Thursday, January 31, 2008

Results of my poll

There were 16 responses to the poll on my side bar recently asking "what kind of support should New Zealand women have after homebirth or early discharge from hospital" .
Of the 16, 9 or 56% felt that there should be state funded homehelp.
5 or 31% felt there should be state funded doula support.
No one thought women should pay for these services themselves.
Two thought women should rely on support from family and friends and one felt that none of these options answered this question.

There is not enough information here to draw any conclusions. However most seemed to think that there should some extra government funded support for women and their families.

Managing my online life in igoogle

On the right is my igoogle home page. On this page I have some online newspapers and my gmail account feeding in. My gmail is automatically loaded and shows here as soon as an email is received.

Above is my midwifery page. I access this by clicking on the second tab (see arrow). It has midwifery blogs, including my own and Sarah Stewart's feeding into it. I have also performed a google blog search for words such as midwifery, midwives and childbirth. Items which are posted with these words also feed in to specific widgets on this page.

Here is my elearning page. Again accessed through a tab at the top of page. Here items which are posted on elearning are updated.

Finally his is my last igoogle page. It is on facilitating learning communites. I have done a google blog search for these terms and created widgets which update whenever items are posted on these topics.

I can create more pages if I wish and if I think of more areas I would like to cover. All of the photos here were taken by me with jing and transferred to flickr then onto my hard drive. I did this to make the file size manageable.

Just adding one more picture. this is a close up of the tabs section of my igoogle page.This is the second page, my midwifery page.

Wednesday, January 30, 2008

How and why to wash your hands.

This is a fairly good video about hand washing. I suppose stating she is a doctor gives her some credibility. I do not think the list of when to wash hands is a complete list, for example you should wash your hands after touching an animal, I am sure there are more examples of when to wash hands. If you stick with the video I think the demo of hand washing is quite good. This is a very important issue which I have blogged about previously.

Pushing up daisies in second life

Last night I was in email contact with on online friend/mentor/colleague expressing my frustration and not having a home. She (Arwena Stardust) then helped me to set my home to Koru Island, the Kiwi educators second life island. I am so pleased I finally feel I belong somewhere. Also if I do get into a tricky situation in second life it is much easier to run away if your have a home to run to.

After getting me sorted with my new home Arwena taught me how to start building things in second life. This is not something I had anticipated doing. I thought I would leave this up to others with more skill. Very quickly though she had me pushing up daisies. I made a box, flattened it and added a texture of daises. This is the basis of how things are created in second life. So maybe I will have a bit of a play and see what else I can create.

Image: Daisy from Bigtallguy's photos on

What is the good evidence for midwifery practice?

With such an overwhelming amount of information available on matters to do with pregnancy and childbirth how do midwives and midwifery students make sense of the often conflicting information they may find. A Student guide to the medical literature is a very good guide to accessing evaluating and utilising evidence for practice. I found this link in Helge Sherlund's blog.

Sarah Stewart discussed the value of blogs in her posting on the academic credibility of social networking. I believe that blogs may provide an opportunity for those with an interest in a particular topic to present evidence they have found to support their perspective. Whether or not this can be considered as a reliable source depends very much on the credibility of the blogger and the evidence that has been presented. Those seeking to use this as evidence have a responsibility to verify the sources presented and critique their suitability.

Image: Another day in library from Svenwerk's photos on

Sunday, January 27, 2008

Gilly Salmon talks about designing elearning

This is Gilly Salmon who is well known for her 5 stage model of online facilitation, mentioned by Sarah Stewart in her posting about online facilitation.

Liecester university introduction to elearning in second life

A wee bit more about the potential of second life in higher education. Am I posting too much on this topic?

