Desperately seeking women

Readers of this blog will know that I am a lecturer at Otago Polytechnic school of midwifery. Our end of year exams are about to take place and we have students sitting exams in Whiterea, near Wellington and in Dunedin. We desperately need women to role play a scenario for our students. Women who could do this for us do not need to be pregnant or even to have a baby, in fact because this is an exam we cannot have babies or children present. You would need to be available for most of the day, from 0845 through to around 1500 hrs (or 8.45am to 3pm). In Dunedin this is on Tuesday the 30th of November 2010 and in Whiterea it is on Thursday the 2nd of December 2010. Please contact me, Carolyn McIntosh through Otago Polytechnic 0800 762 786 if you think you might be able to help.

Image Life of a midwife from Sarah Stewarts photos on Flicr.com

Good intramuscular injection video

My only critical comment about this video is using the spirit swab on the injection site following the injection. This would sting. A plain gauze would be better.

Learn How to administer an intramuscular ventrogluteal injection. For more Medical Diagnosis How-To Videos & Articles, visit WonderHowTo.

Kingston Clinic: A lovely day for rural midwifery in NZ

I have had a busy few days in Lumsden. No babies born here, well not yet anyway, but plenty to do. Visiting Mums and doing some administrative tasks around the unit in Lumsden.
Lumsden is situated in Northern Southland, a little more than half way between Queenstown and Invercargill. It also is the local maternity service for women from TeAnau. So it is in the middle of one of the most scenic parts of New Zealand and it is a real privilege to work here. The local community is mostly a farming community but there are also a lot of overseas visitors a long term residents in the mix as well. Many women from Queenstown want to birth in Lumsden as it is not quite as far as Invercargill but is closer to transfer there if there is need to in labour.
To make this service more accessible to Queenstown women we have just started running an antenatal clinic in Kingston. Kingston is on the very Southern tip of Lake Wakatipu. The friendly people from the local golf club have agreed to let us use their club rooms for a clinic. I travelled up there on Friday for the first clinic day. We had three women come to this clinic so not really busy, but I think this will pick up in time.
Here is a picture of the clinic in the Golf Club at Kingston. See Lake Wakatipu and the snow capped mountains in the background.

Listed in top 50 midwife blogs

My goodness what a surprise. I received an email to say that this blog has found its way onto a list of the top 50 midwife blogs! Thank you to those who selected it for this exalted position. I am just a little bit chuffed.

You can view this list here http://onlinenursepractitionerprograms.com/2010/top-50-midwife-blogs/

Pharmacology and prescribing for midwives

I have just added more information to the Midwifery Wiki about pharmacology and prescribing from a midwifery perspective.
I also added a couple of new resources about fetal and placental development in the bioscience section.

Midwife prescribing in New Zealand

One thing I did not mention in my last post about the Midwifery council forum was the debate about midwife prescribing.

In New Zealand midwives are able to prescribe within the scope of midwifery practice. There is no list of drugs that midwives can prescribe however the midwives scope of practice is quite clearly defined. It is this definition which enables us to identify when we can and when we cannot prescribe. For example we can prescribe to a woman who has a urinary tract infection during pregnancy as this is often associated with a normal uncomplicated pregnancy and needs to be treated early to prevent complications such as preterm labour. Prescribing is a last resort of treatment in most circumstances. Midwives offer advice to try to reduce the chances of infection or to elliminate infection before it gets to the point where antibiotics are required. Midwives cannot however prescribe for a woman who has a chest infection as this is not directly related to pregnancy and requires a medical consultation, usually with the woman's General Practitioner.

The dilemma discussed at the Midwifery Council Forum was the issue of midwives prescribing to other members of the woman's family, in circumstances where this is of direct benefit to the woman and the progress of her pregnancy. The particular situations where this dilemma arises is with Nicotine Replacement Therapy (NRT) and antibiotics for Chlamydia.

NRT
Midwives are taking part in education about smoke change in pregnancy. Midwives are encouraged to discuss smokechange with women and the benefits of Nicotine Replacement Therapy. Midwives can prescribe NRT to women and this is seen as being within the midwives scope of practice. The issue we were discussing at the forum was whether midwives should be able to prescribe to partners or family members of the woman. Research suggests that a partner who smokes adversely affects a woman's ability to quite or remain smoke free. Smoking during pregnancy has a negative impact on the infant both during pregnancy and for the newborn infant. We know women are likely to be more successful in quitting smoking during pregnancy if their partner is also smokefree . The question then is should midwives be able to prescribe NRT to partners or close family members of the woman? If so what would this mean for the midwives scope of practice. We had a lively debate but did not reach a clear conclusion. What do you think? Should midwives be able to prescribe NRT to the partner of women? If so should this only be to assist the woman to stop smoking? What if the woman does not smoke but the partner wishes to quit?
Clearly their are benefits for the baby if the family are smokefree, but is this part of the midwives role?

Antibiotics for Chlamydia.

