Thursday, December 18, 2008

Round up of developing a midwifery practice skills course for flexible delivery.

Image: Pohutakawa, the NZ Christmas tree. from Andy Eakin’s photos on

As the year comes to a close Lorna and I have been making great progress towards the midwifery practice skills course we are developing in a blended delivery format. I have not been blogging much because I have been so busy working on this but I now need to record what I have been up to for the last few weeks. So to bring you up to speed on what this is all about here is a brief outline of the programme.


We have been developing a midwifery program to be delivered in a blended format over the last couple of years. We start at the beginning of 2009. Students will be located in groups or cohorts in various rural towns as well as the main centers. Otago Polytechnic are developing this in collaboration with Christchurch polytechnic. The process we have developed is as follows

We are using the moodle LMS for the online course delivery. All content is being developed in modular format using EXE as a development tool. We are using a mix of written material, links to online content and free online resources. We are also using powerpoints with voice over, converted into shockwave flash files with ispring and either embedded or hyperlinked to exe files. Students are given a plan for progress through these modules although they can also work at their own pace if they wish. It is expected that they will progress through this material ready to attend the face to face components ready to discuss and debate the theory they are learning and to gain experience with the practical skills they will need for midwifery practice.There are formative assessments, such as quizzes and interactive games, to support learning in the online resources. Each section has clear learning outcomes to help students understand what they are expected to learn from the resources.

Students will meet in their local groups once a week with a local midwife/educator who will facilitate their discussion, direct them to learning support services if they are having difficulty with the learning and provide teaching and guidance with selected midwifery practice skills. The facilitator will also encourage the students to share and support each other through their learning experience and will coordinate placements in the various clinical or midwifery practice areas, liaising with midwives and other health care providers.

In addition the entire class will come together at four two week blocks in the year. At the start of the year they will be introduced to each other, the courses, the technology and support services they can access. Some face to face teaching and team building and group activities will be scheduled. Later their will be more face to face teaching and at the final two week block examinations and summative assessments will take place. In addition to this teaching and learning students will have midwifery practice placements in a variety of settings.

Progressing to this point

As we approach the start of this new programme. I am feeling very positive about it. We have been working very hard to structure our course in a logical way which should clearly link theory and practice and progress the students through from the basics to to more complex practice skills, while keeping these firmly linked to the context of midwifery practice.

As I have recorded in previous posts we separated the skills into modules which made sense in terms of midwifery practice. These are, antenatal, labour and birth, postnatal mother and child and therpeutics. More recently we realised we needed another module for the core component which overrides all of these others, that is communication. In this fifth module we will have material on communication skills and also include material on documentation, which is another form of communication. We were going to put material about the components from this course which will fit into the student developing portfolio, either paper based or electronic. However at the moment we feel that we will keep this alongside the course information, which is where the students will enter the course.

I have been working on the EXE files, which are on my hard drive, developign the course content. I then felt I needed a better overview of how the students would actually move through the course material. Which aspects would be taught face to face in the intensives. Which would be taught face to face in the tutorial groups and which would be principally online learning. I sat down and worked out where all these components would fit within the year of the course. At this point we hit a small block as we were not all thinking along the same lines here. My boss, head of the school of midwifery and head of the health group at Otago Polytechnic, Sally Pairman, obviously liked the way I had shaped this up and developed this further alongside all of the other courses the first year students will be involved in.

Earlier this week I flew up to Christchurch and had a meeting with Lorna. This was very positive. Lorna and I share very similar ideas about how the course will work and so we have very few problems in working alongside each other. It was lovely to spend some time with her and her family, she gave me a bed for the night. We have negotiated with the math department from CPIT to run the examination of Math for our students and to take a couple of tutorial sessions with them as well. This is fantastic and will definitely be a bonus for us.

So now the road ahead is very clear, there is still some development needing to be done with the online resources but I am feeling confident and positive about the programme.

What have been the highs a lows of the development process.


I have been very lucky to be working alongside Lorna in CPIT. It has been great that we agree so well on so much. Lorna identified EXE which has been a godsend for course development and also ispring which has been great for converting power point to shockwave flash files.

I am sooo… glad I participated in the Facilitating online learning communities course with Leigh Blackall and Bronwyn Hegarty and also the Design for Flexible Learning also with Leigh and Bronwyn. I would not be nearly so able to engage with this process without the learning I did in these courses.

Finding all the great stuff that is out there on the internet, free for anyone to use has been just amazing. The generosity of those who have developed these resources is amazing. I wish we were able to reciprocate, perhaps in time??


The main point of difference is with our institutions and the way that they perceive students should engage with learning. OP has an open policy where we as lecturers own the material we develop, we can take it with us when we go as long as we acknowledge OP if we use it. We can make it freely available on the internet if we wish to. CPIT on the other hand have a closed policy, all of their resources belong to CPIT and cannot be shared in an open environment. None the less I have loaded some of the content I have developed onto wikieducator and slide share etc, and I hope to do more development of this as time permits.

The time frame has been tight, the pressure has been quite enormous, and the workload allocation for development in no way related to the reality of the job. It has also been a struggle to do this and keep our existing students ontrack. I have to say our first year students this year have been a group of wonderful women and have been enthusiastic is supporting us as we have worked to develop the new course materials. Some of this new work has also filtered through to them to their benefit also I think.

A times I have felt quite alone and isolated. It is hard to get the IT support needed as we are experts in midwifery and so we really have to develop things ourselves. I do think the IT support has been less than it could have been at times however.


So now I am on leave for abpout 3 weeks. I am going to have a total rest from this and back into it on January 5th.

Merry Christmas ( or happy celebration of whatever you celebrate at this time of year). Happy holidays to all.
This post is also on my other blog Fled: Flexible learning education design. All hyperlinks are included there.

Sunday, November 23, 2008

Lactation conference online: Gold 09

As part of my role as a midwife working in a rural maternity unit I have been enrolled in a lactation course. I have only just enrolled and have not traveled very far with the course yet, however there are a couple of things I want to comment on at the moment.

The course has been developed by a group called Health E learning and has been developed on the Moodle platform. This interests me as we are developing our new midwifery programme through Moodle. The course looks professional and engaging and may have some ideas which I can incorporate into the work I am doing.

Health E learning seem to be a commercial group who are engaged with producing learning resources for lactation consultants. These courses are available for a fee. I realise that there is a cost in developing these resources, however it does seem a shame that only those who can afford to pay will have access to them. In my case my employer is paying.

The Health e learning group are running an online conference (Gold 09)which can be attended, once again for a fee. As they say, the cost will be significantly cheaper than actually flying overseas and attending a conference. I am very interested to see how this goes and to find out how the networking opportunities compare with face to face opportunities at a conference.

It is exciting to see that rural health groups are taking advantage of the learning opportunities afforded by the internet. This is the third year that the Gold conference has been run but it is the first time I have heard of it. I think this is a great initiative and hope that all midwives have an opportunity to attend, supported by there employers, not only with the fees but also with time off for the conference.

I will let you know how i go with the course as I work through it.

Image: woman breast feeding baby, from hdptcar's photos on

Monday, November 17, 2008

My E-Portfolio

I am well behind my colleague Sarah Stewart in terms of online presence and developing and e-portfolio but I have made a start with this on the Wetpaint wiki site.Wetpaint have agreed to provide an advert free site for educational sites. You have to apply for this and I have been granted this status for my site.

Your thoughts comments and suggestions are very welcome.

