Carolyn's blog

Casearean section. Midwives play their part

2012-01-22T01:10:00.001-08:00

birth, a photo by maria mono on Flickr.

Increasingly babies are being born through an incision in their mothers abdomen. Sometimes this is after the mother has gone into labour but often without labour having been initiated at all. The baby is plucked without prior warning from familiar surroundings and brought into the world. The mother then has to recover from a major abdominal operation. Such surgery requires many weeks if not months of recovery. Why is it that this proceedure is increasingly required to bring babies into the world? On the 9th of February midwives in Otago are coming together to consider this issue to explore what is that we do that can might set women on this path. We are also looking at what we can do that can support women to avoid unnecessary caesarean section.
If you want more information about this call me through the 0800 Otago Polytechnic number and i will give you the phone number for registrations.

How to create a youtube account

2011-09-21T19:06:00.000-07:00

Next year I may be asking students to upload a video to youtube. This is a video which explains how to create a youtube account and how to upload a video.

Sally Tracy on the cascade of intervention

2011-09-02T04:02:00.000-07:00

The wonderful Sally Tracy talking about the cascade of intervention which happens in birth

And what happens with the baby after all of this

Primary birthing and National standards for maternity care.

2011-08-30T16:16:00.000-07:00

I was just reading the New Zealand Maternity Standards document from the Ministry of Health. Standard three states "All women have access to a nationally consistent, comprehensive range of maternity services that are funded and provided appropriately to ensure there are no financial barriers to access for eligible women."

There is however no primary birthing facility option for women birthing in Dunedin. There is no national consistency in the provision of primary birthing facilities for women. This is a matter that needs to be addressed if we are to support women to birth without medical intervention.

At last: Making a change, promoting normal birth.

2011-08-30T02:22:00.000-07:00

The momentum seems to be building to raise public awareness about the dangers of ever increasing intervention in childbirth.
In new Zealand we have the Maternity Manifesto. This initiative is raising public awareness in New Zealand and lobbying government to:
◦Become informed about the impact of maternity services on the welfare of women, their babies, whanau and our communities
◦Set a comprehensive definition for ‘normal birth’ consistent with international standards
◦Develop an accessible, practical NZ campaign to increase the understanding of ‘Normal Birth’ and how this can best be facilitated
◦Publicly acknowledge positive maternity care outcomes.

And now, on the 1st of September, a new project is about to be launched raising awareness and initiating change around the world. Here is the video which launches this project. Lets get behind these initiatives and start to make a difference. The time is right! For all the women children and families we work with we need to get behind these initiatives and do what we can to raise awareness and support normal birth.

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Updating midwifery pages on WikiEducator

2011-08-26T16:36:00.000-07:00

I have just been updating the Midwifery pages on WikiEducator. These are free resources on midwifery education, with many links to other useful online material, for student midwives and those with an interest in midwifery education. Anyone can edit these pages and add content which may be useful. I check it fairly regularly and so far no one else has added any content. If you feel that there is something you think might be useful, which is not included there, please feel free to add it. Or you could let me know here and I will add it for you.

My wee game has gone :(

2011-08-25T13:10:00.001-07:00

I am sad to say I have just discovered that the wee game I had linked on my blog has gone! Sorry to all the many fans of that wee game who came here solely to play it.

Pelvic floor muscles

2011-08-24T21:33:00.000-07:00

Necessity is the mother of invention so they say. Well this week I have been proving that statement to be correct. I have been at home with flu but had to meet with my lovely Invercargill group of students on Wednesday. We were to cover pelvic floor muscles and I had no model of these available without travelling through to Polytech so I decided to make a model to fit with the wonderful wee pelvis model I had sourced earlier in the year for the students from the Hesperian foundation.

I used photographs of the models which we use with our regular sized pelvis models, which I had available to me and developed the model to be constructed out of paper or card or any other medium you might wish.
Here is the pattern
Pattern, Small Pelvic Floor Muscle Model

And the instructions
Instructions for Making the Model of Pelvic Floor Muscles

Please note that you will need to download these before you can print them off and use them properly.

E portfolio from the BMJ

2011-06-09T23:11:00.000-07:00

I just discovered that the BMJ have started a free eportfolio service. Ihttp://www.blogger.com/img/blank.gif can register for free and when I logged in I see that access is provided by the NZ Ministry of health. I am not sure how useful this will be. I think if you do any continuing online education through the BMJ it is automatically recoreded on the portfolio. I thought this was interesting and others might also find it interesting. Here is a screen shot of the my portfolio. There is no data entered there yet.

Disturbing story of birth in Africa and developing countries

2011-05-10T04:21:00.000-07:00

I watched this video which discusses some of the issues for women birthing in Africa. I am disturbed and concerned that many women in Africa and in some developing countries do not have access to the health care they need to support them to birth safely. The video starts by showing a baby being held upside down and slapped and suggests that this is the type of care that is lacking. Now I know that the health of women and babies in these societies is often compromised. They often begin labour in a state of anaemia and may be malnourished and have many health issues but I am disturbed as much by what is suggested as good care for them. The video says many women choose to stay at home, well so would I if that was the type of care I could expect to receive in a hospital.

