points that arose during this discussion were as follows.
Open access, i.e. available to all on the WWW:
Provides the opportunity for stimulating interest and involvement from a much wider group of people than would be possible in any other way. This may provide wider information to the participants and raise issues that would not otherwise have been considered. It provides the opportunity to maximise the learning potential of the course. Participants will be able to develop skills in what is and what is not appropriate to share in this type of environment and will develop greater skill in maintaining confidentiality and not sharing that which should not be shared.
Open to the course participants only:
Provides the opportunity for shared learning within the group without going out into the WWW. this may be a false sense of security as information shared within the group could still be shared wider by member/s being indiscreet. If the sharing occurs through a group activity through a medium such as elluminate, and is not recorded, it may be not be much different to the type of tutorial groups which currently occur in the midwifery program. However written open journal group are used then there could still be issues of breach of confidentiality. Indeed the fact that there will be a written record of the communications could pose particular problems in the heath field. If the health and disabilities commissioner is investigating an issue he/she has the power to subpoena any written record, which may also include these journal entries. Issues of professional safety for client, health professionals, lecturers and the Polytechnic need to be considered. In addition there is the opportunity for the unscrupulous to use this written record for nefarious purposes.

Closed journals, only shared between the student and lecturer:
Have limited opportunity for learning but may allow the student to be more open in their own reflection. Might also offer the lecturer the opportunity to encourage a greater depth of personal reflection form the student. Once again as this is written record it could be open to misuse and abuse as above.

I have to say that I found this discussion to be very useful and clarified my thinking on this issue which I have been mentally struggling with to some degree since I started participating in this course.My conclusion is that there are advantages and disadvantages to all of these methods of communication. I feel there should be a mix of these options available and required within an online midwifery course. Students do need to have the opportunity to share with a group of peers and tutors in a secure non recorded environment for a small proportion of the course.

Sunday, October 14, 2007

Safe Motherhood

Safe Motherhood
Originally uploaded by Christian Lagat

The Lancet medical journal is devoting its current issue to the safe motherhood initiative, which is 'celebrating' its 20th anniversary. There are several excellent articles in this issue on the topic of childbirth. It also has podcasts. The articles and podcasts are free. They are well worth checking out. Sadly it seems that there is now acknowledgment that the global initiative, of the World Health organisation and United Nations, to reduce maternal mortality by 75% by 2015 is unlikely to be reached. It seems that there is a lack of effort by societies and governments to make this happen.
You can get access to the Lancet through free registration. Some issues have free open access articles. I have this in my RSS feed and just check to see if there is anything of interest to me before I open it.

Saturday, October 13, 2007

Digital media in Teaching

I have stolen this from Helen Lindsay's blog. I saw it there and just thought it was so good I had to put it in mine too. Hope you don't mind Helen. It is from a slide share by Tony Whittingham. Tony has lots of other good things in this Wikispace. Well worth a look.

practicing with creating and embedding videos

I have spent the whole day trying to get this happening. I very nearly felt like throwing the whole thing away however I have finally managed to do it. WOOOHOOO! I know the video itself is not stunning but it has been a huge effort. I have one or two other topics that I would like to do similar videos for.

Friday, October 12, 2007

What have I gained from this course

This posting is in response to a suggestion by Sue in Leigh's blog

What have been the highlights?
There have been quite a few.
the 10 minute lectures have undoubtedly been really great. I can see the opportunities to do this sort of thing in the field of midwifery and maternity care. Wouldn’t it be great to get speakers like Anne Frye or Janet Balaskas or Sheila Kitzinger or Robyn Maude to speak on a particular topic and provide students with the opportunities to talk with these people online? How inspiring would that be? Or perhaps to speak with midwives who work in different aspects of midwifery care, an isolated rural midwife, a core midwife, an antenatal educator, etc.

I have really enjoyed getting started with this blog.
Although I have always seen the value in regular reflective journaling or writing I have never been able to sustain this activity for long. Somehow I feel I might be able to keep this blog going. I do need a more private space as well for more personal reflection, or reflection relating to particular aspects of clinical practice and I have now managed to establish this also through Mahara.
I got a lot out of the collaborative wiki that Sarah and I worked on developing up as
an abstract for conference and I think this is something I could use more.
One of the biggest things I think has been finding all the great Google tools there are that I had no idea about. I love igoogle, I signed up for gmail yonks ago but had never really seen the value in it but now I have it on my igoogle page and am using it all the time. Leigh has done a great wee video on google maps with lots of neat features. I have started using firefox and love that also.

I have enjoyed participating in this course with others from different disciplines. As a midwife I have seldom had the opportunity to work with others in this way and it is an aspect of the course that I have really enjoyed. The person I have communicated most with however has been with Sarah, with whom I share an office. This may be because we know each other face to face but could also be because we share many interests (not romantic novels or rugby however - I am not a fan)

What aspect(s) caused you the most anxiety?
I think the shear volume of resources that there are. I am still finding things which are pertinent to this course that I did not know existed. For example some of the resources that Leigh has on his blog that I am only just exploring now. I think also that sometimes I am bit off track, trying to see how I can use these resources in my teaching rather than how I can use them to meet the requirements of this course.
When you try time and again to get a particular thing to work and just can’t get it to happen, it is very frustrating. Mostly I have managed to work through these things though, and this is a really valuable learning experience. I do worry about future students out there struggling with these tools though? I am not sure they would stick with it.

