Thursday 29 September 2011

Midwives and Social Media

Midwives are becoming more engaged with social media and electronic communications in both their professional and personal lives. Because there has been controversy with the use of social media by a few health professionals lately, I explore some of the pitfalls, precautions and powerful possibilities that social media offers to midwives in this post.
Social media and midwifery

Midwives love networking - whether sitting in the tea room, hanging out at the ‘desk’, having dinner out with colleagues or catching up at midwifery conferences, workshops and meetings. The buzz of midwives conversations and laughter is inevitable. The move to using social media as a way to stay in touch and keep connected has become easy for midwives.
What is social media?
The term ‘social media’ is an umbrella term which covers the multiple ways that technology is used for social interaction. Social media differs from traditional media, such as newspapers, television and radio; in that anyone using mobile and web based technologies can publish and receive information at any time. Real time interactive dialogue enables the co-creation of meaning and value of all aspects of social life - perfect for a socially-based profession such as midwifery.

Forms of social media

Mobile and web based technologies take many forms. The main forms used by midwives are: Email, Texting, Forums, Facebook, Twitter, LinkedIn, Blogs, Ning, Wikis, OneTrueMedia and YouTube. Wikipedia has an extensive categorized list of social media. There are links on the Wikipedia page to an explanatory note about each modality.  Google ‘social media’ and you will be amazed with what comes up for you to explore.

Uses of Social Media

Social media offers a means through which people can post their experiences as they go about their activities and enables their ‘followers’ and/or ‘friends’ to be updated instantaneously. You will be familiar with email and texting, so I won’t go into those tools in this article. Most of you will be familiar with Facebook too. Midwives who engage with social media tend to use Facebook as their social network platform, sharing their lives and their photos. Some midwives also use LinkedIn, a platform used by business owners and other professionals.  The microblogging site, Twitter, is popular with midwives too but most of them are from the USA.

Apart from social networking and updating friends on daily/hourly activities, social media is an excellent tool for raising awareness about issues, sharing information and organising events.  As recent world events have demonstrated one of social media’s most powerful roles is in mobilising community support for political and/or public interest issues. When the Gold Coast birth centre was threatened with closure in 2010, a massive campaign was launched on Facebook and Twitter to inform people that closure was imminent. The social media campaign culminated in a well publicised rally, traditional media became involved and the birth centre remains open.  Facebook and Twitter were used effectively as both official and unofficial sources of news and information during the Queensland floods at the beginning of 2011. The immediacy and success of that social media intervention dramatically increased the profile of social media for both government and the general public.
Ning is a useful social networking site for groups as it is password protected and requires moderation to enable access. You will find midwifery, birth and parent related communities on Ning. Another popular social media tool is blogging. Many midwives blog. The word ‘blog’ is the contraction of “Web log” and is a website which functions as an open online journal maintained by an individual. The blog owner, or an invited guest, writes regular commentaries about events, ideas and/or experiences. An example of a midwifery blog is Queensland’s Rachel Reed’s MidwifeThinking.

If you would like to find out more about the way that health professionals use social media, Sarah Stewart, the social media guru midwife has a blog article A discussion with health professionals about their use of social media with a video discussion on the use of social media. Sarah has initiated and coordinated the immensely successful and popular Virtual International Day of the Midwife, a virtual conference held over a 24 hour period on May 5th. This year, 2011, marks the third year of that conference. Details can be found on Sarah’s blog.  Social media is making inroads into health care as health care facilities and doctors seek to improve patient doctor communication. Dr Kevin Pho, has a popular Medscape blog, KevinMD, He also discusses on YouTube Social Media to Traditional Media the way that social media helps to prepare doctors to talk with patients and the general public.

Traps for the unwary in using social media

Some of my greatest learning has been from sharing stories about birth with other midwives. Sitting in the tea room or going out to lunch and talking ‘shop’ is usually safe for discussing clinical issues and we are all aware of the need to ensure confidentiality in those forums. Those words we shared disappeared into thin air and only our memories recorded what we talked about. However, the online environment and communicating through social media permanently records our conversations. The fact that what we say and how we say it can be read by anyone forever in the online world means we as health professionals must be careful to project a professional persona in all our online communications. A rule of thumb for engaging in any social media is to ensure that you don’t write or say anything that you wouldn’t want to read on the front page of the national newspaper.

A recent study found that there were inappropriate physician comments on Twitter. The researchers in this study identified 3% of the posts that were unprofessional because the posts contained:

  • Discriminatory statements;
  • Potential violations of patient privacy;
  • Profanity
  • Sexually explicit material (Rettner, MyHealthNewsDaily/MSNBC, 2/17).

