Creating Optimal Birth Space

The environment in which we live and move and have our being is critical to our physical, mental, spiritual and social functioning. More and more understanding is emerging about how the environment plays a pivotal role in all aspects of our lives. From mice to (wo) men, science is demonstrating that the body's neural network is "plastic", that genes are not destiny and that the "environment" is an integral part of how living creatures function and develop. Every physiological interaction and behaviour, from the way genes are expressed in the sperm and the ovum to our health and experience across the lifecycle depends upon the environment. The environnment gives feedback which will be either nourishing and provide the stimulus to function well and grow or hostile, which disrupts our functioning, leading to disease, distress and decay.

Recognition of the way the environment is integral to optimal functioning is expanding our understanding of the role of maternity care in providing optimal environments for childbearing women. The science is also demonstrating why woman centred care, facilitating the fulfilment of woman's choices and incorporating women's rights into maternity care are so much a part of optimising outcomes for women, their babies, their intimate relationships and society in general.

My friend and colleague, the wonderful Maralyn Foureur, Professor of Midwifery at the University of Technology of Sydney (UTS) presented on this topic at the recent homebirth conference in New Zealand.  Maralyn is heading up a research team exploring birth space and has attracted a highly prized NHMRC grant for this work. 

Click the link below and it will take you to the slide share of her presentation

Creating Optimal Birth Space

I think you will enjoy and get a lot out of her research.

Quotes for Midwives

My last meeting with the lovely midwifery students I've been working with in Papua New Guinea is this morning.

 Pacific Adventist University Midwifery Students PNG

I've been surfing the net, looking for quotes that relate to midwifery, women and birth that I thought would inspire them.   I've come across the following and thought I'd share them with you.

"You are a midwife, assisting at someone else’s birth. Do good without show or fuss. Facilitate what is happening rather than what you think ought to be happening. If you must take the lead, lead so that the mother is helped, yet still free and in charge. When the baby is born, the mother will rightly say: “We did it ourselves!”  - From The Tao Te Ching

Speak tenderly to them. Let there be kindness in your face, in your eyes, in your smile, in the warmth of our greeting. Always have a cheerful smile. Don’t only give your care, but give your heart as well. ~ Mother Teresa

Ask me for strength and I will lend not only my hand, but also my heart. ~ Unknown

If you lay down, the baby will never come out! ~ Native American saying

Offer hugs, not drugs ~ Adina Lebowitz

Someday, after mastering the winds, the waves, the tides and gravity, we shall harness for God the energies of love, and then, for a second time in the history of the world, man (sic) will have discovered fire. ~ Pierre Teilhard de Chardin

  Just as a woman's heart knows how and when to pump, her lungs to inhale, and her hand to pull back from fire, so she knows when and how to give birth. ~Virginia Di Orio

You gain strength, courage and confidence by every experience in which you really stop to look fear in the face. ~ Eleanor Roosevelt

For God hath not give us the spirit of fear, but of power, and of love, and of a sound mind. ~2Timothy 1:7

If I had my life to live over, instead of wishing away nine months of pregnancy, I'd have cherished ever moment and realized that the wonderment growing inside me was the only chance in life to assist God in a miracle. ~Irma Bombeck

Making the decision to have a baby – it’s momentous. It is to decide forever to have your heart go walking around outside your body. ~Elizabeth Stone

What's done to children, they will do to society. ~Karl Menninger

A woman
in harmony
with her spirit
is like
a river flowing.
She goes
where she will
without pretense
and arrives
at her destination,
prepared
to be herself
and only herself.
~Maya Angelou

Right Livelihood Award: Ina May Gaskin

The world's premier award for personal courage and social transformation, The Right Livelihood Award honours and supports those "offering practical and exemplary answers to the most urgent challenges facing us today".

The wonderful Ina May Gaskin, affectionately referred to as 'the mother of midwifery', was awarded the Right Livelihood Award this year for:

“… for her whole-life’s work teaching and advocating safe, woman-centred childbirth methods that best promote the physical and mental health of mother and child.“

Ina May's acceptance speech is sobering as she carefully catalogues the abuses that have been and continue to be perpetrated against women and their babies in the name of industrialised birth; inspirational as she talks about the brave and loving doctors who have acted in the face of repression and vilification from their less than women centred peers and seek to scare women into submission to the medical juggernaut...

"We must wake up to the fact that it is easy to scare women about their bodies, especially in countries in which midwives have little or no power in policy-making, relative to physicians and the influence of large corporate entities. This takes no real talent. Given such imbalance, fear, ignorance, and greed begin to reinforce each other, and rates of unnecessary intervention soar, with women and the babies suffering the consequences"

Ina May's speech is heart warming as she asks the Hungarian Goverment to release Agnes Gereb, a Hungarian doctor who supported women to birth at home and encouraging as she offers a vision of a better world through optimising midwifery care and supporting women's choices ...