This post also appears on my Fled blog

Friday, October 10, 2008

Best outomes from midwifery care

A Cochrane systematic review. Which is internationally recognised as the best available evidence on a topic, has found that women who have midwifery led care have fewer antenatal problems and as good or better outcomes than other models of care. The reviewers conclude that all women should have the option of midwifery led care.
Below are the main results of this study from the reviewers

We included 11trials (12,276 women). Women who had midwife-led models of care were less likely to experience antenatal hospitalisation, risk ratio (RR) 0.90, 95% confidence interval (CI) 0.81 to 0.99), the use of regional analgesia (RR 0.81, 95% CI 0.73 to 0.91), episiotomy (RR 0.82, 95% CI 0.77 to 0.88), and instrumental delivery (RR 0.86, 95% CI 0.78 to 0.96) and were more likely to experience no intrapartum analgesia/anaesthesia (RR 1.16, 95% CI 1.05 to 1.29), spontaneous vaginal birth (RR 1.04, 95% CI 1.02 to 1.06), to feel in control during labour and childbirth (RR 1.74, 95% CI 1.32 to 2.30), attendance at birth by a known midwife (RR 7.84, 95% CI 4.15 to 14.81) and initiate breastfeeding (RR 1.35, 95% CI 1.03 to 1.76). In addition, women who were randomised to receive midwife-led care were less likely to experience fetal loss before 24 weeks' gestation (RR 0.79, 95% CI 0.65 to 0.97), and their babies were more likely to have a shorter length of hospital stay (mean difference -2.00, 95% CI -2.15 to -1.85). There were no statistically significant differences between groups for overall fetal loss/neonatal death (RR 0.83, 95% CI 0.70 to 1.00), or fetal loss/neonatal death of at least 24 weeks (RR 1.01, 95% CI 0.67 to 1.53).

Great news for New Zealand where all women do have access to midwifery led care. We have a huge responsibility to make sure that this does result in the best possible outcomes for mothers and babies.

I just have to put this video in here again. Midwives Rock!!

Sunday, October 5, 2008

Routine epidural denied. Is this a problem?

A news item today discusses women in the UK being denied epidurals because of a lack of anaesthetists. Epidurals are a local anaesthetic injected into the epidural space in the spine near to the spinal cord, which provides numbing and therefore relief of pain in labour. This emotive article quotes the Vice President of the Royal college of Obstetricians saying that epidurals should be routine in birth.

There are clear associations between epidural anaesthetic and the need for other interventions in labour, such as instrumental birth with forceps or ventouse(suction cap applied to the babies head)or caesarean section.

The article sites the Cumberland Royal Infirmary as being particularly affected by this inability to provide epidural. It is not so strange then that the Cumberland Royal Infirmary has a lower level of intervention in childbirth compared with other local hospitals. Cumberland Infirmary has a 50% normal vaginal birth rate, Cresswell maternity has a 30.8% normal birth rate and Furness has a 44.4% normal birth rate. Normal vaginal birth leads to lower incidence of complications in the postnatal period for both mother and child. There are also fewer complications with following pregnancies. Do women want pain free birth at this price? What do women think about 'routine' epidural? How do staff support women to birth normally and without intervention if they expect every woman to have a epidural? How do they walk alongside women through the triumphant process of normal and natural labour and birth?

Do you have any thoughts or comments about this? Are women told enough about what to expect in childbirth and the effects of interventions such as Epidural?

Wednesday, September 24, 2008

Baby wearing sling

For midwives who are interested in supporting women with this and for women who want to know how to do this. This is a great video about how to position a baby comfortably in length of cloth.

Saturday, September 20, 2008

NZCOM prsentation: rural midwives network

Nzcom Presentation 2
View SlideShare presentation or Upload your own.

This is the presentation I gave at the NZCOM conference in Auckland in September 2008. The sound file are on the wee TV screen from Blip TV, click here to start thw sound then work through the slideshow. If you are interestead in brainstorming ideas for a rural midwives networ please contact me at Thanks for your interest.

Monday, September 15, 2008

NZCOM conference Opening ceremony

Very many thanks to Auckland region for a great conference.
Here are one or two of my recollections of the opening ceremony.

Powhiri - The conference began with the powhiri and Maori welcome. I understand a few words of Maori now and appreciate this ceremony more than I used to. It was not excessively long. Midwives were genuinely welcomed and their importance to women and birth was recognised. Henare spoke on behalf of the midwives. We are so lucky to have him as part of our organisation. He is an impressive speaker in either tongue.

This was followed by a performance by local school children which had been choreographed by a couple of midwives. I wish I had some photos for you. I was watching this with my eyes filling and was very pleased when i looked around and found I was not alone. It began with a young woman in Maori cloak walking down the centre isle calling, when she got to the front Dave Dobbin's song Welcome home began and others filed through the audience, dancing in a variety of costumes, including a young woman in a lack dress with silver fern. Some were small children, all performed brilliantly. They were welcomed to the stage by the young woman in the Maori cloak. They all continued to dance as others gradually joined them. The memory of this performance will stay with me for a very long time.

Judith McAra-Couper spoke recognising Sue Bree's important contribution as chair of NZCOM as Sue stands down at this conference. Sue has been a wonderful chairperson. She is an amazing woman who is also on the midwifery council and continues with a midwifery practice. She has such a lovely quiet dignified presence and always seems interested and willing to listen. We have been very lucky to have her leading the college through some turbulent and difficult years.

Wednesday, September 10, 2008

NZCOM conference

I am off to another conference this weekend. The New Zealand college of midwives conference. This is my opportunity to share my research with my NZ Midwifery Colleages and to see if there is any interest in a rural midwives network in New Zealand. I have been busily changing and adapting my presentation to reflect this audience and to gage interest in this concept. I will post again on my return and discuss this idea further then. In the mean time if you have any interest in a rural midwives network or a rural midwives practice community leave me a comment with your thoughts.

Saturday, September 6, 2008

Blended learning and midwifery education

Do we really understand the potential?

I have been looking at this video. Wouldn't this have been a great conference to be at? How exciting that we are entering a new era of midwifery education at this time and potential that is there for us and our students, as long as we leave the doors open enough to be able make the most of what the world wide web has to offer. As Myles says the virtual world has a lot to offer but needs to stay connected to the real world. We can do that, we can make the most of both!

Wednesday, September 3, 2008

Unsafe practice and medical experimentation on women's bodies

Image: Heroine from Erik Vanden's photos on

The Irish Times has published a story discussing a dramatisation of events which occurred in the late 1990s in a hospital in Ireland. This dramatisation portrays the events where a senior Obstetrician was performing classical incision ceasarean sections which were resulting in haemorrage for which he then continued to full intrapartum hysterectomy. This was happening on a regular basis to a significant number of women in the care of this doctor. The medical, nursing and midwifery staff were all aware of the shortcomings of his practice however no one did anything to challenge or to stop him, such was his godlike status. A midwife came to work in Drogheda, where this occurred, from outside the area and was so concerned she eventually managed to speak with the Health Board management and the concerns about Dr Neary's practice came to light.

An inquiry was held and Dr Neary was stuck off the register. During this inquiry concerns were expressed, not only about the doctors practice, but how he was able to continue unchecked with the knowledge of so many people. Following the publication of its decision, the Medical Council advised the Minister for Health and Children that a broad inquiry was needed to explore the context of the tragic events at Drogheda and this was initiated in 2004. The findings of this inquiry can be seen here.

What happened to the midwife who "blew the whistle" on this situation? She has maintained her anonymity but the Irish Times suggest that she had to leave Drogheda and perhaps the country in order to practice. I can understand her desire for anonymity however I find it shocking and concerning that she was not able to continue to practice. By bringing this matter to the fore she has saved the lives and contributed to the well being of the community and should be applauded and rewarded.

The reason I am commenting is because it is so similar to the events which took place in National Womens Hospital in Auckland New Zealand from the 1960s to the 80s. It was two journalists, Philida Bunkle and Sandra Coney who raised the initial concerns about treatment at National Women's hospital. A woman who had concerns about the treatment she had been receiving brought the matter to their attention. As was the case in Ireland, medical, nursing and midwifery staff were aware that Dr Green was placing the lives of women at risk and did nothing to stop him. The findings of the inquiry into these events, conducted by Dame Sylvia Cartwright, were released in August 1988, 20 years ago. This lead to major changes in the health services in New Zealand. Ethics committees and the health and disability commissioner were appointed and the code of patient rights was developed. The importance of informed consent to any medical procedure and the patients right to refuse treatment were embedded in New Zealand legislation. The Cartwright Report emphasised the need for the focus of health services to shift from the doctor to the patient and was the beginning of the move towards women centered care in childbirth also coinciding with the start of the New Zealand College of midwives and the push towards midwifery autonomy in New Zealand. There have been profound changes in the health services in New Zealand subsequent to the Cartwright Inquiry and, hopefully, the events which lead to it cannot happen again in this country. We do need to understand the importance of Dame Sylvia's findings. We are all responsible for our own practice and, if we are aware of practice in others which is clearly unsafe or unsound we have a professional responsibility to act, to do nothing is to be complicit in the actions of the person providing unsafe care, and we are equally responsible for the outcomes.

