my interests are all things midwifery, birthing psychophysiology, teamwork, collaboration. attachment, perinatal psychology, teaching and learning, emotional and social intelligence, breastfeeding, mothering, fathering, midwifery students
Skills and Expertise
TeachingCurriculum DevelopmentHigher EducationWritingNeonatal ResuscitationMidwiferyFetal DevelopmentMidwifery EducationMaternal HealthPrenatal CarePregnancyEmotionBreastfeedingMidwifery ResearchFacilitationTeamworkMidwivesPostnatal CareChildbirthMaternity CarePostpartum PeriodPerinatal CareNatural ChildbirthMotherhoodBirthSpeakingWomen's RightsPreconception Care
Feb 2007 - Nov 2009
- Holistic physiological care compared with active management of the third stage of labour for women at low risk of postpartum haemorrhage: A cohort study.
- This study suggests that ‘holistic psychophysiological care’ in the third stage labour is safe for women at low risk of postpartum haemorrhage.
Awards & Achievements (5)
Grant · Dec 2012
Boosting Indigenous Midwifery Students Success (BIMSS) Project
Award · Sep 2012
Midwife of the Year NSW Johnson and Johnson
Award · Sep 2008
Hunter New England Health: Best Unit Quality Award for Belmont Birthing Service
Award · Jun 2008
Midwife of the Year NSW Midwives Association
Award · Jun 1999
Midwife of the Year VBAC support
Research Item (74)
- Jun 2014
Background: The importance of optimising maternal/baby psychophysiology has been integrated into contemporary midwifery theories but not in the detail required to really understand the underpinning biological basis. Method: The functioning of the autonomic nervous system, as it relates to the uterus is reviewed. The physiology of myometrial cell contraction and relaxation is outlined. The main focus is on the factors that affect the availability and uptake of oxytocin and adrenaline/noradrenaline in the myometrial cells. These are the two key neuro-hormones, active in the 3rd and 4th stages of labour, that affect uterine contraction and retraction and therefore determine whether the woman will have an atonic PPH or not. Discussion: The discussion explains and predicts the physiological functioning of the uterus during the 3rd and 4th stages of labour when skin-to-skin contact and breastfeeding occurs and when it does not. Conclusion: We recommend that to achieve and maintain eutony and eulochia, midwives and birthing women should ensure early, prolonged and undisturbed skin-to-skin contact for mother and baby at birth including easy access for spontaneous breastfeeding. This recommendation is based on strong neuro-physiological evidence.
- Jan 2013
Background: Midwives should be skilled team workers in maternity units and in group practices. Poor teamwork skills are a significant cause of adverse maternity care outcomes. Despite Australian and International regulatory requirements that all midwifery graduates are competent in teamwork, the systematic teaching and assessment of teamwork skills is lacking in higher education. Question: How do midwifery students evaluate participation in team-based academic assignments, which include giving and receiving peer feedback? Participants: First and third year Bachelor of Midwifery students who volunteered (24 of 56 students) Methods: Participatory Action Research with data collection via anonymous online surveys. Key findings: There was general agreement that team based assignments; i) should have peer-marking, ii) help clarify what is meant by teamwork, iii) develop communication skills, iv) promote student-to-student learning. Third year students strongly agreed that teams: i) are valuable preparation for teamwork in practice, ii) help meet Australian midwifery competency 8, and iii) were enjoyable. The majority of third year students agreed with statements that their teams were effectively coordinated and team members shared responsibility for work equally; first year students strongly disagreed with these statements. Students’ qualitative comments substantiated and expanded on these findings. The majority of students valued teacher feedback on well-developed drafts of the team’s assignment prior to marking. Conclusion: Based on these findings we changed practice and created more clearly structured team-based assignments with specific marking criteria. We are developing supporting lessons to teach specific teamwork skills: together these resources are called “TeamUP”. TeamUP should be implemented in all pre-registration Midwifery courses to foster students’ teamwork skills and readiness for practice.
Project - Birth Territory
This publication has had an amazing number of people reading and citing it.
That interest is so exciting. Our fervent hope is that it makes a positive and effective difference to the way that childbearing women and their partners are cared for by midwives and obstetricians in the health care system. We also hope it makes a difference to the way that health policy writers and planners think about the provision of maternity care.
Project - Learning to TeamUp
I'm delighted to say that I've had my abstracts accepted for both the Transforming Midwifery Practice through Education conference on the Gold Coast in September (https://www2.griffith.edu.au/health/transforming2018) and the Australian College of Midwives 'Coming of Age' Conference - the 21st National Conference in Perth in October this year. (https://www.midwives.org.au/news/acm-2018-coming-age-21st-national-conference-call-abstracts-now-open). The presentation at the exciting Transforming Midwifery Practice conference on the Gold Coast is on the TeamUP model. I'm speaking about the results of the latest analysis and also providing a workshop on the way group-work projects are utilised to develop students' teamwork skills at the ACM conference in Perth. I can't wait to share this information on developing these so called 'soft skills' associated with great teamwork with other educators and midwives.
Project - Learning to TeamUp
Analysis is an interesting part of the research process. I'm doing thematic analysis as suggested by Braun and Clark in 2006. I found their explanation of the process very helpful. Here's the paper if you are interested in their take on thematic analysis
Braun, V. and V. Clarke (2006). "Using thematic analysis in psychology." Qualitative Research in Psychology 3(2): 77-101.