I have worked with many mothers who have emigrated to New Zealand from the Philippines. Many of these women have already had babies in the the Philippines and just about all of these women who have birthed in the Philippines have had a caesarean birth. Most tell stories of not having wanted a caesarean but having been told that the baby will die if they do not with little or no reason for why this may be. These are not the poorest of Philippine women who would not be given a caesarean because they could not afford it, but are women who will struggle to pay for this care. They are then sliced from umbilicus to pubis instead of the accepted low line incision that is common practice in most developed countries. This leaves them with an enormous, ugly and uncomfortable scar.
This is not the care that these women need. Yes women need to have care during pregnancy, yes they need advice on how they can best care for themselves. Yes women's place in society needs to be valued much higher so that they can get the care they need. They need and deserve the best of care. They do not need to be coerced into birthing in dirty disgusting institutions where they and their babies will be subjected to care which is known to be harmful. Practices such as dangling a baby by its feet and slapping it are of no benefit and are known to be harmful.
I wonder how others feel about this.
I feel distressed that women do not get the care they need. I do not believe that any support is better than no support. I believe that we can do more harm than good by interfering when it is not required. I believe that what the world needs now is many well trained midwives and a reasonable number of excellent obstetricians, who support midwifery care, and provide necessary medical care when it is indicated that it is required. I believe that this is what all women need and deserve no matter where they live. It is what society needs as women are the mothers of the next generation.
We have a serious problem in most developed countries where women are experiencing far too much unnecessary intervention. In developing countries women cannot get the intervention they require. We need to start getting this balance right for goodness sake.

A politician with passion and evidence supporting homebirth

2011-05-10T02:59:00.000-07:00

This man would definitely get my vote.

Another jump in caesarean section rates

2011-05-10T02:44:00.000-07:00

Recently the Otago Daily times published and article which reported that the caesarean section rate in Dunedin hospital had reached the rate of 42.6% in the month of February 2011. I was moved to post this on my facebook page and this resulted in conversation some of which I wish to share here. The reason for this post is to try to stimulate a wider discussion.
What do you think about this rate of intervention in what, for most women and babies, should be a normal and natural process?
Is there anything you think that midwives can do to help turn this around?

Here are some of the comments I placed on my facebook page.

I am greatly worried but these statistics. Jenny says that when the decision is scrutinised there is a reason for that particular caesarean. However the reasons for performing caesarean seem to grow all the time. How do so many women get to this point where they are being advised to have a caesarean?

It is an enormously complex issue. There isn't one group who are more accountable for these statistics than another, one group cannot change this. For years now we (well midwives at least) have been gasping in horror at ever rising caesarean rates.I think, as more and more women birth by caesarean it (CS) becomes less feared. While more and more women are afraid to birth away from secondary care services because they might need to have a caesarean or other intervention. We shouldn't ...forget that caesarean is not the only intervention in the birth process. Every birth then virtually becomes a "trial of labour". I do think as midwives we have a responsibility to help women and those close to them to understand that the best way, for the 80% of women who can anticipate having natural, uncomplicated birth to achieve that, is to choose to birth away from secondary care services.
I think it is a society issue and until society are shocked and horrified and choose to do something about it there is little else that we can do. Many midwives too are frightened to take that step to experience birth away from secondary ca...re services. As a midwifery educator this is something I struggle with every day. How do I play my part in trying to help midwives see what is happening and find the way to support the women they work with to birth away from secondary care services, whether that is at home or in a primary unit? Without blame we need to look at every birth and try to see the decision points which led to intervention in the normal process, assess where this could have been changed and how this might impact on the outcome.

Working in Lumsden, a rural maternity unit

2011-03-04T21:11:00.000-08:00

For the last 18 months, as well as teaching at Otago Polytechnic I have also been working as a midwife in a lovely wee rural maternity centre in Northern Southland. It is a lovely part of the world. Lumsden itself is a junction town but the surrounding countryside is lovely. The community here are mainly involved in farming and rural service industries. As dairying has expanded in this area the ethnicity of the childbearing population has changed too with quite a number of asian dairy farm workers. A number of women from the Kingston and Queenstown areas also birth here and these are often professional women or women involved in the tourist industry.
I have really enjoyed working here and would recommend it as a place where midwives can practice midwifery care autonomously in a supportive small team of experienced rural midwives. It takes time to find new staff in an area such as this and I am hoping that a midwife may see this and think this would be a good place to work. If you want to know more they have a website which tells you a bit about the facility. They also have a page on facebook where you could communicate with them. If you have any questions about working here I would be happy to try to answer them.

Midwifery Students learning palpation

2011-03-03T21:28:00.000-08:00

Those who read this blog will know that I am lecturer at Otago Polytechnic School of Midwifery. I mostly work with students in the first year of the three year direct entry degree programme. On the Wednesday the 16th of March 2011 our students are going to be learning about abdominal palpation. We need women from the community to be available to help our students with this learning. We need women who are pregnant and are 30 weeks or more gestation. This will be the first time most students have ever had the opportunity to feel a baby during pregnancy and to listen to a babies heart beat. It is very exciting for them and this is usually exciting for the women who come forward and offer to help our students learn this technique.
We have students based in the lower North Island in Whangarei, Palmerston North and throughout the Wellington area. We have students in Central Otago, Southland and throughout Dunedin.
If you are pregnant and feel that you would be able to help us with this please contact Carolyn McIntosh, freephone 0800800583. If I do not answer leave full details on my answerphone and I will get back to you. BTW we do offer a small gift of a book token to women who agree to help us in this way, it is not much but it is a wee something to say thank you.

Taking blood pressure

2011-02-26T15:21:00.000-08:00

One of the assessments midwives perform every day, numerous times a day is blood pressure recording. It is one of those things that we quickly gain expertise with and feel that we know very well how it should be done. Since I started teaching undergraduate midwifery students I have become aware of many aspects of my practice that are not necessarily best practice.