About 1% of posts included unsupported claims about a product or repeated promotions for certain health products. Ten of these tweets contradicted medical guidelines or knowledge (HealthDay, 2/17).

The results of that study are demonstrated further in a situation concerning the indiscriminate use of slang on twitter by several doctors. Anne Marie Cunningham, a GP lecturer from Cardiff, Wales wrote a professional and reflective blog post Social Media, Black Humour and Professionals about her experience when she sought to discuss privately what she thought was unprofessional language on social media with the doctors concerned.  Her post led to a very heated response from some, including an item on the Facebook page of The Medical Registrar in which Anne Marie was called a 'humourless old trout' amongst other things.  I've blogged about this situation which some wag labelled #hcsmgateuk (health care social media 'gate', referring to the watergate affair in the US). 
The Australian Medical Association, concerned that its members could find themselves in trouble through inappropriate behaviour on social networking sites, developed A guide to online professionalism for medical practitioners and medical students (available on their website). Even Liberal Party MPs now have a Liberal Party guide to social media, after several MPs were forced to resign for posting controversial tweets.

People do strange things, like calling in sick and then updating their status on Facebook talking about what they are doing for the day - neither wise nor honest.  Even parents complaining about childrens' messy rooms can sometimes find their words have fallout they couldn't imagine. Employers don’t take kindly to employees who bad mouth their workplace on social media sites either. Remember that the information and images you post on social networking sites are there forever.

An increasing trend is for employers to check prospective employee’s online information and take that information into their consideration of the applicant’s suitability for the position. Employers are looking at what their current employees are writing. I was told recently that someone employed at a university was advised to ‘defriend’ another person who posted a negative news item about the university on their Facebook page. Women in our care, and our colleagues, may also check us out on social networking sites.
As a summary of the perils that befall the unthinking, here is a list of “dont's” that have led to people being  fired because of their behaviour on social media.

Don’t post off-color remarks

Don’t post confidential details

Don’t badmouth your clients

Don’t disrespect your employer

Don’t post inappropriate photos

Don’t create animated videos of your co-workers

Don’t talk trash about your boss

Don’t play hooky - and then post about it

Netiquette and Social Media
So how do we engage in social media and stay safe?  While I’m sure the mistakes made in the examples above will not be made by any midwife, there are other pitfalls that need to be considered. We need an appreciation and understanding of the set of social conventions regarding online communication to ensure our communication will not offend others or land us in ‘hot water’. An important consideration is that there are no body language cues available for people to ‘read’ what we mean in online communication. The lack of body language cues means that humour can be misread or misinterpreted, especially what we may consider as merely ‘sarcasm’ and ‘wit’. We therefore have to ensure our message is clear and personable. Other important aspects of Netiquette are:

  • Capital letters for whole words indicate shouting and is considered rude
  • Keep emails short and put the important part of the message in the top sentence
  • Make sure the email subject line is appropriate to the email topic
  • Don’t expect or demand immediate responses when emails or texts are sent and don’t send another one immediately if there isn’t a quick reply
  • If something private or urgent needs to be discussed, ring the person or direct message (DM) them. Don’t put it where everyone can see it
  • Don’t conduct personal, private conversations on social media unless the site is locked and even then realise that the information, even DMs and emails can be subpoenaed by a court 
  • Be courteous and polite
  • Ensure the message is the message you send: reread before posting and ask yourself, how will this message be interpreted by the person who receives it? 
  • Avoid the use of profanities
  • Avoid any words or images that victimise, blaspheme or vilify
  • Avoid any words or images that are racist, sexist  and  anti religious 
  • Treat everyone and talk about everyone in positive terms, remember, what is written lasts forever   
  • Don’t post and/or tag unflattering or compromising photos of friends. Be aware of your own photos and ensure the photos you are posting are professionally appropriate
  • Be wary of who you ‘friend’ and your privacy settings; often you are required to take some action to ensure privacy
  • Be aware that privacy settings are still vulnerable
  • Ensure spelling and grammar are correct
  • Remember that you are projecting your professional image whether you realise it or not
  • If someone else makes a mistake, be kind. If you choose to correct them, do it privately and kindly       Be respectful of intellectual property

The USA’s Centre for Disease Control and Prevention produced an excellent Social Media Toolkit for health professionals you will find interesting and useful.