As is evidenced by the Irish inquiry these circumstances are not unique. It is very concerning that this could be happening now in some other place. If you are aware of unsafe practice you do have a duty to find someone to tell who can act. There should be proper channels which you can follow to bring your concerns to light. If this is not the case or if the problem is not being addressed then perhaps you need to look at other ways to do this. In New Zealand it was two feminist journalists who were able to arouse concern initially. In Ireland it was a Health Board solicitor who recognised the problem. If you are aware of a similar situation I urge you to find someone who is willing to listen and take the steps necessary for questions to be asked.

Sunday, August 24, 2008

Lovely wee birth video

Just had to share this one. I love the commentary.Thanks to the health-nut family.
A lovely water birth.

Thursday, August 14, 2008

now I am going to really embarass myself

This is my very first ever attempt at poetry.

Deep deep in the deep dark night
I feel you stir within me
Not long now
Soon you will leave this warm dark place
And travel through the deep dark night
To arrive
Much loved
In my arms

Deep deep in the deep dark night
It starts, I feel a thrill, a rush
No more guessing and wondering
I know the time has come
Our journey has begun
Keep heart
Keep love
Soon you will arrive

Deep deep in the deep dark night
My thoughts travel
Wondering about this miracle to come
Wondering about this essence of my spirit
Which moves me
And surges on
To new life

Deep deep in the deep dark night
We work together we two
You move and I feel whole
I do not want to let you go
Yet I long to hold you
Come love
Our rhythm moves
We ride the waves

Deep deep in the deep dark night
I lose myself to this experience
This overwhelming flood
This primal sensation
The waves carry me
I am lost
No more
Please come now

Deep deep in the deep dark night
I feel that overwhelming urge
The primal noise erupts from within
Time stands still
As you make your final surge
Towards the light
Towards my love
Into my arms
At last.

Friday, August 8, 2008

The business of being born in Dunedin

At last, after a long wait, I have finally had the opportunity to see this documentary.

On the worst night of the year, wintery showers of sleet and hail we went to Logan Park High school to view this film. There was a fairly small group of us, not surprising due to the weather. None the less enough hardy souls made the effort to cover the costs for the Otago region of the College of Midwives. It was a mixed group with good number of student midwives and midwives from Queen Mary maternity center. A few independent midwives and sprinkling of consumers.

I had a fairly good idea of what to expect from the online discussion that has been generated. I will not go into the details of the film, others have done that much better than I could. I have to say it is very similar to "Giving birth: Challenges and choices" produced by Suzanne Arms in 1998. Marsden Wagner features in both of these films with a very similar message. This new film is longer and more in depth, it is also significantly longer at 1 hour 30 mins as opposed to 35 mins for the Suzanne Arms film. It has more births and stronger historical overview of how America lost midwifery in the first place. Overall the material and the information was not something that is new to me. The benefits of being upright and mobile in labour were highlighted. The importance for no restriction on the pelvic joints was mentioned and the ability of the woman to move through out the birth. The benefit of water was highlighted.

Overall it is a good film but I think for those, like me, who have been involved in the business of birth for a while the information was not new. It has been around for a long time. I think that obstetricians and midwives have heard this all before and they either agree or disagree with the arguments. None the less it is a good to reiterate, and clearly in America the message desperately needs to be heard. The real value in this film is to women who are thinking about birth. It is a shame therefore that there were not more consumers in the audience. It would have been good to have some sort of debate scheduled for the completion of the film to allow us to talk about how this might impact on us and our situation in Dunedin. To talk about what, if any, relevance it had for us. It is also a shame that the film is not more available so that midwives could show it to women. The arguments are valid and well presented, why is it so protected? I understand that the marketing of the film has stimulated interested and created a whole culture around it which I beleive has been having an impact in America, which is great.

The question that remains to be asked is how does this apply for us in New Zealand. We have the most supportive legislation for midwifery care in the world. All women can choose midwifery care for normal birth. One would think that all choices should be available to all women. Any woman should be able to birth at home if she wishes. The benefits of birthing outside of the hospital should be explained to women. All women should be able to birth in water. The benefits of birthing in water should be explained to them. All women should be able to decline obstetric intervention in the absence of clear and apparent medical risks. Most women should be able to birth in the care of a midwife without ever having to see a doctor. If this is the case why is our caesarean section rate so appallingly high, 22.7% in 2002
, (the last available statistic) and would appear to be much higher than this now. What do others think about this. As reported by Paul Kruger in response to the screening of this video in Sydney Australia "The Royal Australian and New Zealand College of Obstetricians and Gynaecologists says there are a range of complex factors to explain the high caesarean rate, including the older age at which women are giving birth, and litigation against doctors". What do you think about this? Does this video have any relevance for us? Or is it only important for women in America?

Wednesday, July 30, 2008

Charlie Parr 1922: That vodaphone ad

Does anyone else love that vodaphone ad? If so here is a video of the man himself singing his song. I think I'll need to get some more of this man's music, ain't that the way it is?

Thursday, July 17, 2008

Tittle tattle in the corridors: confidentiality and all that::-

This post discusses the issues of confidentiality particularly in relation to blogging.

I am back on board having had a wonderful, much needed, break. It was great to be involved in my first ICM. Although there were some organisational hiccups it was a great experience. Now back to reality and there is plenty to do so not much time for blogging at present. There is an issue I do feel a great need to address however and this is about confidentiality and midwifery practice. This is of course an issue for all health professionals not just midwives. The other issue is around how shared experience contributes to learning within the profession and the value of blogs in facilitating this. I do not pretend to have the answers to how these contradictory issues can be managed but feel that this discussion needs to take place. As bloggers we need to develop some sort of best practice guidance around how to blog about professional issues. My friend and colleague Sarah Stewart has also been blogging about this issues recently.

When we enter the midwifery profession we all sign a confidentiality agreement. We will only share information if it is necessary for the health and wellbeing of the woman or her baby and only to other health professionals involved in their care. This meets the requirements of the Privacy Act 1993. For student midwives to learn from the practice experiences they are having it is necessary that to share and reflect with lecturers. Women who have students working with them are made aware that this may happen. Students in our school have small tutorial groups where they can share their experiences, reflect together and promote safe practice and shared learning.

Despite these safeguards issues around confidentiality arise from time to time. During my career, from time to time, I have heard people talking in the corridors about something that has happened, I may well have been guilty of this myself. Sometimes a complaint is made because someone heard something in the supermarket, or the bank, or wherever about a patient. Blogging takes this illicit sharing of information to a whole new level. No longer is it a whisper in the corridor, it is a trumpet blast to the world. We always should have been aware of how we can properly share information to promote learning without compromising confidentiality but now it is urgent that we get on board with this. We need to be able to share and learn, we also need to protect confidentiality.

As midwives we are involved in the most intimate experiences of a persons life. We need to be trustworthy. We might know things about the woman the no one else knows. I might know the sex of her baby from scan, I might know that she is unsure of the paternity of her child, I might know that she cursed and swore through labour when normally she would never utter these words. Women need to trust us not to share this information with anyone. When other health professionals need to be involved in a woman's care we can share information which is relevant to this situation and only that.

So where does that leave us when we are blogging? How can we share experiences so that we can promote learning? To whom does the experience we are sharing belong? Is it ours to share? What about the other health professionals who may feature in our tales? How do they feel about having their practice exposed in this most public of forums?

I welcome your thoughts on this.

