Opportunities for postgraduate study for midwives in New Zealand

On the 5th of August 2009 I attended and educators forum, organised by the new Zealand College of Midwives. The principal focus was to brainstorm ideas about how government funding for formal midwifery postgraduate education could best be directed. This was an exciting day and one I had waited a long time to see.

Way way back in 1994 I embarked on a long process of self development. I was working at Balclutha Maternity as an LMC midwife and the new direct entry degree midwives were just graduating. I realised that my midwifery education had been a very long time ago, in a different time and a different country. I never went to college of University, in fact i left school when i was 15 years old with just enough qualifications to get into practice based Registered Nursing when I was 17. In 1994 I went to Polytech for the very first time and started papers towards a Bachelors Degree in Midwifery which I obtained in 1998. Around 2002 I started doing papers towards a Masters Degree in Midwifery. In 2004 when I became a midwifery lecturer my employer paid the remaining costs of my Degree but all the other study I did was self funded.

I could see that this was inequitable back then. Nurses at Balclutha were able to do a Masters Degree and have their education funded but the Clinical Training Agency. Local doctors too got funding from the government through this source but midwives did not have access to this funding, we had to pay for it ourselves.

Since 2007 the government have started to make small amounts of funding available to support continuing education for midwives. Making sure that this funding is dispersed equitably is a challenge. The midwifery workforce is about equally divided between those who are employed by a facility and those who are self employed and claim directly form the government. Funding needs to reach all midwives not just those who are employed by a District Health Board. First of all the Midwifery First Year of Practice programme began. This has provided a mentorship relationship for midwives who are newly graduated. In 2009 a new postgraduate course was funded for employed midwives who are caring for women with complex health problems. Now the CTA are looking at what they can offer to other groups of midwives, particularly rural midwives. The details have not been completed and however next year there will be further opportunities for midwives to engage in study without having to meet the whole cost of this themselves. Exciting times!!
Find out a bit more about midwifery education in New Zealand here

Learning to be a midwife in second life

Lately I have been involved, on the periphery, of a project to devlope a birthing unit in Second life. my colleague Sarah Stewart has blogged extensively around the development process for this birthing unit. The development of the birthing unit is now complete for normal birth scenarios. It may be that in the future, if more funding is available, that scenarios are developed which challenge students a little more. They may get to deal with more complicated scenarios, perhaps even where referral is necessary. For now it is great that students have chance to explore normal birth in a primary birthing unit. The SLENZ group who have been running this project have produced this excellent video help you see what the possibilities are. It is very exciting and anyone can use it.

Midwives sharing the cream of what they know

One of the comments on my post about the Group B Streptococcal pamphlet I developed suggested I should feel free to share more pamphlets. Now I do have more pamphlets that I developed a few years ago, one on gestational diabetes, one on third stage, but none of these have been kept up to date and, as all midwives will know it is quite a challenge to keep the information we share current and up to date with the latest research evidence. Although I keep as well informed as I can be on all the issues pertaining to LMC midwifery practice I cannot develop information on everything. I did study GBS in some depth as a postgraduate paper a few years ago and I have committed to trying keep the Group B Streptococcus pamphlet current and up to date.

I know that other midwives have studied a variety of topics, one of my postgraduate class members studied herpes, and produced some good concise information at that time on the implications of genital herpes in its various forms. I think it would be wonderful if we as midwives had a place where we could share the information we have spent so much time and energy developing. Of course we can publish in journals and that is a great way to share, but not all of us have the time or energy to commit to this activity. I wanted to create a place where midwives could easily share information and make it available to a wider audience. To this end I have created a group in SCRIBD where anyone can join and upload information that might be of use to midwives and to women. As discerning midwives it will be for us to decide if the information on this site is evidence based, and if it is of use to us and the women we care for.

I completed a Master of Midwifery degree a couple of years ago and the subject of my research was how midwives access and share information. Many of the midwives I spoke to said that they would love to share information that they had discovered when they had come across some particular issue in practice, but they did not want to write up a journal article. This idea of how we can share information has been something that I have pondered considerably over the last couple of years. I believe midwives have a lot of knowledge and information that would be of considerable use to others and I believe that this group may be a good place to start sharing. I welcome your thoughts and comments and if you feel the urge please join the Midwives Group in SCRIBD. At the moment there is only me and my GBS pamphlet there but I do hope that this is something that grows.