Another site came across my computer screen this morning, and given the content is highly relevant to the content of Ina May's speech, I thought it was entirely appropriate to link it here.

I'm not sure why the midwife broke the sac on this breech baby as she was born, I would have thought it was better left alone to provide that lovely buffer that intact membranes offer.  Even so, I'm grateful to the woman and her family and to the midwives for sharing this delightful photo journey. The explanatory notes are very useful.

Ina May's book Spiritual Midwifery, together with Frederick Leboyer's Birth Without Violence, changed my world when they were released in 1976.  I first heard Ina May speak at a preconfernce workshop at the 1992 Homebirth Conference in Sydney.   I was so emotional on being in the presence of Ina May, that I spent most of the workshop in tears - her passion and 'right thinking' about women and birth still has that effect on me as I watch and listen to her speech accepting her Right Livelihood award.  Thank you Ina May for all you have done and are doing for Women and Birth and Midwifery.  Congratulations on receiving this prestigious award. You certainly deserve it.

The Beautiful Cervix Project

As part of my evening reading and reviewing, I happened upon a guest post on the Feminist Breeder blog of Gina Crosley-Corcoran.  The post was about taking control of fertility and knowing about one's own body. The blogger, Kim Buettner-Garrett said:

"... the idea of taking hormones to prevent pregnancy really made me uneasy. And the mere thought of inserting a hunk of metal into my uterus to create a “hostile” environment for a fertilized egg (leading to possibly heavier and more painful periods) also made my stomach turn — I don’t want to make any part of my body “hostile”, thank you very much"

 Kim recommended a book  Taking Charge of Your Fertility by Toni Weschler and you can read what she said on the site here.  I haven't read the book, but by the sounds of it, I need to get it and read it soon.

Kim's concerns  reminded me of the way that Gail J Dahl referred to hormonal contraception as 'chemical castration' - a term I hadn't associated with the 'pill' (and other forms of hormonal contraception) until I read those words of Gail's. Kim's comments and others who responded reminded me how few of us women know much about the inner workings of our marvellous bodies.  I remembered a wonderful site I came across some time ago "The Beautiful Cervix Project"

A student midwife decided to photograph her cervix through the menstrual cycle as a project for her course. Out of that project grew this amazing webiste and the project has expanded to include photos of the cervix across the reproductive cycle.  Her site has had over two million hits.  All different people with different reasons for exploring the wonder of the cervix visit her site.  Take time to explore and get to know the cervix. You'll be glad you did!

Oh, please explore at your discretion. If you are likely to be offended, please don't go there, avoid it.  The curator of the art has had trouble with people reporting her site for inappropriate content.  As it is a blog about the cervix, photos of the cervix in all its phases and roles is highly appropriate.

So be warned.

Come back and share what you've learned and your reaction to the project. I'd love to read what you think about it.

What birth activists can learn from Steve Jobs

Steve Jobs, the person, will be sadly and achingly missed by his family and friends and Steve Jobs the genius, will be missed by those of us who enjoy the amazing fruits of his formidable creativity and attention to detail.

So why, on a midwifery and birth related blog am I talking about Steve Jobs?

Hugh @gapingvoid an amazing cartoonist, had an obituary for Steve Jobs on his site yesterday.  He quoted Steve Jobs in this way:

Hugh rightly said that Steve's legacy is more than the hardware, wonderful as that all is, it's what he "helped us believe about ourselves".

So important to believe we are capable, strong and courageous and that we can go beyond the boundaries and limitations imposed by upbringing, culture and the myriad other influences that seek to contain our genius and creative self expression.

Nowhere is this more important than with birth and the bringing forth of life.

Those of us who are birth activists, who care about how women are treated in the birthing world; who care about the way that babies are born and how the whole childbearing experience is constructed for women, partners/fathers and babies all over the world need to read these words of Steve Jobs and take them to heart.

We want to change the birthing world for the better and we can!

Thanks for reminding us what we are capable and who we are Steve.  RIP.

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 5^th. 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.

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.

Picture: http://www.crystalinks.com/midwifery.html

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!

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?

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!

Compassion hurts

The massacre of young people in Norway has shocked and distressed me. I know I am not alone in feeling these emotions. My heart goes out to all those youngsters who survived as they now process the loss of their friends and the feelings of guilt that comes with surviving such unfathomable horror when others didn't. I have been reading all the reports and stories, quite compulsively I realised. I was surprised by my compulsion and became aware that I'm trying to get some sense of where that cold, calculating killer was coming from; what enabled him to mercilessly and methodically shoot scores of young people. 

I read that this killer lived with his mother. As a midwife, my life has been dedicated to helping women, their partners and babies connect, knowing that our primary relationship(s) set the stage for our future health and well-being in every aspect of life.  I wondered how his mother was feeling. There was no mention of his father or any other family member in the news items. 