Saturday, January 26, 2008

Keeping it clean in midwifery practice

[Image: wash away your sins; from Carol Esther's photostream at]
I am becoming increasingly concerned about recent news reports about problems which relate to health professionals not performing adequate hand hygiene. I teach in a midwifery education program and we have a strong focus on universal precautions and in particular performing good hand hygiene. We are soon to have a new intake of midwifery students into our school and so this topic is at the forefront of my thoughts at the moment. So perhaps I am just being super-observant about news items on this topic. None the less it is concerning that the message about hand hygiene does not seem to be getting through to health care workers.

The first item that caught my attention in the last few days was a new item from the Center for Disease control in America.This talks about the prevalence of Cytomegalovirus during pregnancy. Although in the normal population this virus does not have any major health concerns it can have serious implications in pregnancy. Prevention of spread of this virus is through good hand washing, particularly after changing nappies of babies and young children. This is such basic common sense information and we, as midwives have a duty to make sure that we tell women about the importance of this and demonstrate the importance by always washing our hands after changing babies nappies ourselves.(Photo: Fresh air change; from Kongary's photostream at

Today, in the Scotsman newspaper Clostridium Difficile is becoming resistant to Metronidazole, which leaves only Vancomycin as a viable treatment option for this bacteria. This is a enteric (bowel) bacteria and once again it's spread is controlled through good hand hygiene. A quote from this article "Margaret Watt, chairwoman of the Scotland Patients' Association, said: 'We need to bring back ward matrons who are responsible for ward cleanliness and staff who are found not washing their hands should be given a written warning.'" "Health Secretary Nicola Sturgeon said: "We expect all health boards to have robust policies in place to help manage C diff. These should include monitoring of compliance with cleaning standards, infection control precautions, prudent prescribing of antibiotics and rapid, accurate diagnosis of cases."

We have known about the importance of hand hygiene for a very long time. In 1847 Ignaz Semmelweis found that hand washing reduced the instance of puerperal fever. Yet still we have regular news stories about poor hygiene practices leading to iatrogenic infection illness and death. Lately there has been the introduction of hand cleansing gel and this has greatly improved compliance with hand hygiene practices amongst health professionals. However in this study, even with the improvements compliance was still only about 50%. We need to do better.

Enhancing student learning in second life

I found this youtube video of a medical scenario where students were being instructed in the procedures to be followed. This is something that I think has a potential for midwifery also. I can think of many situations, such as antepartum or postpartum haemorrhage, shoulder dystocia or breech birth, that could possibly be simulated in a virtual environment. Even just a simulated routine meeting between a woman and her midwife would be a useful learning tool. Students could make decisions about the course of action to be taken. In this video the students are being instructed, I believe the value of this virtual learning environment is for the students to make decisions themselves and then evaluate if they took the correct course of action in the corcumstances.

This seems to be achieved more in the next video where high school students are practicing a CPR scenario. In both of these videos there is actual talking which I am not sure is possible in Linden labs Second Life at present. Perhaps someone can correct me if I am wrong there.

Here is a wee article form the Sydney Morning Herald about some of the possibilities for web 2.0 technologies in education.

I really enjoyed reading this post from E learning Weekly about different ways to set up e'learning courses to add interest for students. Food for thought!

Managing widgets in my blog

I haven't done a screen cast for a wee while. Decided to do one about widgets, explaining what they are. In particular I explain what the widget of my blog is. I hope this wee video works for you.

Friday, January 25, 2008

Playing with my blog

I have been having a wee play around with my blog and have added a couple of items into the side bar and at the bottom of my blog, just for fun. The widget of my blog in the side bar was created here and can be uploaded to your own site if you want. The game at the bottom is just a toy, I can find these things quite addictive at times. I want your feedback here. Are these things just over the top and too much? Do one or both of them detract from my blog? What do you think? If there is a consensus that I should remove them then that is what I will do.
Otherwise have fun with the game but don't get too carried away, remember the pots on the stove.

Wednesday, January 23, 2008

Unicef: State of the worlds children 2008

These statistics have just been published. They are down-loadable. New Zealand sits alongside countries such as Canada, Australia and the UK. Countries that do better than us are Singapore, Iceland, Spain and Germany amongst others.