Image: Sharing the ice cream, from Clappstars photos ion Flickr.com

Group B Streptococcus the confusing and nasty bug

Group B Streptococcus is a concern for women during childbirth and for those who care for them. The issues surrounding Group B Streptococcus are complex and the outcome of serious infection in the newborn is severe and sometimes fatal. It is a difficult issue to discuss with women during pregnancy and women need to be informed so that they can make an informed decision about screening for Group B Strep and the possible use of prophylactic antibiotics. Some years ago I developed a pamphlet for my own practice to help me to inform women about this issue. Other local midwives have found this pamphlet useful and I have recently updated the pamphlet to meet new local guidelines. I want to make this available to anyone who might find it useful and loaded it as a PDF onto Google Docs. Google docs will only allow access to PDF files to those who have a Google docs account and have been invited to view. I have now uploaded it onto SCRIBD and hoping this works
GBS Pamphlet 30th June 2009

Video about moodle

Usually I would not post this here as this is my midwifery blog. The blog I use for matters to do with e-learning, education etc is my Fled blog. However it is ion Wordpress and not all embed codes work in Wordpress so I am posting this here. It is a hard decision to make but i do think i will need to leave Wordpress and return to blogger for my Fled blog as it is frustrating not being able to do some of the things I need to do.

Forced caesarean, informed consent?

I was linked to this post by friend on Twitter. I have no way way of knowing the exact circumstances of this child being removed from its parents. Perhaps there were other issues, I hope it was not, as the story suggests, because of the mother declining to sign a consent form for a caesarean section, should it become necessary, during her stay in the labour ward. Ultimately the woman had a vaginal birth of a healthy child and caesarean was not necessary, however she was taken to court because of her refusal to sign a consent and her child was removed from her care. There may well be other circumstances involved and this is only part of the reason however the simple story of requiring a woman to sign a consent for caesarean "just in case" it is required and then accusing her of breach of her responsibility to the child because she refused to sign is something worthy of serious consideration. This took place in New Jersey in the United States of America, so a different cultural social and medical perspective to ours in New Zealand. None the less I would have thought that processes around obtaining consent, and considerations of when intervention in birth is appropriate, should be similar in any supposedly 'civilised' 'western' 'economically advantaged' society

Seymour (2000) discusses informed consent in childbirth in terms of UK, US and Australian legislation. He suggests that coercing women to accept treatment is not supported in law and that women have a right to full information and to make their own decisions based on that information. Seymour suggests it is paternalistic for a practitioner to discuss risks and benefits of different options and then expect a woman to take a particular course which the practitioner feels to be the correct and obvious choice. Informed decision making means that women are free to make decisions based on information, their knowledge of the situation and their own circumstances and preferences. Once this decision is made women should not be coerced into making a different choice unless circumstances change. The woman is then informed of this change and is able to reconsider her decision.

In New Zealand this right for women to make decisions about their care is upheld by the code patient rights and is monitored by the Health and Disability Co missioner. When acknowledging that the woman has the right to consent we must also therefore acknowledge that the woman also has the right to decline treatment for herself and her child. Informed decision making therefore involves a process of giving information and allowing the individual time to consider this information before asking if they will agree to the procedure, or which of several choices she will take. Signing a form on admission to a health facility to give the health practitioners blanket rights to perform any procedure they feel may be necessary in the circumstances is therefore not informed decision making.

Giving information in such a way that there is no real choice is not informed decision making. For example to state "I need to do this now, is that OK?" is not an informed consent process. Some practitioners seem to use this type of statement for consent to a variety of procedures, from taking a blood test, to obtaining a heel prick blood test from a baby, taking blood pressure, to administering medication. For the decision to be truly informed the practitioner needs to find out what the woman knows about the procedure and fill any knowledge gaps for her in simple, non medical terminology. It is preferable to do this well in advance of the intervention that is being undertaken and to give some written information for the woman to consider. Only then can the woman make a truly informed decision about whether she is happy to have this intervention or not. If the practitioner believes a decision places the woman or baby at risk then he or she has a responsibility to tell the woman. The practitioner has the option of declining to provide care for the woman if he or she believes what the woman wants is outside their scope practice and would place the practitioner at risk. IN this unusual circumstance the woman should be given the opportunity to be referred to another health practitioner who may be able to accommodate her needs. For example if a woman wants a home birth and the practitioner does not provide this service then the woman should be given the names of practitioners who can provide this for her. This option of refusing to care for a woman should not be used as a means of coercing the woman to accept a decision she is opposed to.

