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.

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