My information about the horrible events in Norway have come from individuals and links posted on Twitter. I have read the various newspaper reports that were linked on twitter. As the information trickled through the net, painting the picture of the events unfolding in Norway, I couldn't get my head around the way that the killer set off the bomb in Oslo, then travelled to a small island where teenagers were on a summer camp and slaughtered so many of them.  Why????

A link on twitter provided a clue "Who kills 80 Teenagers, one by one?" .

We now know there have been at least 94 teenagers murdered, but there are still some young people unaccounted for and still to find. I can only hope they are alive, but the prospects are grim. 

The car bomb was placed near the offices of the socialist government and the teenagers were worker's party members. Rick Falkvinge, the blogger, suggested that the bomb in Oslo itself was a diversionary tactic to keep the police busy while the killer "executed (the teenage party members) in cold blood, as a political strategy to cripple a political party decades in the future." 

The killer's murderous rampage drew the following comment on Falkvinge's blogpost. 

Let Norway show him mercy, not because he deserves it, but because their vision of civilization is more complete than his.

A steady stream of information was tweeted by Ketil B Stensrud, who described  himself as a 'football-fantatic journalist, who worked for The Independent, Daily Mirror, AP, TV2 and VG, turned general manager at Radio NRJ Kristiansand.  One of his tweets contained the following:

BREAKING: Here you can download the Oslo/Utøya gunman's manifesto, in which he gives detailed account of planned attack. 

The manifesto is enlightening, if depressing. 


There are pages and pages of anti-Muslim, anti-multiculturalism rhetoric. There is anti feminist rhetoric. The manifesto is worth looking at as it shows how a mind seeks the evidence it needs to support its biases and bigotry. We are all capable of that self affirming and self referencing behaviour. As you read it, you can see how delusions can become very powerful and how the brain can become closed to any other way of thinking. 

In the document, the killer's reasoning is carefully laid out. His plan to decimate the pro-multicultural element in his country has been brewing for 9 years according to the information in this document. The level of lies and deceit he employed are breathtaking. 


The New York Times article this morning "Scouring the Web for Clues to a Suspected Attacker's Motives" contains sources and links to information about the murderer and his motives by both the journalist and the readers.  A psychologist has, in response to the massacre, written that mass murderers see themselves as victims. That somewhat fits this killer's positioning, however, he seems himself more like an avenging angel or knight. 


He saw himself as a Justiciar Knight fighting multiculturalism. You can read in his manifesto what that means. He surrendered easily to the police when they arrived on the island and under interrogation, confessed to the crimes. This newspaper heading indicates what is to come.    Norway massacre suspect calls his deeds atrocious, but necessary

There have been examples of extraordinary heroism throughout this horrific event by individuals and immense courage and resiliency of the young people.  The leader of the party Jens Stoltenberg has been an inspirational and compassionate leader, saying: 

Today,we have been hit by two savage and cowardly attacks. Tonight, we all stand together, taking care of each other"affirming that "The answer to violence, is even more democracy. Even more humanity"

The massacre in Norway illustrates the profound problems inherent in fundamentalism of all stripes. The killer espouses a vile fundamentalism that strips away people's dignity and worth. His fundamentalism seeks to validate violence for the 'right' reasons of his own making. Norway and her people and their response to this ghastly event remind us that respect for different viewpoints and valuing diversity is the only way humanity can evolve and even survive.  

I feel sad. I feel a bit despairing that a native of a country with such great values and social justice practices as Norway could commit such a crime, but people are people. 


I take comfort in the knowledge that for every person like this dangerously misguided and deluded individual there are thousands who are trying to live life in the best, most socially responsible, inclusive, generous hearted way.  


Elizabeth of @mymilkspilt fame posted this earlier today. The comment summed it all up for me:

 "Compassion hurts. When you feel connected to everything, you also feel responsible for everything. And you cannot turn away. Your destiny is bound with the destinies of others. You must either learn to carry the Universe or be crushed by it. You must grow strong enough to love the world, yet empty enough to sit down at the same table with its worst horrors."

Andrew Boy (Source: myspiltmilk via changingmyperspective, via guerrillamamamedicine)

I don't know who Andrew Boy is, but I sure admire his sentiment.


The following are the last two tweets from the man who provided much of the information I've shared in this blog post. 

ketilbstensrud Ketil B. Stensrud

The brutal, calculated home-grown terrorist has confessed. Rest is now left to our judicial system. I'm exhausted. Time for bed.

ketilbstensrud Ketil B. Stensrud 

One last thought: It's a beautiful world we live in, with warm, inspiring, loving, courageous people all over. Let's keep it that way. Out.

I love his parting comment. It truly exemplifies the spirit of the Norwegian people. I hope he managed to get some sleep.  Thinking of all the people in Norway as they recover and heal from this terrible ordeal and come to terms with the loss of so many beautiful young people. I know that Norway will continue to provide the inspiration, ideals and values that we all love and admire so much; the leadership and people have demonstrated that commitment in the worst of times.