I gained my first midwifery qualification in 1975 at Cresswell Maternity in Dumfries. It was a separate hospital in those days but is now part of the general hospital, a common trend nowadays. I learned to take blood pressures much earlier when I was a student nurse at the old D&GRI, not this new one which opened in 1975. The claim to fame of the D&GRI is the first use of anaesthetic ether in 1846 for surgical operations.Suffice to say I had many years to get sloppy in my practice, feeling I knew very well how to take a blood pressure, before I started teaching students and had to look at this again.

I try now to take blood pressures according to best practice however I do admit to not always doing this, old habits die hard. When I was looking for learning resources for my students I came across the British Hypertensive Society. They explain the process of recording blood pressure and provide clear rationale for why it should be done this way. One of the resources on this web site is an interactive learning resource, excellent for anyone wanting to know how to take blood pressure properly or learning this skill for the first time. I recommend this highly to my students.

Here are some other learning resources related to blood pressure.
For those interested here are a couple of videos about the physiology of blood pressure and hypertension by John Campbell, a UK nursing lecturer.
Video one
And Video two

Desperately seeking women

2010-11-01T17:52:00.001-07:00

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

2010-10-27T01:05:00.000-07:00

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

2010-10-02T23:03:00.000-07:00

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

2010-08-30T12:53:00.000-07:00

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

2010-08-23T03:47:00.000-07:00

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

2010-08-15T01:11:00.000-07:00

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

2010-07-30T02:00:00.000-07:00

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

2010-05-21T18:24:00.000-07:00

Protecting, supporting and promoting normal birth in New Zealand

2010-05-18T02:36:00.001-07:00

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

2010-04-23T19:14:00.000-07:00

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.

2010-02-15T19:46:00.000-08:00

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

2010-02-15T19:43:00.000-08:00

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

Opportunities for postgraduate study for midwives in New Zealand

2009-09-10T20:11:00.001-07:00

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

2009-08-25T02:00:00.000-07:00

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

2009-07-05T16:01:00.000-07:00

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

2009-06-26T00:39:00.000-07:00

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

2009-06-10T20:22:00.001-07:00

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?

2009-06-05T17:07:00.000-07:00

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

2009-04-01T03:20:00.000-07:00

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

Many thanks to rachlezucker and family.

A couple of midwifery resources

2009-03-21T03:02:00.000-07:00

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

2009-03-21T02:11:00.000-07:00

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

2009-01-15T18:19:00.000-08:00

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

2009-01-06T16:24:00.001-08:00

stages_of_labour

Orgasmic birth

2009-01-06T14:11:00.000-08:00

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

2009-01-06T13:55:00.000-08:00

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)

2009-01-04T19:13:00.000-08:00

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.

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

2008-12-18T22:23:00.001-08:00

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

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.

Background

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.

Highs

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??

Lows

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.

Conclusion

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.

Lactation conference online: Gold 09

2008-11-23T16:43:00.000-08:00

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 flickr.com

My E-Portfolio

2008-11-17T12:34:00.001-08:00

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

Best outomes from midwifery care

2008-10-10T17:17:00.000-07:00

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!!

Routine epidural denied. Is this a problem?

2008-10-05T19:09:00.000-07:00

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?

Baby wearing sling

2008-09-24T15:00:00.000-07:00

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.

NZCOM prsentation: rural midwives network

2008-09-20T21:45:00.001-07:00

Nzcom Presentation 2

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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 cardacs@gmail.com. Thanks for your interest.

NZCOM conference Opening ceremony

2008-09-15T01:25:00.000-07:00

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.

NZCOM conference

2008-09-10T17:59:00.000-07:00

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.

Blended learning and midwifery education

2008-09-06T16:19:00.000-07:00

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!

Unsafe practice and medical experimentation on women's bodies

2008-09-03T02:36:00.000-07:00

Image: Heroine from Erik Vanden's photos on Flickr.com

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.

Lovely wee birth video

2008-08-24T21:59:00.000-07:00

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

now I am going to really embarass myself

2008-08-14T16:31:00.000-07:00

This is my very first ever attempt at poetry.

Birth
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.

The business of being born in Dunedin

2008-08-08T15:14:00.000-07:00

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?

Charlie Parr 1922: That vodaphone ad

2008-07-30T04:06:00.001-07:00

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?

2008-07-30T04:06:00.000-07:00

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

2008-07-17T14:20:00.000-07:00

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.

Confidentiality
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 flickr.com

Carolyn's ICM presentation

2008-06-28T11:53:00.000-07:00

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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.

A taste of ICM

2008-06-05T10:36:00.000-07:00

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

2008-06-05T05:20:00.000-07:00

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.

Christine Webb at Otago Polytechnic

2008-05-09T15:42:00.000-07:00

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.

Beating the open access drum

2008-04-24T15:29:00.000-07:00

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 (http://www.icp.org.nz/). 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 Flickr.com

Blogging and reflecting on midwifery practice

2008-04-20T22:14:00.000-07:00

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.

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

2008-04-10T14:14:00.000-07:00

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.

Men becoming fathers

2008-04-02T22:57:00.000-07:00

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?

2008-04-02T17:56:00.000-07:00

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

2008-04-02T17:08:00.000-07:00

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 flickr.com

Calling all midwives interested open access elearning

2008-03-31T18:45:00.000-07:00

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

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

Second life and flexibility in learning

2008-03-24T22:38:00.000-07:00

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.

Thinking about midwives in second life

2008-03-15T20:07:00.000-07:00

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

2008-03-15T01:51:00.000-07:00

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

2008-03-15T00:10:00.000-07:00

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.

Must see birth video

2008-03-13T14:00:00.000-07:00

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.