Was there any aspect(s) that surprised you?
I am continually surprised at the amount of resources there are out there and all the really interesting things that people have done and put out to help others.
With the knowledge you now have gained — what would you do differently?
Not much I think. Perhaps it would be good to have a bit more direction at times. I think the idea of finding out what the students want to get from the course at the outset is a good one as not everyone will be here for the same reason. I think Leigh and Bronwyn have done a good job of commenting on our online work to let us know they are reading them and have often offered helpful hints at this time.

Friday, October 5, 2007

Midwifery, Breastfeeding, Camping and Possums

I have just had a week away doing a couple of the things I love best.
Firstly I was doing some locum midwife cover from Friday through to Monday last weekend. The midwives I was covering for have a fairly busy caseload and so, for these few days, I got to do a full range of midwifery practice. I saw women antenatally at all stages of pregnancy, from booking through to end of care postnatal visits. I was supporting women beginning to breast feed their babies, visiting women at home with new babies and seeing women at varying stages of pregnancy. It is a challenge to step into these women’s lives for a few days and make sure that they receive the care and support they need. I was also able to care for a young woman during the labour and birth of her first child. This young woman had a posterior lying baby but was able to focus in on her body and her labour, with great support from her family, and birth her baby with just a little entenox to help her through transition and birth. My job was just to help everyone stay calmly focussed on the labour, on cervical dilation and on birthing the baby. It was a very joyful and empowering experience for everyone, including me.

While I was there I found out that the midwives had a breastfeeding workshop arranged for the Tuesday and I was welcomed to join them. This was very opportune for me as it is the one aspect of the midwifery recertification program that I had not yet been able to do this year. I leapt at the chance. The facilitator, Dawn Holland, used some really good visual aids to help get her message across. The main points that stood out for me were
• Women have varying amounts of glandular breast tissue.
• Breast size is not a good indicator of the amount of glandular tissue there is in a breast.
• Babies do not realise that their mother has more or less glandular tissue than any other mother but adjust their feeding requirements to meet their (the babies) nutritional needs.
• Babies will obtain adequate nutrition from their mothers’ breast if they are allowed to feed on demand.
• Babies may need to feed very frequently, if there is less glandular tissue, or might be able to feed much less frequently when there is an abundance of glandular tissue.
• The volume that babies receive does not change much over time.
Another interesting point was regarding prolactin receptors which are stimulated through early frequent feeding. Dawn likened this to the buckets with lids on. As the new mother feeds the lids come off the buckets which can then be filled with milk. After about six days no more lids can come off the buckets, so the volume of milk the breast is able to produce is set. This reinforces the importance of early frequent feeding for the establishment of lactation. If the baby is not able to feed for some reason frequent expression is necessary. To establish good and adequate lactation Duration, Intensity and Frequency of feeding are the key factors. It is the DIF in DIFference that makes the difference.

On Wednesday my sister her two children and I headed off in my campervan for the last days of the school holidays. Although it was wet and cold we had a great time. Went to Alexandra, Queenstown, Glenorchy and Arrowtown and home today. It was a shame we had quite a lot of rain but it did not stop us from getting out and about. Now I want to get back to those places again, especially Glenorchy and Arrowtown and really explore them.I came home with some lovely pieces of possum fur, purchased in Glenorchy, ready to get crafty and make some lovely (I hope) things.

Wednesday, September 26, 2007

Bloggers teachers and learners

I am very new to blogging. Just learning the skill and starting to see the possibilities. I am enjoying using a blog as a personal and professional reflective tool while having that visible for others to share, to stimulate their own reflection. When they too share it creates a spiral of learning and growing. I do not believe learning is ever a two dimensional process, i.e. material delivered = learning occurs. Learners make connections with past experiences growing their understanding, raising questions to which they seek answers, and so the cycle continues. The experiences to which they can relate their learning are not limited to the subject in which they are involved at the particular point in time. Thought processes can make varied links and connections all of which add to the ability to learn and grow. I am thinking about blogging and how this can be used a reflecting and learning tool for our students. How much of ourselves should we share in our own blogs and what form should they take. I have been stimulated to consider this by these blogs from Konrad Glogowski and Sarah Stewart.

As teachers I think we should keep a focus on what our students need to learn. We need to create a climate of learning which will engage students and stimulate the possibilities for sharing and reflection. Dewey (the educational theorist and philosopher who died the year I was born) believed that education must engage with and enlarge experience. Dewey also identified the importance of reflection and thinking on how we learn and was concerned with education creating an environment in which this could happen. I think Dewey would be enraptured by the possibilities of this new medium to stimulate and support learning.