The rule of thumb bears repeating here. Don’t post anything you would not want to see on the front page of the national newspaper.
Remember, even with all those social networking rules, engaging in social media is fun and informative. The various forms of social media provide great tools for keeping in touch with family and friends. Social networking is a wonderful way to promote midwifery and you can make friends across the world in your areas of interest and expertise. Here's a link to a post Medical Students and Social Media: How to get involved that has some good tips for using social media to your advantage.  If you keep the ‘rule of thumb’ in mind, you will enjoy the sense of connection social networking brings and even feel free to develop a blog and tweet, secure in the knowledge that you are safe professionally and personally because you know the rules of engagement.

I look forward to seeing you online!

This article was first published in the Australian Midwifery News, a publication of the Australian College of Midwives newsletter in the Autumn edition, 2011.  I'm reproducing it here with permission and with some extra information added.

Hastie, C. 2011, 'Midwives and social media', Australian Midwifery News, Vol. 11, No. 1, Autumn 2011, pp.

Monday 26 September 2011

Strong College, Strong Midwives, Strong Mothers


I've talked previously on this blog about the fact that:

"Birth is not only about making babies. Birth is about making mothers - strong, competent, capable mothers who trust themselves and know their inner strength". Barbara Katz Rothman

The environment a woman finds herself in is a great mediator for how well she is able to develop that strength. A supportive environment is enabling. A supportive environment is capacity building.


Midwives have traditionally been a vital part of the woman's birth territory where ever the woman gave birth. Midwives have protected the space and provided the support, encouragement and trust in the birth process that is so integral to women feeling free to birth and mother well. Midwives stand strong with women as they bring their babies forth into the world. Many's the time I've been with a birthing woman who would glance at me as she laboured and I'd smile and nod and she would go back to her process satisfied that she was 'on track'. Those women would invariably say later, "I was feeling frightened and when I looked at you and you smiled at me, I knew I was ok".

The word 'midwife' comes from the Anglo-Saxon "mid-wyfe" which means 'with woman'. There is a long history (at least the last four thousand years has been recorded) of the way that being with women has brought midwives into conflict with 'authorities'. The Bible gives evidence that midwives have always stood with women and protected them and their infants in the most difficult circumstances and despite powerful edicts to the contrary. Exodus (1:15-22) contains "several verses recounting the experiences of two Hebrew midwives who refused to kill male infants in defiance of the King of Egypt".

And now, in Australia, women and midwives have a new challenge.

In response to political posturing by various authorities, the Australian  College of Midwives has released an Interim Statement on Homebirth in an attempt to restrict where women can birth and what midwives can do. The statement, hastily drafted as it was, nonetheless was rapidly endorsed by the newly formed Australian Nurses and Midwives Board, even before the statement was reviewed by the College's members.  You will note that the statement endorsed by the board does not mention the word 'interim'.  What is also concerning is that the College statement references two papers whose data collection methods have been poorly regarded (Kennare et al (2010) paper on planned homebirth in South Australia, and Bastian et al (1998).

Interesting.

Submissions on the statement were requested by Friday 23rd September 2011 (after publication on the web). The College states it intends to finalise the statement in October this year. Many of us are not impressed by the statement as it stands because it does not position the woman as the decision maker. Midwifery ethics are all about the woman as decison maker.

You will find considered responses to the interim statement on homebirth by midwives who work in private practice on the following links.

Rachel Reed of MidwifeThinking's response

Australian Private Midwives' Association's position statement on homebirths

I was thrilled to see the clarity of thinking and recognition of women's rights in the response from the National Alliance for Students of Midwifery.

This statement from the International Confederation of Midwives on women's choices and birth territory is clear and unfortunately, not reflected in the interim statement by the Australian College of Midwives.

So here's my  submission to the College for consideration in the Board's deliberations over the wording and intent of the Final Statement on Homebirth.

Carolyn Hastie
Midwifery Facilitator
23rd September 2011
Dear Colleagues,
Re: Australian College of Midwives Statement on Homebirth: Women's Rights to a Homebirth and Their Right to a Skilled Attendant
Firstly, I want to know that my College supports women to have sovereignty over their own bodies and agency, including the right to choose where they give birth.

I also want to know that my College supports midwives to support women with their choices.

Guidelines and standards are important, however, risk status is an indicator, not a predictor and each woman has the right as an adult to be self determining. As an adult, a woman has the right to informed consent and informed refusal.

What enables women to be safest when giving birth is a known competent midwife, agency to choose to give birth where she feels most relaxed, a seamless means of transfer and acceptance at a local health service and collaboration with that service and prompt medical attention as required; the woman's chosen midwife able to continue to provide midwifery care with the support of the hospital's midwifery team.