New Midwifery education

2008-03-11T14:46:00.000-07:00

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 flickr.com pb31's photos

Todays midwives meeting in second life

2008-03-08T15:19:00.000-08:00

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.

| View | Upload your own

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.

PLEASE COMPLETE THE SURVEY ABOUT SECOND LIFE AND MIDWIFERY EDUCATION
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.

New Blog

2008-03-07T15:11:00.000-08:00

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.

Next meeting in Second life.

2008-03-06T14:46:00.000-08:00

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.

Place:

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

2008-03-06T12:39:00.000-08:00

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 flickr.com

Facilitating online learning communities.

2008-03-06T01:47:00.000-08:00

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.

Background
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.

Reflection
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.

References
Boud, D., & Middleton, H. (2003). Learning from others at work: communities of practice and informal learning. Journal of Workplace Learning, 15(5), 194-202.

Fahey, C. M., & Monaghan, J. S. (2005). Australian rural midwives: perspectives on continuing professional development [Electronic Version]. Rural and Remote Health, 5. Retrieved 25th June 2006 from http://rrh.deakin.edu.au.

Hmelo-Silver, C. E., Duncan, R. G., Chinn, C. A. (2007) Scaffolding and achievement in problem-based and inquiry learning: A response to Kirschener, Sweller and Clark (2006). Educational psychologist, 42 (2) 99-107

Knowles, M. S. (1990). The adult learner: A neglected species. Houston: Gulf Publishing Company.

Leiner, B. M., Cerf, V. G., Clark, D. D., Kahn, R. E., Kleinrock, L. L., & Lynch, D. C. (2003). A brief history of the internet. Retrieved 26th June, 2004, from http://www.isoc.org/internet/history/brief.shtml#Origins

McIntosh, C. (2007) Wise women's web, rural midwives communities of practice. Unpublished masters thesis. Dunedin, Otago Polytechnic.

Roberts, S. M., Pruitt, E. Z. (2003) Schools as professional learning communities. Thousand Oaks: Corwin press. Available online

Russell, L,. Russell, J.(2003) Leading change training. American Society for training and development.

Smith, M. K. (2007) 'Paulo Freire and informal education', the encyclopaedia of informal education. [www.infed.org/thinkers/et-freir.htm. Last update: December 28, 2007]

Tolson, D., McAloon, M., Hotchkiss, R., & Schofield, I. (2005). Progressing evidence-based practice: an effective nursing model? Journal of Advanced Nursing, 50(2), 124-133.

Wenger, E. (2006). Communities of practice, a brief introduction. Retrieved 29th December 2006, from http://www.ewenger.com/theory/index.htm

Survey

2008-03-05T18:50:00.000-08:00

I have created an online survey using freely available software. This will gather anonymous data about the impression midwives and others have about second life and its potential use in midwifery education and professional development. I have loaded a link to this survey into my side bar so it is permanently available here. I have also loaded a link onto the Midwives in Second Life Wiki

I hope to gather some data to support any future publication or presentations I may make about the use of second life for midwives.

I would value your input to this and it will take very little time to complete. When you click on the link the survey should appear straight away and you can complete it there and then,

Thanks for your help

Minutes from midwives in Second life

2008-03-05T02:31:00.000-08:00

I have created a wikieducator page to save documentation from our virtual meetings in second life. Here you will find two links at the moment, one to the notes or 'minutes' that were made of the meeting, which is stored on another Wikieducator page. The other is to the complete transcript of the meeting which is stored in Google docs.

If you have information you feel could be added to the Wikieducator page please feel free to do so. You will need to register with Wikieducator first but this is free and simple to do. You then just need to hit the edit button and you can edit the page. If you wish you can hit the Discussion tab at the top of the page and leave a comment. I welcome your feedback on this. Thanks to Clare for this picture.

By the way I finally managed to add a photo to Wikieducator with a lot of help from the tutorials for wikieducator.

Safer Motherhood. Supporting midwives in third world countries.

2008-03-03T19:49:00.000-08:00

Image : Mother and son. from Teseum's photos on flickr.com

While I am busy trying to provide an opportunity for midwives to come together and collaborate, using second life, my thoughts go to midwives working in situations of poverty, in third world countries. These midwives and the women they are caring for need our support. Her is a link to a shocking statistic that I think will impact on anyone who sees it. At the time of writing this 89,365 women have died due to childbirth related causes in 2008 when you read it it will have ticked up even more.

The midwives who are struggling to provide care and support to women in these situations must find the whole situation so emotionally draining. I just cannot imagine it. One such midwife is an amazing young woman who has made her home in Malawi. It is this blog posting that made me think of this in the first instance. Many of her postings bring tears to my eyes and I admire her hugely. I was going to suggest she might find some support by connecting with other midwives, perhaps through this virtual environment and then I think about the challenges that she faces on a daily basis. Would this provide her with support or appear shallow and futile? Can collaboration in this way do anything to support midwives and women in these environments? Would she even be able to find the resources to do this. Clearly she does have internet access at least from time to time as she blogs.
What about midwives working in war torn areas of the world, Iraq, Afghanistan, what could we possibly do for them. Or the poverty stricken areas of South America or Asia. I was also moved byt the trailer for this movie Born Into Brothels: Calcutta's Red Light Kids.
I would love to help and support these people in some way.

Here is one young mothers story

Just wanted to add a little to this post. I was chatting with a fellow midwife here recently and we were talking about the dreadfully high caesarean section rate in parts of South America. This midwife had spoken with someone who told her that women in the location he came from choose elective caesarean a little before the due date as they do not want to have to travel to the hospital in the middle of the night when they could be hijacked shot and/or robbed. Elective ceasarean is by far the safer option. It does put another perspective on the situation doesn't it?