Tuesday, January 22, 2008

Can't post comments

Image: Broken dreams from KMEVANS photstream at

My blog seems to have stopped allowing comments to be posted on items. does anyone know why that it. It is very very frustrating. Particularly as I had just put out a call for comments. Please email me at if you have any ideas, or if you have any comments. I will place them when I get things working again, fingers crossed.

This is very strange. I have had a comment here and responded. Both of these comments have loaded fine. I have tried to post a message a colleague tried to post on the Fathers posing, see below, and it will not load. I have tried so many times, I have tried posting it in the Fathers posting and in this posting and no luck. I have closed my computer and opened again, still no luck. I would really appreciate help if anyone knows what the problem is.

I have solved this problem now. It was an issue with a combination of brackets in the text of the message. I am leaving this posting as I really like the picture and the post has had one or two comments.

Fathers roles at birth and parenting

Image: New father from Clairity's photostream at

A discussion on how women are supported postpartum began on this blog in the comments to my post about doula and midwifery assistants. I decided to commence a poll (see side bar) however this has not attracted many votes or much attention. One of the issues that we discussed in these comments was the role that men play during the postpartum period. I am also interested in the role that men play during pregnancy and birth.

When I first began in the midwifery profession it was very unusual for a man to attend antenatal classes or to be present at the birth. The father of the baby might have a couple of days of leave from work when a baby was born and then he was back to work. It was usually the woman's own mother, sisters, aunties or female friends who provided her with support at home after her baby was born. this was in the early to mid 1970s.

Now things are very different and fathers are involved and encouraged to be involved from conception onwards. As women have demanded equal rights in the workforce they have also demanded that men take equal responsibility for parenting and care of the family and home. This is an enormous transition in a very short space of time and of course for some families life has not changed much from the way it was in the 1970s and others may be anywhere along the continuum to full emancipation of both parents.

I discovered that a book has recently been written by men about mens experiences at birth. I am happy for all comments here but I would love to hear from men. What are your thoughts on societies expectations of men and women in birth and parenting. How was the experience of birth and early parenting for you? What do you think the role of men should be in supporting their family with a new baby? Do both men and women need some additional support when there is a new baby in the family? Do men feel prepared for the new roles that society expects of them? Are they adequately prepared for these new roles?

One of the issues that I see is how we treat fathers immediately after the baby is born in a hospital, which rightly or wrongly is where most babies are born at present. At homebirth fathers are there from the start and continue to be there right through with their partner. In birthing centers fathers are often encouraged to stay with their partners. In hospitals, once the baby is born, the father is sent home, by himself. The support he has been encouraged to give during the pregnancy and birth is not longer wanted or allowed. I wonder how fathers feel about this also?

Saturday, January 19, 2008

Formula for disaster WHO Code violations in the Philipines

This is a 5 part documentary on you tube. I am only posting the first two here. I encourage you to go and view them all.
In New Zealand we may not have the level of poverty apparent here but we do have young women who have great difficulty affording formula. Babies need to have breast milk (or a breast milk substitute) for the whole first year of life. How many women feeding formula continue it for a whole year?
Our baby friendly hospital initiative is being looked at again. We MUST STAY STRONG. We cannot rely on formula companies to comply with the code. We must keep advertising of infant formula and samples out of our hospitals and away from health care professionals. When women absolutely must have formula for some reason we can tell them how to do this without brand promotion. We must not do the job for Wyeth or Nestle, they do a good enough job themselves. We must stay vigilant. this is absolutely shocking, disgraceful and a crime against humanity for the for the profit of corporations.

If you want mor information on this issue or want to know what you can do about it here is a link to Baby Milk Action

Virtual midwifery in the "Mommy and Me clinic"?

What a strange experience I have just had.
Those who have followed this blog will know that I joined second life a wee while ago and have blogged about some strange experiences before.