Science is clear that when women have a perception of control over what happens to them, they have reduced levels of glucocorticoids in their peripheral circulation. Stress hormones are implicated in much of what goes wrong in labour and birth. Our role as midwives and as a midwifery organisation is to be 'with woman' and reduce stress, not create it.

As Barbara Katz Rothman said, "when there is a strong and autonomous midwifery profession, women and their babies do well".

We need to be a strong and autonomous midwifery profession. I want to feel proud of my College and our final Statement on Homebirth. The Interim statement both horrifies and embarrasses me, especially as it has been already endorsed and published by the Australian Nurses and Midwives Board - how on earth did that happen?

Yours Sincerely,
Carolyn Hastie
ACM Member and Fellow
MO5257

Women's rights to sovereignty and bodily autonomy are under threat and we need to stand beside them, to ensure they have the information they need to make their choices and support those choices.

That is what 'midwife' means.

We need our College to support women’s right to choose what suits them and their families and to support us to support women. We need a strong College, so midwives can be strong to support women in their choices so they can become the strong mothers they need to be.

The Environment is everything!

Saturday 17 September 2011

King hit on the funny bone: Labia room

I love humour.
I love those people who have a great sense of humour. I'm always amazed when someone can come out with just the right response to a situation. I love it when something someone says is so funny, I laugh til tears roll down my face. Quirky, off beat, clever humour like that of the Monty Python team really appeals to me. I can watch their skits and movies over and over again.

However, unkind and derogatory put downs or sling offs aimed at those who are vulnerable I find rude, offensive and inappropriate, not funny.

I also love social media. I love the way the various forms of social media provide an easy and quick way to keep in touch and gain and share information. Twitter, for example, was invaluable to many as a tool of communication during the recent natural disasters. The ability to communicate over huge distances with a minumum of fuss has meant that social media is increasingly used as a tool for health promotion. With that ease of communication enabled by the various social media platforms has come concerns about privacy, online behaviour and confidentiality. A code of conduct for online behaviour, coined 'netiquette' has emerged.

Unfortunately for many, they think their conversations on social media are the same as in the tea room, pub or corridor.

They are not.

They are permanently recorded and therefore able to be read by anyone for all time. A good way to think about it is to consider that what you say on a social media platform is like writing it on the front page of a national newspaper. If you wouldn't want what you are going to say recorded in that way, then don't use social media for that conversation.

Many of us have written about the use of social media for health professionals. I wrote an article earlier this year for midwives in our college newsletter. Still I see indiscretion amongst my colleagues posts at times that I feel concerned about. I do wonder how those who use health care think about some of the comments that are made; how would prospective employers perceive such comments if they were to look.  My understanding is that human resource departments are using social media platforms to find out more about applicants.

So a blogpost about an interaction on twitter between male doctors by Ann Marie Cunningham, a GP and lecturer in Wales UK with an interest in social media caught my attention when she said:

"I came across a discussion between several male doctors on twitter which caused me to reflect on this very topic. The doctors were using slang, which I have not come across before, to refer to the wards in which they might have been working. The terms used were 'labia ward' and 'birthing sheds' to refer to the delivery suite where women give birth, and "cabbage patch" to refer to the intensive care ward where many patients are unconscious.

I was shocked at this and angry and did query the doctors about some of the other things they said, but I felt I couldn't challenge them directly at that time about this language. One of the doctors referred to midwifes as 'madwives'"

The blogpost "Social media, black humour and professionals" and the responses are well worth reading to get a sense of what the doctors themselves and the readers of Ann Marie's blog thinks about these remarks.  There are some very interesting comments on Ann Marie's blog itself, but by far the most fascinating reaction has come on Facebook on the The Medical Registrar's fanpage.

Alongside the link to Ann Marie's blog are the words:

The medical registrar " makes no comment, other than anyone who uses terms like "space" to describe a blog is a humourless old trout until proven otherwise"

The medical registrar didn't need to say anymore, because the readers have made up for it with 72 comments at the time of writing this post. These comments are also worth reading.

The attitudes and values of the people responding are clearly discernable. A former CEO of a large Boston hospital, Paul Levy, has discussed the response to Ann Marie's post on his blog.

Paul Levy wrote that he is 'left aghast' at the some of the comments and found the mindset of a few medical colleagues 'extremely upsetting'.

According to the good doctors however, using those terms "labia wards" and "birthing sheds" for rooms where women give birth and "cabbage patch" for ICU where people are unconscious is just good old fashioned humour, a way to let off steam in a stressful environment. Others, like me, find them offensive and degrading.