Image: Whispering, Saams photos on

Saturday, June 28, 2008

Carolyn's ICM presentation

A very quick post from me. Doug and I are having a great time being together with my family in the UK. We have had a family Christening in Ireland and a family wedding celebration in Buckinghamshire. We had a lovely cruise up the Thames for this party. Have had very little time to blog about anything to this point. Leaving for a few days in Thailand soon before heading back to NZ. We also had a day in Paris after a big walk around old haunts in London - poor old feet - ouch!
I have just put my ICM presentation on slide-share and I am posting here. I will try to add the audio track I recorded during the presentation later, when I get my head around this technology.

Thursday, June 5, 2008

A taste of ICM

If you would like a wee taste of ICM and you were not able to attend here is a link to a webcast that has been posted by ICM. Several symposia were videoed so perhaps in time there will be more of these webcasts available. This one is the first Place of Birth symposium chaired by Sue Bree, from New Zealand. speakers are Edwin Van Tijlingen from Scotland, Marijke Hendrix from the Netherlands and Oda von Rahden and Petra Kolip from Germany.

Glasgow ICM conference

I am at conference in Glasgow at the moment. There have been some great moments and it has been fantastic to be with so many midwives and hear midwives speaking about their research work which I have previously read. What a buzz that is. I was particularly pleased to be present at the presentation given by Jaki Lambert (Scotland), Gisela Becker (Canada) and Sally-anne Brown (Australia).

Jaki spoke about supporting and strengthening midwifery in rural and remote parts of Scotland. She described and initiative which has seen continuing professional development for and by rural and remote rural midwives to meet the needs they have identified. This has created improved confidence and self esteem with these midwives and has seen an increase in women being able to birth locally, with skilled and competent local carers. I am very interested in this initiative as my research also identified that rural midwives in New Zealand wanted more locally delivered and context specific professional development activities. The similarity in circumstances for rural and remote rural midwives is amazing the sense of identity and difference acknowledged by rural and remote rural midwives seems to be felt across international boundaries. I believe that this is bond that we could build on to support each other in our practice.

Gisella described the development of a local birthing service for women in a remote rural community in the northern territory of Canada. Once again the issues for women and midwives share many similarities with remote rural communties in other countries.

Sally Anne spoke of a rural community in Australia reclaiming local birthing and re-establishing a local birthing service after it had been lost. This too was a thought provoking and inspiring presentation.

Yesterday I gave my presentation and this was well received. I recorded this and hope to save it online and link it here. I was thrilled to meet Pauline Costins [see the photo and top of this page] and have a chat face to face.

I will try to write more soon.

Friday, May 9, 2008

Christine Webb at Otago Polytechnic

On Thursday I had the honour of meeting Christine Webb. Christine is the executive editor of Journal of Advanced Nursing, a prestigious international journal of nursing. Christine is also the professor of health studies at the University of Plymouth in the UK.
Christine was here to speak with staff at Otago Polytechnic about "growing a profession through research".

Her lecture discussed the various types of research. She suggested that we should not undervalue quantitative research in nursing, midwifery and allied health fields. She mentioned the preference that is often expressed in these areas for qualitative research and suggested that this is not always as well conducted or as rigorous as it could be. She spoke of the importance of looking at a phenomenon under study from more than one perspective, "triangulation". Christine also stressed the value of systematic review and suggested that this is something that we as educators could do to within our fields to support dissemination of evidence.

Christine discussed the importance of practice based on the best available evidence and spoke of research into evidence based practice which highlights the preference, in all health fields, for gaining knowledge and information from colleagues and other contacts. There is a tendency, when this is the case, for traditional practices to be promoted without good supporting evidence. This can lead to practices which have been proven to be ineffective, or even harmful, being continued in practice. She gave examples of this, for example pressure area care. This relates to my own research which found a similar preference amongst rural midwives, some of whom had small groups with whom they shared information and some of whom did not have this opportunity. The challenge is to get information about evidence for practice to these groups to support change in practice. However I do not believe it is enough to only get the information out there. In many instances I beleive it is important for some role modeling of the new practice to be available. For example one of the participants in my study commented that she would like to start using a sterile water block for lower back pain in labour. This is something that has been known about for some time but she has never seen it done in practice and so feels unable to take that step and try it in practice herself.

Christine suggested that one answer is for educators to get out into the workplace and make themselves known, being a resource for evidence for practice. I can see this is something that might help in some way but I think we need greater recognition of the importance of social networks and communities of practice (COP) to learning, we need to find innovative ways to utilise COP to disseminate information and evidence and we need to find way for role modeling innovations based on evidence. I see online resources as one way in which this might be achieved.

Thursday, April 24, 2008

Beating the open access drum

Sarah Stewart has blogged about meeting with midwives from Pakistan and the exchange of ideas that occurred in this online meeting. I expect these midwives discovered her through her Blog? It seems to me that reaching the wider audience is one of the great things about blogging. I wonder if any of these midwives blog?

I think it is exciting to explore midwifery in other contexts. Perhaps in the future there might be resources we can share which will be beneficial for anyone. For example the Christchurch medical school have a lovely interactive animation about pharmacology ( There are many videos that apply to clinical midwifery some of which I have linked in the Wiki I have created for midwifery. Certainly we need always to be aware of the context of midwifery practice. We cannot assume that what we do and teach here will be of any benefit at all to midwives in other countries. None the less I am sure that there is a great deal of material that is relevant. Reflection is a great way to learn and, if the material does not exactly match the situation in another country, the midwives or students can reflect on this difference and discuss it. Providing material online with a creative commons license which allows them to use and adapt the material to their own needs is even better. They can then take the material and make if fit their own situation.

We are fortunate in Otago Polytechnic that our management support us to do this. Their are no barriers to us producing and creating online freely available courses and our education development centre have led the way with the course I am currently enrolled in, Design for Flexible Learning Practice and others. The challenge is therefore ours. How do we make this a reality within our own discipline?

Image: Drummer Billy Cobham at Womad. From Pix Gremlin's photos on

Sunday, April 20, 2008

Blogging and reflecting on midwifery practice

I started blogging in September last year and since then I have been blogging about many aspects of midwifery practice. I choose to blog about issues to do with midwifery or midwifery education as they catch my interest. This is an opportunity for me to explore these issues and do some reflective thinking about them. I have also found my blog useful to reflect on study days and educational opportunities that have arisen for me. I have another blog which I have devoted to the learning I am doing in the Design for Flexible Learning Practice through Otago Polytechnic. I started that other blog as I wanted to keep this blog for my midwifery practice. I have found it useful to do this reflection on midwifery here. It is rather like keeping an open journal. Some of the posts came in useful to demonstrate my reflection when I recently participated in the Midwifery Standards Review as part of my recertification program.

I can only reflect on midwifery practice in broad terms and I have been contemplating creating a third blog, which I would keep closed from public view, in order to reflect on my clinical midwifery practice. I provide casual locum midwifery cover for one or two midwifery groups in the lower south island of New Zealand and I might blog about something that has spurred my interest during practice but I cannot blog about my work in detail due to confidentiality issues. I have just returned home from a weekend in practice and I want to record what I was doing during the weekend but need to keep this private. It suddenly occurred to me that I do not need another blog to do this. All I need to do is create a blog post but do not publish it. It will then remain on my list of posts for further reflection or for any future midwifery reviews but will not be available to anyone but me.

Problem solved I think.

Thursday, April 10, 2008

Evaluating reliability of online information. For midwifery students and educators.

This is a useful self guided paper which takes you through the process of evaluating the reliability and usefulness of material found online. Interestingly the male pregnancy story is used as an example to evaluate the reliability of the evidence being presented. I discovered when doing this process how to access Google directory and find how Google have categorised the information. This is something I was not aware of previously and could be a useful thing to know. I might see if I can find out how this site is categorised.

Wednesday, April 2, 2008

Men becoming fathers

Image: Jude's birth. Kindly donated by Clare.

I have blogged about men at birth before. When I posted this a friend of mine sent me this photo of her son, seconds after the birth of his first born son. It is a very poignant photo and says more than words ever could about the transition from manhood to fatherhood. When a baby is born it is much more that just the birth of a baby it is also the birth of a mother and father and the creation of a new family.