Next second life meeting

2008-03-03T13:44:00.000-08:00

We need to organise the next second life meeting quite speedily as the weekend fast approaches again. I have not yet documented my full reflection but I am basing this meeting on some feedback from the previous meeting. Someone wanted to see how it would be to explore a topic that we might discuss in real life to compare the quality of the interaction. I would appreciate your thoughts on this and if you feel changes need to be made. I have been thinking more about this and want to talk about what we might do on the day rather than nail it down here now.

Date: Sunday 9th March
Time: 09.30am NZ, 3.30pm New York, 8.30pm London, 0530 am Perth (sorry :)), 0730 am Sydney, 12.30 pm Vancouver.
Here is a link to World times for this meeting
(Please note that this clock was stating Friday 7th this was incorrect, the meeting is Sunday 9th morning as now stated on this time chart. Sorry about this, I have trouble keeping the time and date correct while I paste for some reason)

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

Theme: Supporting normal, natural childbirth. (Alternatively we could go to the sandbox and play at building things).

Agenda:
All gather at the Koru Island meeting place.
If we have a large group we could break into smaller groups to brainstorm the topic. Have a think about what you would like to do. It would be fine to go and practice building. We will be talking while we do that. Arwenna has a couple of good ideas also. Can you give me suggestions for how long this should last, I think at least 30 minutes perhaps 45 minutes.

Introduce Midwives group. Get contact details for those who wish to give this. Discuss theme, time and place for the next meeting and firm up arrangements before leaving.

We made it. Midwives met in Second life

2008-03-02T21:20:00.000-08:00

Thanks to everyone who who supported this initiative and came along to our midwives and educators meeting in second life on Kiwi educators Koru Island. I am still feeling a bit tired so just a brief feedback from this session at this time and I will write more comprehensively later.

I am particularly grateful to the following people
Claire Atkins (Arwenna) has been wonderful supporting me to learn more about second life. Setting up the slide show and redoing the whole thing at the last minute when I wanted to change things. Claire also helped me keep an eye on the crowd and helped me to make sure everyone had a chance to participate. The meeting would not have been nearly as successful without her.

Merrolee Penman (Koru Bracken) . Merrolee is and Ocupational therapy lecturer and is a leader in blogging for that profession. She also has an interest in exploring Web 2.0 uses in tertiary education. Merrolee was keen to come along and I co-opted her to keep some notes, rough minutes, of this meeting. She did this job superbly for me. I will finalise these soon and post them in Google docs, linking here very soon. These notes of the meeting are available now in Wikieducator with a link also to the transcript of the meeting which is available in google docs

Sarah Sewart (Petal Stransky) who has encouraged and supported me to get to this point. Sarah came along and contributed to the conversation keeping this alive when I was busy concentrating on other things.

Brownyn (Branwen) and Leigh (leeroy) who ran the course on 'facilitating online learning communities'. I have learned so much from this course and would never have explored second life at all had it not been for this course.

The meeting was a great success, most particpants were from the UK, one came from Michigan where it was 3am when the meeting stared. Arwenna and her co-owner of Koru Island Isa Goodman gave everyone Kiwi Educator status which means they cna return here and can practice constructing things here also. We have been welcomed to return and hold further meeting here. Everyone was keen to meet again in one week. It was suggested that we make it Morning for NZ and evening for UK. This would make it midday or afternoon in North America and a better time for North American residents to participate. There were several midwives from North America and Canada who were interested but were not able to attend. I had met one Trinny Dreamscape from Vncouver a little before the meeting. also met up with Aastra Apflebaum who had difficulty with her computer crashing in second life. She popped in and out a couple of times but had to quit in the end.

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Here is the slide show presentation that I gave to the group to initiate discussion about the usefulness of second life for professional networking and midwifery education.

Final instructions for virtual midwives meeting

2008-03-01T13:04:00.000-08:00

Meeting 9pm tonight our time
2100hrs-NZ, 0800hrs-UK, 0300hrs-New York, Midnight-Vancouver, 7pm-Sydney, 5pm-Perth.

Meeting at Koru Island, Kiwi educators meeting place.
Second life coordinates; Koru 155,122,27 (PG)-Koru

When you go online I should see that you are there and will offer to
teleport you to Koru Island, you should accept this invitation. If I do not
see you immediately give me a minute or two, it could take some time
to get everyone sorted. If you are late arriving and I don't notice
you are there can you send me an instant message (IM)? Sarah will be
helping me (Petal Stransky), so she may offer to teleport you also, you can accept either invitation.

If you are having difficulties, you could send me a message either by email cardacs@gmail.com or through skype - carolynmcintosh . Both of these will let me know instantly that I have a message.

Hope that all who wish to attend make it, fingers crossed for a successful meeting. It will be interesting to see how this works for us and will be good comparison with Sarah's previous Elluminate meeting and the upcoming Elluminate virtual conference on the 6th of March, see previous email from Soo.

See you tonight on Koru.
Carolyn
Dacary Dumpling (Second life)
carolynmcintosh (skype)
cardacs@gmail.com (email)

Last night before the midwives meeting

2008-03-01T00:17:00.001-08:00

I arrived home tonight from a visit to my Mother-in-Law to find several more midwives signed up with second life and ready to participate in our meeting tomorrow night. Very exciting! Some of my colleagues from Otago Polytechnic and the "facilitating online learning communities course' that Sarah and I are completing are also going to join us. One of these is a colleague from Occupational therapy at Otago Polytechnic who has been a leader in blogging for this profession and has developed quite a community of OT bloggers. My mentor in second-life, Arwenna, who has helped me with setting up my presentation and other aspects of second life, will also be there helping me out, thank goodness. I hope she, and some of the others with more skills in second-life than myself, will be able to help answer some of your questions.