Once again there was a lively debate with no clear conclusion on this issue.
Midwives can and do treat women for chlamydia infection in pregnancy. Chlamydia is the most common STI in New Zealand, particularly in those under 25 years of age. It is important to identify and treat partners of women who are diagnosed with Chlamydia infection and this is important to avoid reinfection and serious consequences for the newborn, particularly serious eye infections. The question debated was should midwives prescribe antibiotics for the woman's partner? What about if there is no sexual health clinic nearby and the partner will not visit the GP? What are your thoughts about this and once again what does this mean in relation to the midwives scope of practice? Does the scope need to change to accommodate this type of prescribing?

Midwifery Council will continue to debate these issues and ultimately will make a decision on whether or not midwives can prescribe in these circumstances. I welcome your thoughts and feedback on these issues.

Midwifery Council Forum Dunedin

Having just completed the first audit of my practice by Midwifery Council I have decided there is some value in continuing to reflect in my blog, making it easier to pull some reflection together for standards review and audit. I will not reflect in my blog about actual midwifery practice and will save that for a closed activity as I am acutely aware of the issues of confidentiality. If a woman particularly told me she was happy for me to write in my blog I would do so and would also make it clear that I had permission to post on my blog from the woman and her family.





Image from Luxmart's photos on Flickr.com

The purpose of this post is to reflect on the Midwifery Council forum in Dunedin, which I attended today.

It was great to get together with many friends and colleagues, some of whom I had not seen for a long time. It was also nice to meet midwives I had not met before, for example Andrea Vincent, who is a new member of midwifery council. I was sad to learn that Sue Bree's term of office on midwifery council has ended. Sue is a wonderful and inspiring woman and I have enormous admiration for her.

It was also good to meet up with Ruth Martis, my colleague from Christchurch Polytechnic and arrange to meet up with her in October for a day brainstorming the Midwifery Practice Skills course for 2011.

During the forum we had a brainstorming session establishing what midwives wanted for the next three year cycle of Technical Skills workshops. Everyone was adamant the day on complex skills should remain. There were quite few other topics that the room came up with for the other Technical Skills workshop day. Amongst the topics discussed were Pharmacology and Prescribing and Newborn assessment. Courses on these topics are available as part of the overseas midwives competency programme and are available too for New Zealand midwives who wish to do them. Antenatal screening was another topic, there is a course available through the National Screening unit for midwives to complete at no cost. Other topics discussed were postdates care, keeping birth normal, postnatal care, preventing burnout and complex care. This was a useful session and it will be for Midwifery Council to decide what the components of the next technical skills workshop will be.If you are a midwife do you have any ideas about topics that should be in the Technical skills workshops of available as continuing education for midwives. The advantage of having a topic in the technical skills workshops is that all midwives must do it, however if it is just available as a course only those who choose to will do it.

In the forum we looked at the proposed new code of conduct for midwives and also the new cultural competence guidelines for midwives. We were able to feedback some thoughts on these proposed requirements for midwifery practice. These will provide good guidance to midwives but we need to be careful what we regulate. For example there is a clause in the proposed code of conduct which states that midwives should not have an emotional or sexual relationship with clients. Many at the forum saw this as a problem as many midwives provide care to family members and also there is an emotional connection with families when you have been the midwife with that family for several births. What do you think? Should midwives be able to care for family members, or should they only be able to be a support person in this situation?

Council also explained there move into and electronic format for the midwifery recertification and payment and issuing practicing certificates.

At the end we had an open session where issues such as the timing of midwifery standards review were discussed, some were interested in moving this to a three yearly component but the consensus and midwifery council position was to leave this as a biennial requirement. Do you think that biennial standards review is a good time spacing or should it be annual or three yearly?

It was quite a long day and I picked up some fried chicken on the way home on request of my husband. Not my favourite meal but saves coming home to cook.

Lovely harp and violin

Protecting, supporting and promoting normal birth in New Zealand

In New Zealand we have a National Strategic Plan of Action for Breastfeeding. At the same time intervention rates in birth are skyrocketing, as they are internationally. Breastfeeding is an important health issue for women and their babies, and it is right that we should do all in our power to support breastfeeding in our communities. There is however general lack of acknowledgement of the health risks of birth intervention to women and their babies. Caesarean section is accompanied by significant morbidity to women and to neonates. It also siginificantly increases risks for future pregnancies. This is an issue of concern for me, as it is for many midwives.

I have taken the first couple of pages of the Action Plan for breastfeeding and have substituted Normal Birth for the word breastfeeding. One or two sentences needed to be removed as they were not relevant to normal birth. I would be interested to know what you think of this. If only we could inspire a movement to protect, promote and support normal birth. Is there any way that you think that we could make this happen?

So read on::
The vision for the National Strategic Plan of Action for Normal Birth

Aotearoa New Zealand is a country in which Normal Birth is valued, protected, promoted and supported by the whole of society.
The statements on this page set out the achievements that will show that the vision has been realised in New Zealand.