As the family is the building block of society it seems to me that how this transition occurs is of major importance to society. We can either support and empower new parents or we can take away control and leave them feeling battered and bruised and disempowered.

David Vernon has written a book for fathers. Men have shared their stories of their experiences around birth. As with all things to do with birth and parenting there is no right way for men to be around birth. In a home setting when everyone is in their own environment it is possibly easier for the man to be physically present or not as suits the situation and the needs of the woman. In a hospital situation, in my experience, men can often feel closeted in the room and unable to get away. David has some good advice for how men can be prepared and ready for what is necessary during the birth of their children.

Informed choice in childbirth: What about midwifery responsibility?

This is a great video of a presentation by Barry Schwartz. He is a phsycologist and discusses the paradox of choice.

In midwifery we pride ourselves on offering women "informed choice". What does this mean? Women need to understand what is happening during pregnancy labour and birth. Midwives have a responsibility to support and guide women through the process of becoming mothers. As a midwife I have an responsibility to outline the type of care the woman might expect from me, for example if I provide care at homebirth and in a primary or secondary facility. If I can support her choice for water birth or if this is outside my area of expertise. I need to have these conversations with women early in the care I provide so that there are no unexpected surprises as the birth approaches. If I cannot provide an aspect of care that she wants then I need to refer her to somone else who can.

When it comes to the point where a woman does not want to make a choice and wants her midwife to make this choice for her what should we do? Are the women we care for overwhelmed with choice and is this OK? As midwives and guardians of normal birth do we need to inform women about about all battery of medical interventions that have become part of the 'normal' birth experience? Do we need to prepare all women for ultrasonography, Group B Streptococcus,gestational diabettes, epidural, caesarean section, forceps and ventouse. Should we be more selective in what infromation and choices we give to what women? Are all these choices playing a role in the ever increasing medicalisation and intervention in childbirth in our society?

Baby talk: communicating through sign language

We know that the stimulation is good for brain development in babies and children. Parents have always developed visual ways to communicate with their children before verbal communication has been possible. There is a growing group of parents who are communicating with babies from a very young age using modified sign language for the deaf. Here is a TVNZ Breakfast show interview on this topic.
Sarah Turner, who runs baby talk workshop is interviewed by the breakfast show team and describes simple signs to communicate with babies and toddlers. Using this type of communication children can tell parents they are hungry or thirsty, want their diaper changed or are hurting somewhere. I can imagine that this could lessen the frustration pre-language children might experience when they cannot communicate their needs.
What do you think about this?

Image: Baby talk, from Iandeth's photos on

Monday, March 31, 2008

Calling all midwives interested open access elearning

Image: Super-dupont-we-need-you, from Sorenshaman's photos on

Sarah and I are keen to see educational material availble for midwives free of charge through the internet. If you wish to study at your own pace that would be fine. When you feel that you can meet the assessment requirements of the course you would then enrol and only then would pay the fee for the course.

Do you want access to free open access midwifery educational material?

Would this type of resource aid your professional development?

If you are interested tell us why.

What would be the benefits for you?

We need your support to make this happen. If we cannot demostrate a need for this type of resource then it is unlikely to happen. Spread the word, get others to visit this blog or Sarah's blog and tell us why you would like this to happen for you.

We especially need to hear from New Zealand midwives but would like to also hear from midwives around the world who think this would support their professional activites.

I will add a poll to my side bar but please also add your thoughts and comments about this here. We need your help

Monday, March 24, 2008

Second life and flexibility in learning

I have also posted this on my other blog
As you know I have an interest in second life and have been considering the educational potential of this virtual world for students. When we have students who are at a distance from one another I think second life could be useful for collaboration and establishing a sense of community. It does require a good internet connection however and also a good quality computer. I was perusing the internet today and found a conference presentation delivered by Sarah Robbins “Intellagirl”. this presentation gives a great overview of second life as an educational tool. She also describes the characteristics of the average student population and how this is evolving. It is a worthwhile view when considering flexible course delivery and presents some excellent arguments about why learners need flexibility in courses. Click on the view presentation on the page linked to conference presentation. When I played this video it stalled half way through, I managed to fix this by fast forwarding a couple of times and it started to play again. It is wise to stop the video from playing and allowing the whole thing to load before trying to play it. This will allow it to play without stopping and starting, which can be annoying.

Another very interesting aspect of this presentation is the Medialandscape player which is the software application through which it is delivered. This plays the video and also presents the slide show alongside. I am hugely impressed with this tool and would love to learn more about it.

By the way I have a whole new look in second life, this is me now.

Saturday, March 15, 2008

Thinking about midwives in second life

I have just returned from a walk up the river with my dog. He is a Clumber Spaniel just in case you are wondering and he is called Buster.
As Buster and i were walking along I was pondering the meeting I had in Second Life this morning with a couple of midwifery educators, one from Canada and the other from America. We had a really nice time, just the three of us. We went dancing on Koru Island. We listened to music, communicated through text and watched our avatars dance. We were all amazed at how good it felt and from my perspective it increased our connection and comfort with one another enabling us to communicate more freely.

Sudbury, Lisachris and I cavorted across the dance floor and did some amazing maneuvers. We spoke about possibilities of meeting with students in this sort of environment. We also discussed how we had been searching for places in second life where our students might be able to learn some midwifery skills. We had been looking for clinical spaces for students to learn some of these midwifery skills. This was a preoccupation of mine when I first came into second life and is something that has concerned me since then. My thoughts on this are changing and this was one of the things that preoccupied me on my walk with Buster.

Internationally there is a great deal of concern about rising intervention in birth In Australia in Florida and here is another from Australia, with some good discussion about the problems of caesarean, and this from my friend Sarah . There is lots and lots more on this and easy to find.

So we are concerned about this and many of these posts suggest that midwives are the answer. Midwives are the guardians of normal birth. Midwives can support women to avoid caesarean section. I believe the problem is that many midwives, who are receiving their midwifery education in this time of increasing intervention and rising rates of caesarean section, never get a chance to see women outside the clinical environment of a hospital, or perhaps an clinic type birthing centre. Those who have been fortunate enough to care for women in their own homes, even if they do not birth there, will know that there is a whole world of difference. This virtual environment, of Second Life, provides us with the opportunity to give our midwifery students a totally different environment. I believe many midwives are frightened of stepping outside the walls of the medical establishment. They are worried and concerned about how they might cope without the security they perceive within these walls.

I think the ideal birthing centre in Second Life already exists and I believe it is called Arwenna's Secret Garden. (I am not sure if Arwenna would agree though), somewhere very like this anyway. Imagine working with a woman who is labouring in this environment. Supporting her as the intensity of the contractions increase. Affirming her ability to do this job. When she feels the birth is near there are several places to go. There is a small hut with mats on the floor or there is the lovely rock pool. If there are problems we can talk with our colleagues in the medical establishments if we need to. If the labour was not going so well we could liaise as we would in the real world and transfer the woman to the hospital with all the bells and whistles. This would be great learning for our students. Supporting normal and helping the woman to birth in a lovely peaceful setting observing in case intervention is required. Talking with medical colleagues and supporting the woman as she transfers to a medical establishment and maybe continuing the care in this environment.

When I first came to New Zealand and for about 10 years I worked in Rangiora Rural Maternity Hospital. while I was there we created a small, peaceful, private garden for labouring women. More recently I have worked in Balcutha and Lumsden. All of these have private outside spaces where women can labour in a peaceful garden setting. This is not so unusual in rural maternity units in New Zealand.

Why should we recreate the medical environment that we know increases intervention in birth? Is it not more appropriate for us, as midwifery educators to try to give our students a sense of how it is to care for women outside this clinical environment?

I am not suggesting that this type of scenario based learning is just around the corner. I think as educators we have a lot more to think about and learn before we are ready to start supporting student learning in this environment. But we do need to think about what we want for our students when we are ready to do this and I do think this will happen. We could also be talking with our medical colleagues about how they see this working and the learning opportunities involved in inter-collegial communication. I do not believe that the profession of Obstetrics is happy about the rising caesarean section rates either, but normal birth is not their specialty it is ours. It is for us to support the normal and consult appropriately. This is the real way forward I feel. Mutual support and respect for the place and skills of the other, while keeping the woman and her choices at the center and as the focus of care.