In conclusion women have a right to make informed decisions. This means women also have the right to decline treatment which has been recommended to them. Practitioners need to be able to provide information and allow women to make decisions even if those may not be the decisions that the practitioner believes to be the best in the circumstances. Practitioners should document the information that has been shared with a woman, what the outcome of the discussion has been and what decisions have been made.



Seymour, J. (2000). Childbirth and the law. London: Oxford University Press. Available in part online from google books


Image: "What to do" from starry eyed Cece's photos on Flickr.com

For all you new midwives learning about labour and birth

Here is a really lovely story in video and pictures for you

Many thanks to rachlezucker and family.

A couple of midwifery resources

There are a couple of really exciting initiatives that have arisen, in part, out of our new programme development and both have come about through grants that were awarded for their development.

Midwifery Junction
This is a really exciting resource for midwives in New Zealand who have links to our schools of midwifery. They may be interested in postgraduate study or they may be working with students. It pulls together educational resources, links to online sites of interest and also provides a forum for discussion for midwives and for students. It also provides information to women who are interested in midwifery education, either because they are keen to have a student involved in their birth experience or because they are interested in being a midwife.

Second life birthing centre
This is an initiative that was started by Sarah Stewart and has been a work in progress in collaboration with the SLENZ group and midwifery lecturers, principally in Otago but also in other schools around New Zealand. A virtual birthing unit is being developed which will ultimately be a fantastic learning resource for students, women and also for midwives.

New midwifery education programme

Image: Digging Deep from law-keven's photos on Flickr.com

I have been very remiss with blogging lately. Our new programme of undergraduate midwifery education began at the start of this year and we are now well underway. All our students are following online learning resources we have prepared. These resources contain all the material we would have taught in lectures previously. We started with the whole class face to face for two weeks getting to know each other and the programme as well as a small amount of face to face teaching.At the end of these two weeks the students went to their respective local areas, we have a group of students based in Invercargill and a another small group in Queenstown as well as the much larger group in Dunedin. The students have been divided into tutorial groups of up to 7 students and these groups meet face to face with a facilitator for half a day a week. During these tutorial sessions student are able to discuss the practice experience they are having working with women in a supportive relationship or during practice experiences in the maternity facilities. They also have the opportunity to go over practice skills and talk about question they have. In addition the entire class come together online once a week for a class discussion about what they have been learning for that week. This is facilitated by the course coordinator for the course they are working on. We also have a closed facebook group where the students can share stories and experiences.

Feedback from the students has been positive so far with many commenting how much they enjoy learning in this way. It is quite challenging to keep up with all the students however they have a close relationship with their own practice facilitator who will be able to monitor how the students are engaging with the programme. Their have been some teething problems, and it is has been quite a challenge at times to get all the resources ready in time. This continues to be a bit of a challenge.

We use Moodle to deliver our courses and EXE to develop the learning resources to load onto Moodle. Some of the quizzes in EXE take a long time to prepare and load. I found some free online resources to create quizzes which were much easier to prepare. These online quizzes were also interesting to look at, interactive and stimulating. However I have just discovered that the programme I preferred and used most often has made changes to its site and all my quizzes have been lost. This means I now have to do this all over again. I have discovered that this type of teaching is actually very labour intensive. It is however flexible. It is possible for me to work from home reasonably often, which is good since it takes me an hour to drive to my work. I can also be reasonably flexible with my time and often work in the evening with my laptop on my knee. I know however that this is not something that appeals to many of my colleagues. It suits me since I do not particularly enjoy many television programmes and my children are adult an I have no other distractions at home, other than a husband (who can be quite distracting sometimes :).)

We have developed our programme in collaboration with the midwifery school in Christchurch and they have a satellite group of students in Nelson. Mostly this collaboration has worked very well. Each course has a coordinator in Christchurch (CPIT)and another in Dunedin (OP). There are very large philosophical differences between the two institutions however. CPIT protect all their resources with copyright while OP have adopted a the use of creative commons licensing. This presents a tension around how resources are presented. If OP were to fully follow our institutional policy all the resources would be open and available to everyone online, however CPIT require these to only be accessible to those enrolled in the programme and to teaching staff. It is to be hoped that these issues can be resolved. I personally believe that the OP policy is the more enlightened, however we need to be so careful that all our resources are free to use and have no copyright restrictions on them.