Women and their wha¯nau/family have the information they need to make confident and informed decisions about Normal Birth, and live and work in an environment that enables and supports their decisions. Women and families have access to support to help them gain, practise and pass on knowledge of Normal Birth to family, friends, and successive generations. Communities, along with health and social services, provide accessible, consistent and knowledgeable support to women and families who need it. Normal Birth rates show a significant improvement across all population groups, and there are no longer any significant differences between the Normal Birth rates of different ethnic, socioeconomic or geographic communities. There are accessible and appropriate Normal Birth education and support services for all eligible women, fathers/partners, families and wha¯nau from all cultural and ethnic groups, and for migrant communities, low-income families and young mothers. Government planning, policy and service delivery decisions are thought through with a view to actively protecting, promoting and supporting Normal Birth. This occurs across all relevant government agencies in ways that fully involve and respond to communities. Where it is necessary, legislation actively and explicitly protects, promotes and supports Normal Birth.
1.1 Priority areas for action for the short term: 2008–2010
The Committee has identified a group of issues that need to be addressed in order to make demonstrable progress in improving Normal Birth rates in New Zealand. The priority areas are listed below:
Government
• Objective 1.1(a): The Ministry of Health provides the leadership for Normal Birth strategy and policy.
• Objective 1.2(a): The Ministry of Health continues to strengthen the accuracy and completeness of the existing dataset on Normal Birth.
• Objective 1.3(a): Identification of New Zealand-specific Normal Birth research needs.
• Objective 1.4(b) The Ministry of Health supports a programme of research into intervention in the normal birth process. National Strategic Plan of Action for Normal Birth 2008–2012 page


Family and community
• Objective 2.1(b): The Ministry of Health works with District Health Boards (DHBs) to assess and plan for improving access to ante-natal education.
• Objective 2.2(b): Communities work with DHBs and other providers to establish new or support existing peer support programmes for Normal Birth.
• Objective 2.3(a): the second phase of the national Normal Birth social marketing campaign promotes positive attitudes to Normal Birth in the community and public places.

Health services
• Objective 3.1(a): All DHBs achieve and maintain Normal Birth Friendly Hospital accreditation.
• Objective 3.2(b): DHBs are aware of and act on the Normal Birth support needs of their Māori, Pacific and other ethnic communities.

Workplace childcare and early childhood education
• Objective 4.1(a): The Ministry of Health continues to link with other agencies (for example the Families Commission, Department of Labour) to support the development of a policy framework for options for extending current paid parental leave entitlements.

1.2 The need for the National Strategic Plan of Action on Normal Birth
Normal Birth is important for the physical, social, emotional and mental health and wellbeing of infants, mothers, fathers/partners and families. There are risks identified with intervention in birth. Normal Birth is important to the health of individuals and communities. [We] now require[s] DHBs to actively work towards improving Normal Birth rates as one way of improving the health status of communities. Concern over declining Normal Birth rates is not unique to New Zealand.

Virtual International Day of the Midwife, May 5th

May 5th is the International Midwives Day. Here is what the International Confederation of Midwives say about this day:

"The International Day of the Midwife is an occasion for every midwife to think about the many others in the profession, to make new contacts within and outside midwifery, and to widen the knowledge of what midwives do for the world. In 2010 and in the years leading up to 2015, ICM will use the overarching theme The World Needs Midwives Now More Than Ever as part of an ongoing campaign to highlight the need for midwives. This reflects the WHO call for midwives and the need to accelerate progress towards the achievement of MDGs 4 & 5."

How about participating in the Virtual International Day of the Midwife. This is a free conference for midwives. An opportunity to come together from the comfort of your own home or from your workplace. You can access all the sessions online through the links that you will see beside the sessions. Come and join us. You will have an opportunity to ask the presenters questions or to share your own thoughts.

Wiki for midwifery education.

Some time ago, way back in 2007 I did a course called facilitating online learning communities through Otago Polytechnic and Manakau Institute of Technology. I became very interested in open access education and making resources available for those who have an interest to study. I started this blog at that time and, for a while, was an enthusiastic contributor to online discussion fora etc. Laterly I have been very involved with developing a new programme through Otago Polytechnic for undergraduate midwifery education and have not been very active at all online discussions or posting on this blog. It all just takes too much time.
However I did start a repository for material that I felt could be useful for midwifery education. I commenced a wiki in wikieducator to store this material and to make it accessible to any who wishes to use it. I have tinkered with this wiki from time to time and it has grown over time.
I am aware that this wiki does not get much exposure. I know this blog is rarely frequented also but, in an effort to raise the profile of this wiki I am posting here. Any midwives, or midwifery educators who wish to add content to the wiki are welcome to do so.
Go and have a look and see what you think, follow this link.

Wise womens' web: rural midwives communties of practice

I have just realised how to post a document in google docs as an open document on the web and have loaded up my thesis.
So if you are ready to be bored here it is