Newman, Michael (2006) 'Throwing out the balance with the bathwater', the encyclopaedia of informal education, www.infed.org/ . Last updated: September 21, 2007.Suggests that "In the objective world we act as subjects to objects, in the social world as subjects to other subjects, and in the subjective world as subjects to ourselves, and so we engage and make meaning through physical action, through our interaction with others, and through self-reflection". When we blog we are creating another sphere where we are blending the subjective and the social in ways that were previously only possible in small philosophical intelluctual groups. Newman suggests that "Our purpose in working in adult education at any of the levels, meta or otherwise, is to help people quell their angst and so liberate them from their own inactivity. It is to help them identify and understand their unrequited yearning, and to help them act in order to satisfy that yearning. It is to help them give an object, an objective, to their desire." As teachers then I think we should embrace this new environment for sharing and learning. We can stimulate deeper thinking and point out connections that students might not otherwise see which can lead to that Ah Ha! insightful moment. The spark that brings the subject to life.

In my relatively short career in teaching I have often felt that if only the few students who really get it, who have that insight could share in a meaningful way with their fellow students how valuable that would be. This value is not only to those who could be inspired by this insight and perhaps help to attain this for themselves, but helps the entire group to learn, grow adapt and change.

Now I am getting on a role and could probably go on and on but I think I will stop here. I have more thoughts floating around in my brain but I am really interested to know what others think? Please, if you do drop by, leave me a word or two to let me know your thoughts.

Monday, September 24, 2007

Video conference

I have just participated in a video conference. The first such meeting I have attended. I thought it might be appropriate to blog my thoughts.

There were 6 groups participating in the video conference. I was the only one on my own. Three others centers had two in the room. The main center had a group of four participating and one other center had four participants.

Positive aspects of this meeting

*It was a good opportunity to get people together without having to travel too far
*It is nice to be able to see each other as well as to speak
*There was the ability for the main center to present a slide show on full screen and to talk over this to present it (I do not know if participants in other areas would have been able to also do this or not).
*Connection was acheived through a television with the aid of a remote control.
*Particpants who are not at all happy about using computers or technology found this easy to use and enjoyed participating, saying that they would happily do more of this and use it for different educational and meeting purposes.
*For most it was very simple to get going and use this without it having to be a big learning curve

Negative aspects
*I am challenged by televisions and remote controls.
(I know this is ludicrous as I am quite happy finding my way around a computer and enjoy learning about all these new technologies.)
*Perhaps I did not have adequate instruction but it took me ages to work out when I was able to speak and when I was muted.
*I could quite often hear background noise which I found distracting.
*I found the conversation quite stilted and difficult to get a good flow going.
*Access is limited to the places that have this network available. I believe that Otago has access in the main rural centers and one in Dunedin.

Overall it was a good way to get together and it is interesting that those who abhor anything to do with computers and technology did not have similar feelings about this, expressing support and enjoyment of the process. This being the case perhaps this is a good way to get rural and isolated people together. However it does not provide an opportunity for establishing ongoing communication and is limited to access at certain times in certain locations. Whereas communicating online is more spontaneous and for most can occur anytime from wherever they can access a computer, for most this would be their own home or workplace. It would be very difficult to have a meeting with more centers than were present in this meeting. The screens would not be big enough to see people and it would be too confusing about when people could speak or not speak. Using online group networks such as Elluminate it is possible to have quite a large group participating and to share documents and resources as you go. I feel that participation and interaction is generally more limited in the video conference medium.

Additional thoughts.

Using this is useful for people who cannot use computers. However if they rely on this instead of learning how to use web based communication and networking tools they are cutting themselves off from a huge source of valuable information sharing and networking tools which could benefit them in so many ways. In many ways I feel a bit sorry that we are going down this track instead of encouraging midwives to get up to speed with the internet and web based communication, which i believe has a lot more to offer.

Sunday, September 23, 2007

Suturing videos

The following videos will help you with your suturing practice. Start with the bottom video of Scott and pal and work your way up.

All the best with this. Enjoy your practicing and impress your family and friends with your skills. Get ready to come back next year and start learning the next stage of suturing skills.

Feel free to leave a comment about these videos and how useful you find them. Your comments might help your class mates to decide which ones they want to view.

Holding instrument and knot tying

Nice demo of holding instruments and knot tying. We did not watch this one in class but it looks quite good and covers some aspects not covered int he other videos below.

Surgical knot tying with instruments

Scott and pal show you how to tie surgical knots with instruments

One hnded surgical knot tie

Embedding is not allowed on this video. So follow this link to see Scott demonstrate a one handed tie, right hand predominant.

Scott and friend help you with suturing

In this video Scott and his pal introduce you to suturing.

thinking about students blogging

I have been thinking about the potential for students blogging since I found the previous mentioned resource, 21 Classes cooperative learning, where it would be possible for students to have their own blogs within a closed group. I have been thinking about how these could be used within the Bachelor of Midwifery program and possibly also for groups of health professionals who wish to be able to communicate in a secure environment.
I wonder if these blogs could be assessed in some way as part of the students course requirements. I wonder if the SOLO taxonomy could be used to assess how the students are using blogs as a tool for personal learning and reflection. I can see how this might be a useful way to look at how students make connections between clinical experience and research evidence and use this to inform their learning and future practice. I would be interested if anyone else has any thoughts about this.

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