Wise womens' web: rural midwives communties of practice

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

Opportunities for postgraduate study for midwives in New Zealand

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

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

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

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

Learning to be a midwife in second life

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

Midwives sharing the cream of what they know

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

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

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

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

Group B Streptococcus the confusing and nasty bug

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

Video about moodle

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

Forced caesarean, informed consent?

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

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

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

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

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



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


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