I look forward to your thoughts and comments on this.

Second life

I will be online in second life tomorrow morning at 0900hrs New Zealand time. I will be in the Koru Island Sandbox and will watch out to see if others come along. Remember you can also join the Kiwi educators who meet at 2000hrs New Zealand time on Sunday evenings in the Kiwi educators meeting place on Koru Island.

here are some world times for tomorrow morning 0900 hrs NZ time

and for 2000hrs for the Kiwi educators meeting

Learning about birth. Midwifery students at Otago Polytechnic

Image: Amy does her first catch supported by Renee.

First year midwifery practice
This week we have been learning about normal birth. We started with learning about the size and shape of the foetal head and then the size and shape of the female pelvis. We then moved on to how the baby's head and body move through the pelvis to allow the baby to be born. To remember the movements and manipulations that occur to allow this to happen we use the Acronym
Families In Childbirth Expect Really Impressive Excellent Love
F = Flexion (the force of contractions push the baby down, it meets resistance from the pelvic floor and flexion is increased causing the occiput to become the leading part).
I= internal roatation (the occiput moves towards the area of least resistance, the vaginal opening and this rotates it forwards on the pelvic floor)
C= Crowning (The largest part of the head, the biparietal diameter, passes the ischial spines, the narrowest part of the pelvis. The Occiput escapes under the pubic arch. The head can no longer slide back into the vagina. Point of no return.)
E= extension (the head extends, the face sweeps the perineum and the head is born)
R= restitution (the head undoes the small turn it made and aligns with the shoulders once again)
I= Internal rotation (the anterior shoulder reaches the pelvic floor and follows the line of least resitance and so rotates anteriorly
E= External rotation (As the shoulder rotates anteriorly the head also rotates along with it. The baby now looks towards the mothers thigh)
L= Lateral flexion (The anterior shoulder escapes under the pubic arch and the body is born following the natural curve of the birth canal, in an attitude of lateral flexion.

This is a very exciting time for the students. They really enjoy learning about this aspect of their future job and life as midwives.

Here is a really interesting article that questions some of the traditional teaching about the mechanism of birth, and poses some important questions for midwives on this topic.

It has been a very exciting and invigorating few weeks. Meeting and getting to know this new group of women who will be our future midwives.
In the previous clinical block we covered how to record vital signs, temperature, pulse, blood pressure. The have also considered documentation and collecting specimens for laboratory tests. We have also introduced them to to a program to learn about drug calculations. This is free open source software.

The journey has begun.

Thursday, March 13, 2008

Must see birth video

My friend Sarah
has posted a video that you must go and watch in her blog. Go now! It is fantastic.
Sarah's blog has a great repository of resources and information on matters midwifery.

Tuesday, March 11, 2008

New Midwifery education

In the school of midwifery at Otago Polytechnic we are heading into a new world of midwifery education. We have a shortage of midwives in the workforce and this is set to worsen as many of our workforce head towards retirement. Currently our midwifery students are required to leave their homes and come to one of the main centres to complete their midwifery education. Families have to be uprooted and leave home. Women have expressed interest in a program of study which allows them to remain in their own area for the bulk of the course. This has required a major reconsideration of how we could accommodate these needs and provide a course that is accessible to more women. There have also been some changes to midwifery education requirements by the Midwifery Council of New Zealand which need to be accommodated into our three year degree program. Over the last two or three years we have been getting to grips with this and have entered into a partnership with the Christchurch School of Midwifery. From next year we will have one South Island School of Midwifery operating out of the two centres. We have a new curriculum which has been developed over the last year, is nearing completion and is in the approval processes.

The new program is to begin next year with the first year being offered in a flexible mode with distance and some face to face. I teach the first year clinical skills course and my job is to now identify how the course that we teach can be delivered flexibly in a mix of distance and face to face study next year. I am to do this while also continuing to teach in the current program and meet my other responsibilities within the school of midwifery. I am feeling that I need to develop some supernatural powers in order to achieve this. I am hoping that others in this course may be able to help me and offer support, encouragement and perhaps suggestions as I travel along this path. I am excited as I do believe that the new program is an exciting innovation. I am anxious about the time it will take and all the other commitments I have.

This is also posted on my other blog Fled: Flexible learning education design

Image: Time for study from pb31's photos

Saturday, March 8, 2008

Todays midwives meeting in second life

See the second life midwives wiki for information about future meetings in second life.

We had our second meeting of midwives in second life today. I was great to meet up with three midwives from the North American continent and one from Australia. Thank you to you all for coming and also once again to Arwenna for helping us all out and to Sarah for also coming along and supporting.

I would love to add audio to this slide show but do not have time at the moment.

We struggled at the start of the meeting to get audio working and gave up in the end just communicating through text. This is quite a challenge with a group and I am doubly glad audio worked for us last week. We also had problems for some with getting connected at all and Sarah crashed out of second life once while I crashed and had to resume four times. Others did not seem to crash. The sexual health area looked very interesting but there were lots of scripts being offered to us all the time. if we had been communicating in voice it may have been OK but trying to communicate in text when lots of other text was appearing all the time was too much really. Arwenna's garden and cave are quite magical places and a real pleasure to see.

On reflection for a group such as ours I think second life does hold tremendous possibilities for collaboration and networking. I think these possibilities are yet to be realised. I would not feel happy at this stage to use second life to meet with students as i do not feel it is reliable enough and would cause some anxiety for students. At this stage I would prefer to use software such as elluminate to have meetings with students. Given the pace of development in second life I believe that the time when it is more suitable for meeting with students is probably not far away. I therefore am happy to continue developing my skills in this environment.

It was disappointing that none of the others from last week made it. Understandable though given our busy lives. I have not organised a further meeting at this stage and will wait and see if there is support for this. I will go online on Sunday Mornings around 0900hrs NZ time 1200hrs Saturday Second life time as often as I can at Koru Island Kiwi educators sandbox, (Koru 161, 212, 34 PG - Koru Sandbox). I can then practice building while I am waiting. If anyone turns up I will be happy to see them. I will wait for a little while before logging off. I am not around every weekend however as I often have midwifery locum work in the weekends.

See the side bar of this blog or the bottom of the Midwives in Second Life wiki.
both lead to the same survey form. It is simple and easy and should not take long to complete.

Friday, March 7, 2008

New Blog

I have just created a new blog on Wordpress for the course I have just commenced on Design for flexible learning practice an open access course i have commenced. My new blog is called Fled: Flexible learning education design. Hope to see those with an interest in this area there.

Thursday, March 6, 2008

Next meeting in Second life.

See the second life midwives wiki for information about future meetings etc.

The time is fast approaching for our next meeting in second life. It has been pointed out to me that although it is Sunday morning here and Sunday evening in the UK it will actually still be Saturday in North America so something for you to remember.

Times are Date: Sunday 9th March in New Zealand

Time: 09.30am NZ, 3.30pm New York, 8.30pm London, 0530 am Perth (sorry :)), 0730 am Sydney, 12.30 pm Vancouver.


Meeting in second life at the Kiwi educators meeting place on Koru Island (Koru 155,122,27 (PG)-Koru)

I had thought about breaking into discussion groups and brainstorming a topic at this meeting but on further reflection would like the group who meet to decide what they want to do. So will leave it very loose at the moment. Arwenna has been preparing lots of possibilities for us.

More information can be found at the Second Life Midwifery group Wiki
Please don't leave until we plan where we go from here, how often we meet etc and also until I have you all signed into the midwives group of second life, if you want to of course.

Building an international midwifery community

I am feeling very excited at the moment and feeling that I am teetering on the edge of something that could ultimately be very consuming.
I have been exploring facilitation of online learning communities and have just completed this course and I am now moving into another teaching course designing for flexible learning . I have learned an enormous amount about online communication, networking and web2.0 from this first course and I am interested to see where the next course takes me.

