Christine Webb at Otago Polytechnic

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

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

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

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

Beating the open access drum

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

I think it is exciting to explore midwifery in other contexts. Perhaps in the future there might be resources we can share which will be beneficial for anyone. For example the Christchurch medical school have a lovely interactive animation about pharmacology (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

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.

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

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

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

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

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

Informed choice in childbirth: What about midwifery responsibility?

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







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

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

Baby talk: communicating through sign language

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

Image: Baby talk, from Iandeth's photos on flickr.com