I started my adventure this evening by reading about midwifery awards from the Royal college of Midwives UK. Two midwifery educators received an award for a virtual pregnancy teaching package they developed. This is something that has been on my mind ever since I ventured into this other life of social networking, virtual worlds and all the web 2.0 paraphernalia. so I did a search for virtual pregnancy and found this recent blog post about second life birthing clinics.

So I went into my second life persona "Dacary Dumpling" and searched for a birthing clinic and teleported to Mommy and Me clinic. I was fortunate enough to meet Noble Barnes.
He is a graphic designer and is the person who has built all of this. When I first arrived I sat at a computer console which has a brochure that informs about what is available here and made some notes. I was informed that the chief doctor here is a doula and student midwife. Now I know that this is an American site and midwifery is maybe not autonomous in this part of the world but why would a doula, student midwife want to call herself a doctor??? Sorry Noble, you were very kind but I do find that very strange. You do not have complicated pregnancies here, the virtual women push the virtual babies out by themselves. Lets get real here and let the midwives do what the midwives do at least in this virtual world.

Noble told me that this virtual birthing center was established so that women who cannot have babies in real life can have this experience in the virtual world. Couples can choose what sort of pregnancy they want, they can have a single baby of any colour or twins or, strangest and scariest of all, a furry baby or a wolf baby. Well that really threw me so much so my computer froze and I had to reload. He showed me the tummy he has developed called the tummy talker which the woman wears. She and her partner can pat it or rub it or sing to it and they can see the baby move.

Then he took me to the clinic room. In here they weigh, measure, take blood pressure and perform ultrasound (3D of course). He performed one on me and I saw the typical 3D face on the screen. (I don't know what you would see if you were carrying a wolf). I could also hear the foetal heart. After this he took me to the birthing room. They have a shower with a bar to hold on to. When my Avatar held onto the bar it moved rythmically up and down, there is a similar bar on the wall in the room. Their is also a birth ball to sit and rock on. There is a deliver bed (like a theatre bed) which is where the babies are born at present. He took me through a birth. I jumped on the bed and my body was moving and pushing. Lying semi prone and every now and again gave a wee jump with the hips. (I didn't notice any sound effects here). Eventually the baby moved down through my pelvis and out. Noble told me Avatars cannot birth in the shower currently but they are working on that and also plan to have a birth pool.

I was thinking about the possibilities of scenarios for students and clearly it is a possibility to create something like this, as Noble said it is not the purpose of this center. He felt that such a thing is a possibility. However I can see that what they have done has taken a considerable amount of work and although it may meet the needs of the people who go there it will take a lot more to get something that is useful as a learning tool for midwives or health professionals. To do something like this would need a collaborative effort, with midwifery educators who have a very clear understanding of what they want and computer graphic experts who can interpret this into useful interactive imagery. Still it is a step on the road and much further than I imagined we might be.

Many thanks to Noble Barnes for spending the time to show me around. I do worry a wee bit about people who might have deep psychological problems and how they might handle this sort of virtual experience. Is there some sort of help or support for someone who just can't handle the experience? It is all just a little bit strange.

A tribute to breasts and breastfeeding

How do you react when you watch this video? Why do you think you react the way you do? Does society need to change the way it perceives motherhood, infant nutrition and breast feeding?

Friday, January 18, 2008

Breasts and breast feeding

I have followed another link from the German blog mentioned below and found this website "Hathor the cow goddess". this site addresses issues of breastfeeding. I have been thinking about initiating a discussion here about breast feeding for a while now.

This blog raises some interesting questions about societies attitudes to breasts and breast feeding. Why is it OK to have sexually explicit images of women's breasts in newspapers, magazines and on television and yet people complain when a woman wants feed and nurture her baby in a public place? Could we have a discussion here about this issue?
I think it is not just an issue for the women who want to feed their baby wherever, it is also an issue for those women who feel so uncomfortable with this that they will not feed a baby in public. Some women do not breastfeed at all because of body image.