The meeting is tomorrow night at 2100hrs -NZ time 0800hrs-UK time 0300hrs-Montreal, 0100-Edmonton, Midnight-Vancouver. Midnight-secondlife

Hope this is helpful, here are the other word times for this meeting.

When people arrive I will teleport them to the location for the meeting. There will be some displays with one or two helpful 'how to's' to help get you started communicating. I will ask everyone to give brief introduction about their professional background and interest in Second-life. I have a small presentation prepared to introduce some of the possibilities I have discovered in Second-life and where my interest arises. I will then open the floor to everyone to discuss their thoughts about this medium and how it might be used for the benefit of the midwifery profession and midwifery education. I am hoping we can get people communicating in voice however if this is too difficult we will revert to text communication. When communicating in voice online it is important to watch for the signal above an avatars head, indicating that they are speaking. Trying to have one person speaking at a time is important. We will need to discuss these ground rules before we all start trying to communicate. Participants will be able to also communicate by text even if we are communicating with voice. Thankfully Sarah will be there to help me too. Hopefully between the two of us and with Arwenna's help we will be able to keep ahead and eye on communication and make sure everyone gets a chance to speak. I also want to try to keep some minutes of the meeting and might be able to delegate this task to one of my friends.

After the meeting if people want to go together to explore another second-life environment we might be able to do this, although it may be a challenge to get everyone moving together. If there is enough interest we may be able to arrange a future meeting before we leave. I also hope to get a photo of all participants if we can manage this.

Virtual midwives meeting this Sunday

2008-02-28T00:17:00.000-08:00

Sarah and I are very excited and looking forward to welcoming you all to Koru Island meeting place in second life this Sunday.
Follow this link for world times for the meeting

Hopefully everyone who is interested in this has now downloaded second life onto their computer and has created an avatar for themselves. Email me at cardacs@gmail.com with your avatar name and I will then be able to connect with you in second life and transport you to the meeting.

I will be online at least one hour before the meeting preparing and will log anyone that comes on over the weekend into my friends list then. I will be away from home until Sunday afternoon so will not be able to do it before then.

Just in case there are technical difficulties with second life, an alternative online contact option is through Skype. These are contact details for Sarah and myself through Skype

Skype name
Carolyn - carolynmcintosh
Sarah - sarah.m.stewart

See you on Koru Island Sunday 2nd March 9pm NZ time.

Second life midwives meeting

2008-02-25T00:09:00.000-08:00

Our midwives and midwifery educators meeting on Koru Island in Second life is this Sunday. We will be meeting in a New Zealand bush setting, with New Zealand bird song in the background. We have a large screen available for a brief introductory presentation before we discuss your ideas and questions about Second Life.

Sunday 2nd of March
United Kingdom -- 0800hrs
Perth WA -- 1700hrs
Brisbane -- 1800hrs
Sydney -- 1900hrs
New Zealand -- 2100hrs
Second life time -- 2400 hrs 0000 hrs or (12 midnight)

Here is a link to world times for the meeting.

It is not too late to register with second life. Create an avatar to enable you to participate in this international collaborative meeting of midwives and midwifery educators in Second life. There is information and 'how to' videos on my blog which will help you to do so at this link Let me know your Avatar name and I will add you to my friends list in second life. I will then be able to teleport you to the meeting place when you log on.

I have been busy working with my mentor Clare Atkins (Arwenna Stardust) in second life arranging this meeting. My friend and colleague Sarah Stewart (Petal Stransky) has also been supporting me and will help me to facilitate this meeting. I am also expecting one or two of my colleagues from Otago polytechnic to help with technical difficulties or to help answer your questions about meeting and learning in this environment.

Looking forward to seeing you on Koru Island :)

More fun at Leicester in the UK with my friend Aastra in secondlife

2008-02-22T21:54:00.001-08:00

Here are some more amazing photos from Leicester Media Zoo

This are Aastra and me on the blimp

Here we are in the surround cinema. Not sure where this is though. Let me know if anyone recognises it.

Exploring second life for education

2008-02-22T16:31:00.000-08:00

I have been looking at Second life in preparation for a meeting of midwives. I have been struggling to find good places to go to. When I search in second life I only seem to come up with some very 'dodgy' sites, not the sort of places i really want to hang around in.

I finally did a web search for slurl (which is second life urls) and found a really good wiki with lots of interesting places to explore. I also went to Leicester Universities Media Zoo. Which was very interesting.

This is a slide share of my experience

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Second life in education

2008-02-21T19:34:00.000-08:00

Here is another perspective on Second life in education. To stimulate your interest for our midwifery meeting on the 2nd of March. This is a slideshare presentation from Jokay and was posted a year ago.

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Midwives on the move in America

2008-02-21T01:43:00.000-08:00

Image: Camilo 30 seconds old. From Natashalatrasha's photos at Flickr.com

There have been some positive happenings in America on the issues of midwifery and childbirth. Long overdue one has to say. Midwives and women have been lobbying strongly for changes in legislation to legalise the practice of midwifery across the United States. I have been observing this on the periphery. I have some idea about what has been happening and have been aware of the movement that has been actively lobbying local and national government in the States in recent weeks. This has been termed the big push for midwives .
This movement seems to have been inspired by a movie produced and directed by Ricky Lake and Abby Epstein called The business of being born. This movie seems to have caused quite a stir in the States and midwives and women have been building on this and working hard to make sure that the midwifery option of care is at last available to women.