At the culmination of the last course I facilitated an online meeting of midwives, educators and researchers in Second-life. During the preparation for this I established some international midwifery connections and was helped to form a midwives group in second life. I have now also set up a wikieducator space for this group, this links from the Midwifery wiki I had already established. So online midwifery resources are growing. So far I have not been fortunate enough to have input from anyone else on these resources but I am hoping as others find them they will start to add content.

I am also very interested in the Wikiversity project. I believe that some of the material we are currently delivering is not reaching the audience that it could reach because it is held within our institution and is not freely available. I am very fortunate to work in an academic institution which is committed to delivering as much content as possible through free open access. I am committed to exploring the possibility for presenting educational material that will support midwifery professional development in this way.

I also have a strong interest in the Safer Motherhood campaign . I am aware of the very difficult circumstances for many women on our planet and admire the midwives who work so hard to assist and support these women. I have always had a desire to do something in some way to help and support midwives in these situations. The problem is that the reality of practice for these people is so very different from ours. There is much I believe that we could do to help them but they also have much that they can teach us. Any educational material that is presented in an open access format would need to take account of the diversity of experience of humanity and would need to have some collaborative input from those who are living this experience. To this end I have made a connection with a midwife who is living and working in Africa and who may be able to help me with making some connections, forging links and potentially developing something very supportive and useful to midwives wherever they are working.

I also have a vision of midwives connecting as sisters around the world to raise our understanding and support of one another. I would like to establish a shared mentoring experience where one midwife in the developed world is linked with one midwife in the developing world. They can then support one another share practice stories and perhaps offer some practical assistance as well. Perhaps they could spend a little time together, travelling to the area of the other for a short 'working holiday' and gain a better understanding of the situation of the other. The midwife in the wealthier of the two countries might also be able to raise funds and provide some practical support for her buddy. I would like to know your views on this. Please comment on this post.

Image: African mother, from Joram jojo's photos on

Facilitating online learning communities.

Facilitating online learning communities

Facilitating a meeting of midwives and midwifery educator in second life
Meeting the requirements of assignment 4

Considering what to do
As I pondered what activity I might engage in to facilitate an online learning community my thoughts went towards hosting a meeting of midwives in second life. I was introduced to second life as a part of this course and had developed a love/hate
relationship with it as can be seen from previous postings
. None the less I have felt from the very beginning that there is potential here for midwifery collaboration, midwifery meetings and continuing professional development activities as well as scenario or problem based learning.

I am involved principally in teaching the first year midwifery student undergraduate program at Otago Polytechnic. Our course is already delivered in seminar blocks however it is moving into a more distance based learning program next year and I will be involved in preparing this for the students. So I am interested in anything that could help to get students together to facilitate a sense of a learning community. Communities of practice have been identified as important aspects of learning in practice (Boud & Middleton, 2003: Fahey & Monaghan, 2005; Rogers, 1983; Tolson, McAloon, Hotchkiss & Schofield, 2005; Wenger, 2006). Educational researchers have also identified the importance of facilitation and community to an enhanced learning experience in schools (Roberts & Pruit, 2003) and in tertiary study (Hmelo-Silver, Duncan, Chinn, 2007). Others debate the benefits of teaching or facilitating learning which has been a feature of this course with some vigorous debates on the topic. Case, Harper, Tilley and Wiens (1994) argue that facilitating and teaching are not mutually exclusive but occur together. They suggest that teaching is facilitative when the intention of the teaching is to empower and support students. A feature of facilitation is shared control between lecturers and students over what and how they learn (Case et al., 1994). Hmelo-Silver (2006) discuss student learning as a constructive, collaborative process where students are given goals which scaffold to challenge the students at varying levels. Once students have investigated an area a small teaching sessions may be delivered by ‘experts’ who engage the students in conversation or deliver small lectures, providing rationale for the processes the students have been engaged in. Leigh has challenged us to facilitate learning as opposed to teaching. My understanding of his argument is that the two cannot co-exist at the same time. While a facilitator may also be a teacher they cannot teach and facilitate but they may facilitate a session where someone else teaches as occurred throughout this course with the small 10 minute lectures we experienced through Elluminate. I also have a interest as a rural midwife in midwifery professional development. I investigated this issue from the perspective of how midwives inform practice for my recently completed Master in Midwifery thesis (McIntosh, 2007). My findings suggested that rural midwives in New Zealand value coming together and sharing information, so this is another reason to look at the potential for second life .

We live in a rapidly changing world. Communication technology continues to advance in leaps and bounds (Leiner, Cerf, Clark, Kahn, Kleinrock& Lynch, 2003); it is hard to keep up, while at the same time, we are hearing about dwindling natural resources and increasing costs of travel around the world. In recent years we have become accustomed to conferences, with expert speakers in our field attending, and simulating interest and learning. Would it be possible to have a similar experience in Second-Life? Could we hold a conference with various workshops and plenary sessions in this environment? I had no way of knowing and decided to see if I could arrange a group of interested midwives who might be interested in exploring this further.

Planning the event
I was very new to second life and barely had the ability to move in a straight line so I approached this exercise with a high level of caution. I was very lucky to have the support of Clare Atkins one of the administrators of Koru Island and the kiwi educators meeting place. She offered to give me assistance with anything I needed, including a place for the meeting, a slide show projector and assistance with managing the whole process. This was a major benefit, and helped to make sure things went smoothly. I also had the support of my friend and colleague Sarah Stewart, who has equal skill to my own in Second-life but offered whatever support she could. Just meeting up with her a few time in second life and brain storming how the session might go and who I might invite was a huge help.

I advertised the meeting on my blog. I do have a good amount of traffic on my blog but I do not know how much of that is midwives, so I obviously needed to advertise elsewhere as well. I put a notice out on a midwifery research email list that I had recently joined. This stimulated a good amount of interest and led to a connection with a midwife from the UK (Sufia shepherd in SL) who had good Second-Life skills and was able to help Sarah and I set up a midwives group in second life. Several midwifery educators and researchers, mostly from the UK and Canada expressed interest in attending however there were also one or two from Australia, a couple from Michigan and one other midwife from New Zealand who also expressed interest. I had no idea how many might eventually make it into second life and attend the meeting. My initial attempt at setting a date was not acceptable to some as it coincided with the mid-term holiday in the UK. The date I finally settled on coincided with Mothers day in the UK but I do not think this affected attendance at all.

I made a posting on my blog very early in the planning of this event providing instructions about what to do and how to get online in Second-life. I found some useful YourTube videos which were very helpful. I followed this up with several more postings find tuning instructions regarding timing etc. I found a program on the internet which provided world times which was also very useful. I also emailed several times on the research forum email list, but I was very cautious about this as I did not want to misuse this valuable resource by making unnecessary postings. No one complained however and it has been a great way to promote the event and keep in touch with people.

I had to consider what my goals were for this event and how I was going to do it. I knew that most of the people attending would be fairly new to second life and so I did not want to be moving them around too much. At the same time I wanted them to get a feel for the potential and have the ability to interact with one another. I met up with Clare the week before the meeting and we decided that we would try using voice communication rather that typing everything. This might make the meeting flow better but would mean that not everything would be transcribe as would occur if the communication was purely text based. I wanted the meeting to be as unstructured as possible as this is the basis of facilitation, as described above. However I felt that I needed some structure given that everyone was new to the environment and I had some concern that communication might not flow. As a midwife I should have known better. Midwives do not usually have a problem communicating with one another.

Clare (Arwenna) suggested I prepare a slide for when the group arrived to help them get started with voice communication. This was a great idea and I do think it helped most participants although some my not have realised it was there. I also decided to make a few slides outlining the aims of the meeting. I believe that this still could fall within the realms of facilitation however Leigh has suggested that at this point it became more of a teaching session. Perhaps I did do a bit too much here. My initial power point was quite brief but then I thought I should perhaps add something about where my interest in this had come from, mentioning my Masters Thesis and perhaps outlining my academic credentials for this. Perhaps this was little self serving, not really necessary and getting into teaching mode.