At this point I would say I am confident that we have the new programme pretty right. I believe it is working well and I am enjoying being involved. I do feel that at the moment I am 'on the run' the whole time trying to keep up. I think this will probably be better next year when we are just making some changes and adaptions rather than developing the whole thing from scratch. I do wish I had more time. It can be a bit overwhelming at times and I imagine the students feel the same way. Hence my very limited blogging of late. There are one or two things that we might change. For example at the start of the year we might bring the students in and then have weeks break before bringing them back for the second week. On the whole I think it has gone better than any of us could have hoped. But it is still early days!

another wee quiz

After the astounding popularity of may last quiz I have decided to give you the opportunity to try another one. let me know how you get on. I have to link you to the quiz here as I cannot embed it.
So here you are. You have to match the term with the description. Click on the hand to start. This one is about legislation covering midwifery practice. In particular it is about the legislation which has requirements around how and what midwives document. some terms are abbreviated to fit the window. This is part of a learning package I am developing just now.

Stages of labour quiz

Orgasmic birth

This is another, longer video, on the same topic as last video.
As a midwife I know that this type of birth is very real. What prevents women from experiencing birth in this way is mainly to do with fear and interventions that are imposed on them. Of course a few women will have problems associated with pregnancy and birth and this is why it is important to have skilled birth attendant, a midwife, who knows when to stand back and let things happen and when it is important to step in and intervene or to seek specialist assistance. However at least 85% of women should be able to birth in this way if only they trust themselves and their ability to do this and have care givers who believe in them.

Letting the fear go around birth

This is an intro for a TV series but the best youtube video of birth that I have seen so far. In 3 mins it manages to say so much. What do you think?
It is all about acknowledging and letting fear go while allowing women to do what they need to do in order to birth their babies.

7 More Things You Don't Need to Know About Me ( and probably don't care)

I have been tagged by Sarah Stewart to write about things most people don't know about me. Not sure anyone will really be that interested and I will make this very brief.

1) I was a child model. I was one of three little Gemmell sisters and our parents were good friends of the Pearson's who owned a clothes shop in Friars Vennel in Dumfries. My oldest sister was 5 years older than me, my middle sister three years older so we were ideal ages apart for modeling children's wear. We used to be taken around all the local village halls for fashion shows. The problem was that I got dreadfully car sick at the time. I remember one show where I got an extra round of applause for bravely going on when I had vomited a about twelve times on the trip there, I got another round of applause for being the only one who would model a swim suit.

2) My Dad was a church organist and my mother was a concert violinist. I spent a lot of my childhood hanging out in orchestra pits. I particularly loved the big Timpani. My dad was also the musical director for our local Christmas pantomime and my sisters and I got to star in small roles in several of these. It was through this that I first learned Pythagoras's theorem, the square of the hypotenuse etc. I amazed my teachers with this.

3) I lived in Holland (Amsterdam) for a year and a half in the mid 1970s, when I was early to mid 20s. It was a great experience and just a wee bit wild. My friend and I worked nights at the Academisch Ziekenhuis and learned to speak a little dutch. We suspected our neighbours thought we had some other type of night work!

4) When I lived in Amsterdam I learned to sail. I loved sailing up and down the canals and going for pub crawls by boat. Mooring was a bit tricky at the end of these expeditions. My knowledge of sailing language is all Dutch eg "Klaar om te wended" (The English term is "ready about" I think)

5) I left school at 15 years of age with 4 Scottish O'Levels (GCSE equivalent) under my belt. At that time you only needed 3 O Levels to do Registered Nursing. I did some nursing courses following this RGN and SCM but did not enter tertiary education until 1994 when I enrolled in a Bachelors Degree for Registered Midwives. I now have a Masters Degree. I discovered I really like formal study and education.

6) I hate housework but love a tidy house. How do you balance these polarities? Answer: with great difficulty. Same can be said for gardens and gardening, I guess I am just lazy.

7) My most favourite city in the world is Florence. I went there only once when I lived in Holland and I just loved it. I loved the architecture, the art, the landscape, the people and the food. I am a bit scared to go back though just in case the memory and reality do not match.

Sorry folks but I am not tagging anyone as all the people I would tag have been tagged already.