I received an email today from Steff Hedenkamp of a press release with the following text
(Jefferson City, Mo.) – Midwives advocates across Missouri and the nation today celebrated the passage of Senator John Loudon’s (R, Chesterfield) midwifery licensure bill, SB 1021, from the Missouri Senate Committee on Pensions, General Laws and Veteran’s Affairs. The long-anticipated legislation would decriminalize the practice of midwifery in Missouri and establish a board to license and regulate Certified Professional Midwives (CPMs).

So congratulations to all who have worked so hard to achieve this, it is quite momentous.

I do know that not everyone is 100% behind these changes. Sage Femme, a well known American midwifery blogger has reservations about midwives being required to be licensed and believes there should be a voluntary option to this. I am unsure how this would work but I am not totally familiar with the American situation and therefore not at all qualified to comment on this.

Challenges of technology

2008-02-20T16:14:00.001-08:00

Image from Liam Higgins of flickr

I am feeling very challenged by technology :(
I have what should be a 'super duper' laptop. An HP Pavilion dv6000. Lots of RAM lots of Memory wireless internet etc. I have had it for one year now. It crashed on me completely a few weeks after I had bought it and I lost all my data. After it was reset it worked OK for a while but is always flicking on and off the net and occasional crashes but restarts itself. I took it back to the shop several times but it usually behaves itself while it is there so they say there is nothing they can see that is wrong with it. Finally got sick of it and took it to the computer repair people to check it out and tell me if it is OK. This comes at a cost of $50 for each half hour spent, unless it is a hardware problem which is under warranty.

So they checked it out and thought it might be because I had partially removed Norton anti virus (I use Avast which is good and is free). He completed the removal of this and charged me $164.00. OK, so I bring it home and it is worse than ever, keeps having error messages and crashes to blue screen. I phone the computer repair people who tell me the laptop now needs to have everything deleted from it, back to original factory settings, this will cost between $100-200 for them to do. I took the machine back to Dick Smith where I bought it and they put it back to factory settings without charging me (just as well I just might have hit someone). Back home again, now I have to set everything back up again, all my software, plugins etc, this has taken me virtually all morning this morning.

And what happens now??? Well!!! the computer will not maintain a wireless connection. I have to have it plugged into a cable to be on the internet. Dear reader if you have read this far you will perhaps understand my frustration!! I have called the repair man back and he says "AH!! it is probably a faulty wireless card". He does not have equipment to check this, so this check was not done I suppose in his original assessment. This apparently can be fixed under warranty.

I have no faith in this machine. I want it to be replaced and get another one. It cost me whole lot of money which I cannot really afford. But this is not going to happen. So I am going to tell everyone, do not buy an HP pavilion dv6000.

We have another laptop at home. It did not come with wireless but I bought a pcmc card for it. It is not nearly so powerful or 'super duper' but it seems to work OK. It does lose wireless connection occasionally but not nearly as much as this machine. It cost about 1/3 of the price of this machine and is the one my husband uses.

My advice to anyone reading this would be, do not buy a 'super duper' high powered machine thinking it will be, faster, better, more powerful. Go for the cheap and cheerful. It will probably work just as well and you will not be so frustrated having spent a heap of money on a pile of junk that no one will help you with.

Change of day for second life midwives meeting.

2008-02-18T01:24:00.000-08:00

Change of day for second life meeting from Saturday to Sunday.

I have had feedback from a couple of people that Saturday night for us. Saturday morning UK is not going to suit. I need to change the meeting to Sunday night for us Sunday morning for the UK. I will keep the time at the same time.

New Time
Sunday 2nd of March
United Kingdom -- 0800hrs
Perth WA -- 1700hrs
Brisbane -- 1800hrs
Sydney -- 1900hrs
New Zealand -- 2100hrs

This is the world times with the new time fixed in

world times for this meeting

Sorry for this change and hope that this is Ok with all or most of you.

I do hope you are able to join us. I have a small core of people who have supplied me with their avatar name. I would like to have a few more who might be able to attend. If you would like to talk with someone while you go through the process of entering second life and creating an avatar then please connect with either me or Sarah through Skype or Google talk

Skype name
Sarah - sarah.m.stewart
Carolyn -carolynmcintosh

Google talk uses my google mail
Carolyn - cardacs@gmail.com
Sarah - sarahstewart07@gmail.com

Sarah also has a Twitter account
Sarah - SarahStewart

Midwives and educators meeting in second life.

2008-02-14T20:03:00.000-08:00

I have been furthering the plans for our meeting in second life to
explore opportunities for midwifery meetings, conferences and
educational opportunities.

In preparation I took my laptop to be serviced and somehow have lost
my list of friends in Second Life that I had already created. (This is
one of the frustrations of technology, sometimes it lets you down.) If
you have already offered or accepted friendship from me in Second Life
and receive another request will you please accept it, this is
important?

Plan for meeting of midwives in second life.

When:
Saturday 1st of March (Note now changed to Sunday 2nd of March)
United Kingdom -- 0800hrs
Perth WA -- 1700hrs
Brisbane -- 1800hrs
Sydney -- 1900hrs
New Zealand -- 2100hrs

Here is a World Clock with the time for this meeting in your
time
N.B. If this time is a major problem for you please let me know as
soon as possible so that I can make changes if necessary.

Where:
On Koru Island in the Kiwi educators meeting place, in the virtual
world of Second Life.
I will teleport you to this location

Program:
1. Start time, meet and greet and get settled.
This may take a wee while to get everyone comfortable.
2. 10 minute power point presentation
Highlighting some of the options currently available in Second Life.
3. Open floor for discussion
Brainstorming opportunities for midwifery and midwifery education in Second Life
4. Arrange subsequent meeting to further discussion in venue to be arranged.