I told everyone that I would keep an eye on when they came online and would teleport them to the venue for the meeting. I asked them to be patient if I did not get to them as soon they came online. I also prepared a list of everyone who had given me their details, Bronwyn and Debbie Corder had agreed to come along and offered to keep an eye on this for me. I am not sure but I think they may have teleported one or two in. Merrolee Penman had also said she would like to come and I co-opted her to keep notes of what was happening.

Sarah and I hoped to be physically in the same place for the meeting to offer moral support to one another. This proved impossible as the broadband at her house could not handle two computers in second-life together. We also tried the computers at Polytech but they were much too slow. This is an indication of the power and technology required to run this program.

The evening before the meeting while I was online I met up with a couple of the midwives who had hoped to come along. One from Vancouver did not make it to the meeting but it was good to speak with her then.

Finally on the day of the meeting I discovered that there was a new version of Second-Life available. I downloaded this onto both of my computers and got it running. I had two computers available to me as I was very worried about the reliability of my computer. The new version works well on my newer computer but not so good on the old one. I wonder if it is more graphics intensive

The meeting

I met Clare at the Kiwi educators meeting place and she loaded up my new slides for me. This was not without some hiccoughs and I admire her patience as I tried to get the slides renamed etc. In the end we reloaded the whole lot. There is a very small cost involved in loading slides onto second life, but it is next to nothing really.

People started to arrive almost immediately. Some seemed to teleport in themselves, but may have been assisted by Bronwyn and Debbie. Most I saw come online and I teleported them in. I had to keep my window of contacts open which limited my view of the group that had assembled. One arrived with her ‘newbies’ torch in hand, a good indication that this was her first excursion into second life. With help from Clare I managed to get everyone in and seated. Not everyone who had said they might come did but some of my colleagues from this course came and we had a good attendance.
I think I counted 15 people at one time,4 from this course and the rest midwives, educators, researchers and academics. Most stayed for the duration of the meeting, about an hour and a half.

We started off by having to do some sound adjustments. One participant was very loud but managed to turn down, it was still not optimal but it was good enough. Another popped in with some heavy breathing sounds from time to time, I wonder if this was Merrolee and her shift key? Everyone seemed to be able to hear what was being said but one or two could not speak and so they communicated through text.

Once I felt we had most people there I started off by asking everyone to say who they were and give wee bit of background on where they were from and what there interest was in second life. This is a good way to help people feel at ease and get them involved. It helps to create an environment conducive to learning (Russell and Russell, 2003). This worked quite well, as I invited people to speak I was working though the list on my contacts screen and was still keeping an eye on people who were still arriving. I missed a couple of people but they let me know that they were still to introduce themselves. After this I presented my slide show presentation. I outlined what I thought some of the benefits and some of the difficulties of meeting in this environment might be. I posed these questions to the group.
• How can we use this?
• What is holding us back?
• What is the future of second life for midwifery education and development?
• Could this be a resource for a midwifery community of practice?
I then opened this up to the group to discuss and some useful discussion did occur.
There was general agreement that the technology is improving all the time. For example using voice communication is a recent development that is making communication much easier. Educational resources in second life are expanding all the time. Problems such as time difference can be overcome in part by providing minutes and transcript.

There was a problem for at least two possibly more people who wanted to participate. One was having difficulty getting going as her system was crashing and did not make it at all. Another tried very hard to get to Koru Island but every time she arrived she crashed and had to leave. Sarah crashed her computer once during the meeting and missed some of the chat. I lost connection and had to reconnect once, which was good for me, I usually do this much more. So problems with the technology are reasonably common with second life. Everyone coming had several other contact details for me including skype, as a back up. When I lost the connection I was able to tell Sarah through skype and she told the group. So making sure potential participants can actually access second life is important but there is not much that can be done if they cannot. Providing an alternative contact in case the technology does not work or breaks down. This may limit the type of student or midiwife that could participate.

Arwenna spoke about the Kiwi educators group and gave everyone membership of this group. She also offered the space for future meetings and offered to escort anyone who wanted to stay on for a while to the Sandbox to practice building skills.

As the meeting was coming to a close most said they would like to meet again. There was mention of having some midwifery topic to discuss which might help some communicate and give a comparison with face to face communication. They also suggested changing the time around to make it easier for the North American group to attend.

Most left after this and a few went to the Sandbox with Arwenna and Isa Goodman, the other administrator of Kiwi educators. They helped the small goup of about 6 or 7 who were left to start building. Arwenna also give the group a box of landmarks to other areas.

Overall I think the meeting was a success. I think this is demonstrated by the willingness to have another meeting. I was a bit surprised at the desire to meet again in a week. I think that might be a bit soon but we will see how this goes. Several people who did not make this meeting have said they will come to the next one.

Having someone available who has skills in second life and group interaction is a big plus and I was very lucky to have Arwenna.

I think the planned strategy of not moving around too much worked well for this first meeting, I think this helped people feel a part of the group and concentrate on talking. Some said thy liked being able to move their camera around while they were sitting and look around. Everyone seemed to manage the environment well.

The strategy of getting people to introduce themselves also worked well. Everyone got a chance to speak at least once and most joined in the later conversation.

On reflection I do think the rest of the slide show was superfluous. Had I just asked the group to talk about benefits and pitfalls I think the communication would have been improved also this would have come from the group, not me. I wonder if I did shut the conversation down by doing this presentation. It also meant I had to concentrate on the screen at this time rather than the group. Leigh has since said I was in teaching mode at this time. After a lot of thought I think I do agree with him. Perhaps I could have kept the conversation going and only used the slideshow if it seemed that conversation was not happening. As adults with considerable experience in education and/or midwifery practice this group were very knowledgeable and could easily have brainstormed these issues themselves without me having to lead them. Knowles (1990) developed the theory of adult learning described as Androgogy. According to this theory adults need to be involved in the planning and evaluation of their learning. They need to be able to experience learning and have the opportunity to make mistakes. I believe I limited this by guiding the content in this way. Friere known for his 'pedagogy of the oppressed' believed in shared learning, building learning communities. He believed that learning occurred through conversation and dialogue (Smith, 2007). I need to consider this for future facilitation, particularly with a group such as this. According to Gilly Salmon's five stage model of moderation I think I was functioning at about level 2 or level 3 for this meeting. I was very focussed on the technology and just getting people sorted. I was not really able to participate in the discussion much at all other than to encourage others to participate. I hope I can move this with the greater understanding that I now have of the medium and where I went wrong with this session and can do better next time.

I wish I had taken more time to close the meeting and make proper arrangements for the next meeting. As the facilitator I should have done this better. I also wanted to raise awareness of the midwives group in second life and did not do this.

I think the timing of the meeting for people from this course was quite good as people were interested in getting back into second life and seeing how it all went.

Plan for the future
After the meeting Clare and Merrolee gave me their notes.
Clare had added some of the verbal conversation into the text script and Merrolee had kept notes. I had to find somewhere to store these. This has led me to create a wikieducator page for the midwives second life group. I have developed this up as another online midwifery resource. I also finally managed to get a picture into wikieducator, something I have been struggling with. I put an note and link to this on my blog and also posted to the midwifery research email list.

The next meeting time has been posted on my blog, on the wiki, on the midwifery research list and through the Second life midwifery group notices in Second life. I have also individually emailed everyone I have email addresses for. On some feedback form the first group I suggested we choose a topic for this meeting and suggested normal birth as this topic. On the further reflection that I have done here, I have decided to leave this open and let the group decide when we meet. I have that up my sleeve if I need to pull it out.

Once again we will meet at the Kiwi Educators meeting place. I will open the meeting and invite the group to set the agenda. Arwenna had prepared a few places where the group can break off into small groups to have a chat if they wish. I will teleport these groups to these locations to save them all having to walk, or fly, there if they are struggling with moving around. I will leave this very much up to the group this time and see how this goes. I would like the group to identify what they think we could do with this group in the future. I will introduce them to the second-life midwives group and the second-life wiki. I will try to get email addresses from those for whom I do not have these details and will try to get plan and time for the next meeting.


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