Should have added the breast feeding poster comes from the womens health action web site. It is the image used for breast feeding week 2002. (is it really that long ago), and features Lucy Lawless who played Zena Warrior Princess.

Technology and birth (Monty Python)

One of the things i am able to do with my stats, is to find out where people have come to my blog from. I found today that quite a few recent entries have come from a German blog. I wish I could read this blog as it looks really interesting in my very limited understanding of that language. However one thing I have no difficulty understanding is this video which i found on her blog. As always Monty Python have taken a real situation and blown it up into ridiculous and hysterical proportions. somehow this one, while funny, also makes me feel quite uncomfortable. The machines and the institution are the most important aspects of birth, the woman barely matters at all. I wonder if it is quite as ridiculous now as it was when it was first made, probably about 30 years ago.

Wednesday, January 16, 2008

Doula and midwifery assistants

In my post More about VBAC: Your input wanted. Hannah commented that she felt that the services of a Doula would help to reduce interventions such as Caesarean section. There is some evidence which supports this perspective however this has been conducted in countries other than New Zealand. In New Zealand women have access to free midwifery care for the duration of the pregnancy, labour/birth and postnatal period.
There is some information online about Doula’s in New Zealand. This site explains what you might expect from a Doula as follows:

For childbirth doulas may:
• Prepare a birth plan in advance Midwives are required to do this in NZ
• Help you understand what is happening Midwives are required to do this in NZ
• Support your partner
• Be an advocate in liaising between you and the (other) health professionals Midwives are required to do this in NZ
• Stay with you throughout the labour and until the baby is a few hours old Midwives are required to do this in NZ
Postpartum doulas may:
• Help you to successfully initiate breast feeding Midwives are required to do this in NZ
• Assist you with emotional and physical recovery from childbirth
• Teach you to care for your baby
• Help you with other children in the house
• Do some housework
• Prepare some meals
• Do other tasks around the home that may be required
Doulas will work alongside (but not replace) the work of your midwife or doctor. They can work with you for as long or short a period as you want in the postpartum period.

The italics are my own the rest is copied from the web site. Most of the work of a Doula is a requirement for midwifery practice in New Zealand (see italics). Also Midwifery care is free and Doula's will charge. According to this site about $500 flat fee or $30-50 per hour. (As a locum midwife I am not paid this much!). The difference is that the government pays my fee but women will have to pay for their own Doula.

Hannah suggests a Doula service may be a better option than a midwifery assistant service as recently proposed by the Midiwfery Council of NZ as a measure to address a national shortage of midwives. Midwifery assistants might be responsible for clerical work or house housekeeping duties which might take up the midwives time.

I do believe that for some women, mainly very young women or those who have little personal support, a doula would be beneficial in NZ. However these women are the very women who cannot afford such a service. I have a problem with midwives delegating midwifery responsibility to others and worry that this might be more likely with a doula service than with a midwifery assistant. However it does appear that in some parts of the country something needs to happen to ease the workforce shortage. I wonder what others thoughts are on this issue?

More importantly do others believe that a doula service in NZ would help to reduce unnecessary medical interventions in childbirth? If so how would it be different to the midwifery service we currently?

Photo from Fuschia's photos at

Sunday, January 13, 2008

More about VBAC. Your input wanted

Photo 'Birth' from Maria Mono's photostream on

For those interested in this topic there is an online site '' which has links to useful resources (most but not all of which will open in New Zealand). This is a good place to start looking for evidence on risks and benefits of VBAC . Women who have a previous scar do have some additional risks compared to women with no scar, however having had a previous vaginal birth reduces these risks significantly. The really important point about this whole issue is avoiding the first caesarean section. How can we, as midwives and women, impact on the sky rocketing caesarean section rates internationally? I would love to hear your thoughts on this important topic.

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