Please look at my blog postings to help you understand what you need
to do in preparation for this meeting

In particular check this one to get you started

You need to be registered with Linden Labs Second life to be able to
participate.
You need to create an Avatar and go through the initial process on
Orientation Island in second life. This will take you anything from
one hour to a few hours to do. If you wish to participate you will
need to do this. Once you have done this you will need to email me
your Avatars name so that I can offer you friendship. This will come
to you in second life and as an email. You must accept this offer of
friendship in second life so that I can add you to my list of
contacts. Sarah Stewart will invite your friendship as a back up to
my list. My second life name is Dacary Dumpling and Sarah's is Petal
Stransky.

I will be online for about one hour before the meeting preparing for
it. I will be looking to see when people in my contact list come on
line and will then invite them to teleport to my location on Koru
Island. You need to accept this invitation and will arrive at the
island with myself and the group.

If you are interested please email me directly so that I can contact you clarify the process and make arrangements with you for the meeting.

Carolyn's email, cardacs@gmail.com

Orangutan birth

2008-02-14T13:18:00.000-08:00

I just had to share this one with you too.

Two very different birth videos

2008-02-14T11:19:00.000-08:00

In this post I want to highlight the very different experiences women can have with what might be called a 'normal vaginal birth'.

In this first video a young woman gives birth to her child in water. In contrast to the video posted on my friend Sarah's blog, this baby is taken from the water quite quickly. I wonder if, given a little more time, the mother might have reached down and picked up the baby herself. Obviously all the labour has gone before this and this is just the birth of the baby. It appears a relaxed and loving birth experience. Both mother and child seem to take a moment or two to realise what has just happened.

In this second video a young woman is giving birth in a hospital. We do not see the whole birth. She is fully draped in sterile drapes, with many gowned and masked health professionals and others buzzing around. The doctor at the foot of the bed is ready to catch the baby. He does not seem to be using any instruments so it would seem safe to assume that this is a 'normal vaginal birth'. A friend or family member is taking this video. The language used is Spanish I think, but the body language clearly indicates that the doctor is not pleased to be videoed. I wonder why? The doctor does not seem to engage with the woman at all. His focus is entirely on the woman's vulva. A shame we do not see the rest of this video.

I welcome your thoughts on the contrast between these two birth experiences. All over the world, and I think New Zealand is no exception to this, women can experience birth in the way these two young women do, and many variations in between.

How might these different birth experiences affect women as they start on their journey of motherhood?

Midwives meeting in second life.

2008-02-11T01:29:00.000-08:00

Having had a meeting in second life with my friends, supporters and mentors, Petal and Arwenna my plans for the midwives meeting in second life is moving along. We discussed where we might hold the meeting and decided on Koru Island, the New Zealand educators island. Arwenna is an owner of this place and Petal and I are members and are able to hold meetings here without cost. Arwenna has a screen onto which we can load power point presentations, she thinks we might also be able to organise a screen to stream a video into second life. This is starting to feel much more 'do-able' now. So the plan for the session now is;

Participants log onto second life and I will send an invitation and teleport them to the Koru Island meeting place. (to do this participants need to have registered in Second Life, negotiated Orientation Island and moved to Help Island on the mainland. See my previous blog post.

Meet at the Koru Island meeting place. This has an area where we can sit around in a lovely New Zealand setting with New Zealand trees and bird song in the background. We can sit here and watch the power point.

After this I would like to stream a video if this is possible.

We will then have an opportunity to talk about possibilities the participants envisage for using second life for midwifery education, continuing professional development, conferencing or networking. Might be able to brainstorm, find some uses and answer some questions people have.

If we have the opportunity we might finish off by visiting another virtual place where there is already a midwifery education space. I still need to be able to arrange and confirm this.

Things I need to do now.
Prepare a power point which illustrates aspects of second life.

Try out some options for recording the session

Prepare more information to guide the participants into second life and to Koru Island.

Keep those who have expressed interest in the loop and encourage them to register with second life and go through the Orientation island process.

Finalise the exact date and time. The meeting will be on the weekend of the 1st or second of March. In the New Zealand evening, UK morning.

Facilitating birth through sexuality and intimacy

2008-02-09T13:28:00.000-08:00

In my previous post I linked to an article by a woman who spoke of her increased libido and sexual desire during pregnancy and birth. The article does not hold back and fairly outrageous stuff really. So be warned. This has stimulated me to think more on this topic however. How do we as health professionals handle this aspect of our work. Are we open enough to the ideas of women as sexual beings during pregnancy labour and birth? Midwifery is very involved with womens' sexuality whether we choose to acknowledge this or not. I wonder if down playing or ignoring this can contribute to the medicalisation of birth?

We have known about the benefit of nipple stimulation for stimulating contractions for a long time, Hippocrates was the first to describe its use for induction of labour. Sexual intercourse too is known to stimulate uterine activity however a Cochrane review could find insufficient data to draw firm conclusions with scientific basis about the benefits for cervical ripening and induction of labour. It seems to me that regular uterine stimulation throughout pregnancy must be helpful in toning the uterus ready for labour.

If women are prone to premature labour it is advisable that they try to minimise uterine stimulation and therefore they may be advised to avoid intercourse. Do we however promote this as healthy activity which is likely to facilitate labour and birth? How would you, as midwives, create a space for labour where couples can be intimate with one another in this way? Would you as a woman feel OK about being intimate with your partner in labour or raising this as a possibility with your midwife? If you work in a maternity facility do you have any thoughts about this happening within your facility?