Is it purely a case of 'humorless old trouts'? or something else?

What do you think?





Thursday 8 September 2011

Strengthening Midwifery in PNG

Giving birth and being born is dangerous in Papua New Guinea.

According to the National Department of Health Ministerial Taskforce on Maternal Health in Papua New Guinea the staggering rate of maternal mortality in PNG is a national emergency.

Every day, at least five women die of preventable childbirth related causes. Sixty per cent of childbearing women do not have access to skilled birth attendants and because there are only 270 registered midwives in the whole country, outside of the understaffed and under resourced regional hospitals, maternity and newborn care falls on the shoulders of community health workers and nurses.

In  September 2000, Papua New Guinea committed to combat poverty, hunger, disease, illiteracy, environmental degradation and discrimination against women and signed the United Nations Millenium Declaration, along with the other 190 UN member states. Eight Millenium Development Goals  were derived from this declaaration with specific targets and indicators. The PNG National Department of Health is targetting the 4th (reduction of infant mortality) and fifth goal (reduction in maternal mortality).

Midwives are internationally recognised as the number one primary health care professional for optimal safety for mothers and babies at birth. Even though there is recogntion of the vital role of midwives in optimising maternal and infant wellbeing and thereby reducing maternal mortality and morbidity in Papua New Guinea, the capacity to produce midwives too low and the number of midwives has remained stagnant. The midwifery workforce is aging and the registered midwives, few as they are, are rapidly approaching retirement.  Over the last five years, reports on the state of Midwifery Education and Maternal Health together with the National Health Plan have all focussed on increasing the midwifery workforce with the aim of having a midwife in every health centre and a skilled birth attendant for every childbearing women.

The reality is harsh. Too many women. A failing health system. Not enough midwives.

A sobering article in the Sydney Morning Herald in 2009 captured the issues and conditions succinctly on this date two years ago. Those issues and conditions are unchanged or worse.

Against this backdrop, the National Government of Papua New Guinea has partnered with the Australian Government to strengthen midwifery and capacity build the existing educational systems. Eight midwives started a month ago to work in pairs in four university programs with the educators and students to ensure the PNG National Standards and Competencies are achieved.

I'm fortunate to be one of the midwives, based at Pacific Adventist University (PAU) and working clinically with students and educators in the women and babies wing of Port Moresby Hospital.


The midwifery facilitation team, minus one and plus two!
From right to left Sue Englend (visiting Port Moresby), Lois Berry (based at Madang) Tarryn Sharp and her daughter Willoughby (PAU), Marie Treloar (based at Goroka) Alison Moores (University of PNG at Port Moresby), Glenda Gleeson (Mandang) Annie Yates (the Kiwi: University of PNG) and yours truly (PAU).  Missing from the photo is Heather Gulliver, who is also at Goroka with Marie.

Today, there was another big step in the right direction of strengthening midwifery in PNG.

The PNG Midwifery Society had their inaugural meeting in the conference room of the women and babies wing of the Port Moresby Hospital.


Fifty one midwives, nurses with midwifery education (unregistered) and student midwives crowded into the conference room to discuss professional midwifery matters.

Student midwives from PAU.
We booked a bus to bring the students and educators from PA University (about 30 minutes away from the hospital) and take them home again after the meeting. The students loved the experience. A very new experience for everybody.

The students are great fun and keen to learn. The educators are amazing people who are very welcoming and want their programs to meet the profession's needs and the Council's regulations. The midwives are appreciative of the students' work on clinical days as the midwifery workforce is scanty and the workload is huge. There is a lot to do to get things right in PNG.

Following the business of the meeting, the buzz was electric as the society member's shared food and conversation
                                                           
As part of the Australian College of Midwives committment to supporting and strengthening midwifery in our closest neighbour nation, four members of the society, two from Port Moresby and two from Goroka have been sponsored by the College to attend the Biennial Australian College of Midwives Conference in Sydney. Another initiative in strengthening midwifery in PNG is the  International Midwives Twinning Project. Two members of the PNG society are being sponsored by the Australian College of Midwives to go to the Hague, with two Australian College members to discuss and explore professional matters at the end of the month.

We know that when there is a strong and autonomous midwifery profession, mothers and their babies do well. The PNG Midwifery Society has the potential to play an enormous role in strengthening midwifery and creating a proud and powerful professional group for midwives, which in turn, creates a safety net for the  mothers and newborns of PNG.


Judging by today's conversation and the turn out for the meeting, the Society is well and truly up for the job!