Thematic analysis is a poorly demarcated, rarely acknowledged, yet widely used qualitative analytic method within psychology. In this paper, we argue that it offers an accessible and theoretically flexible approach to analysing qualitative data. We outline what thematic analysis is, locating it in relation to other qualitative analytic methods that search for themes or patterns, and in relation to different epistemological and ontological positions. We then provide clear guidelines to those wanting to start thematic analysis, or conduct it in a more deliberate and rigorous way, and consider potential pitfalls in conducting thematic analysis. Finally, we outline the disadvantages and advantages of thematic analysis. We conclude by advocating thematic analysis as a useful and flexible method for qualitative research in and beyond psychology.
Project - Learning to TeamUp
I'm excited and happy because I've just submitted two abstracts for the Perth Conference. One abstract is for a workshop to present the TeamUP model and give participants an opportunity to experience a 'student team meeting' based on the TeamUP structure. The other abstract is to present a paper about the way senior students and early career midwives who'd experienced the TeamUP strategy, put that learning into practice. Fingers crossed that I've written the abstracts well enough for them to get accepted!
Project - Learning to TeamUp
I'm delighted to let you know that my article explaining the TeamUP model for teaching and assessing undergraduate midwifery students' teamwork skills has just been published online and will be included in the Midwifery Education Lancet Series in the journal 'Midwifery' in 2018. My next task is to analyse the interviews with senior students and new graduates who experienced the TeamUP educational intervention to discover their learning and application of the skills they gained through the program. I'm so grateful to those students/new graduates who participated in my research about the program. Thank you to each and every one of you.
Objective: to develop an effective model to enable educators to teach, develop and assess the development of midwifery students' teamwork skills DESIGN: an action research project involving participant interviews and academic feedback. Setting: a regional university PARTICIPANTS: midwifery students (n = 21) and new graduate midwives (n = 20) INTERVENTIONS: a whole of course program using a rubric, with five teamwork domains and behavioural descriptors, to provide a framework for teaching and assessment. Students self and peer assess. Lectures, tutorials and eight different groupwork assignments of increasing difficulty, spread over the three years of the undergraduate degree are incorporated into the TeamUP model. Findings: the assignments provide students with the opportunity to practice and develop their teamwork skills in a safe, supported environment. Key conclusions: the social, emotional and practical behaviours required for effective teamwork can be taught and developed in undergraduate health students. Implications for practice: students require a clear overview of the TeamUP model at the beginning of the degree. They need to be informed of the skills and behaviours that the TeamUP model is designed to help develop and why they are important. The success of the model depends upon the educator's commitment to supporting students to learn teamwork skills. https://doi.org/10.1016/j.midw.2017.12.026
Project - Learning to TeamUp
I'm writing an article for publication that outlines the TeamUP model and explains how it works to help health students develop the emotional, social and practical skills which underpin effective teamwork. The article provides information about what is required of educators who wish to facilitate the learning of these skills by their students. I'm really enjoying thinking about the model and how effective it is. The process of development of the model has involved students' and new graduates' feedback on their experiences and perceptions of what worked for them and what didn't work for them. I'm so grateful to the students and new graduates who have taken part in this study for their insights, feedback and suggestions.
Project - Learning to TeamUp
Traditionally, university students are given group work assignments throughout their course. We know, from the literature, that some students engage fully with the group work processes for the assignment, others do as little as they can. The usual practice is that all the students get the same mark for the group work assignment, regardless of the quality of the final product or the individual's effort involved. Health course graduates are required to enter the workforce with the personal attributes and communication skills to engage in teamwork effectively. In thinking about our role as academics to provide learning opportunities for midwifery students at our university to develop these highly needed skills, we took a whole of course approach to develop a curriculum enhancement strategy to meet the needs of both the students and the professional environment.
Our strategy had two goals. The first, was to provide students with the information and a safe learning environment within which to develop the social and emotional skills that underpin effective teamwork and secondly to determine the individual student's engagement and productivity in completing the assignment so that the mark obtained for the assignment was a more accurate reflection of the individual student's work. I am in the process of writing up the curriculum enhancement strategy so that other universities can do the same thing for their students.
Project - Learning to TeamUp
What is the difference between 'collaboration' and 'teamwork'? Are these words actually standing for the same concept? Is one a sub-concept?
I'm investigating the development of the social and emotional skills required for effective teamwork in healthcare in undergraduate health (midwifery) students.
Project - Birth Territory
"Holding Sacred Space in Labour and Birth : weaving presence, consciousness and guardianship" is chapter 7 in a new book on spirituality and childbirth to be released in September this year. A French-Canadian midwife, Céline Lemay and I co-wrote this chapter. Céline had done her PhD on holding space for birth and I had co-edited and written chapters for the book Birth Territory and Midwifery Guardianship, which is why we were invited to collaborate on this project. We met for several months via Skype to establish common ground in our understanding of the key concepts we were exploring in the chapter. The collaboration has been a delightful one. I'm looking forward to reading the whole book now - it is destined to become a classic in the midwifery literature.
Pre orders now available:
Project - Learning to TeamUp
I'm exploring the differences and similarities between what is meant by collaboration and what is meant by teamwork. Often the words are used interchangeably - is there a difference or do they mean the same thing?
Project - Learning to TeamUp
I've been thinking about the bullying in the workplace and the numbers of health professionals ending their own lives. SBS did an important story on this tragic reality and the mental health consequences of the bullying culture a few days ago.
Here's the link for those who didn't see it. It's harrowing viewing.
I've also been reading stories from midwives on a Facebook page dedicated to stopping bullying. The stories there too are harrowing.
One way to help change these appalling statistics is how we educate health professionals. Ongoing analysis of interviews about the TeamUP project is indicating that this whole of course educational strategy may be beneficial.
Project - Learning to TeamUp
I'm analysing the data from interviews with senior midwifery students and new graduates about their learning through the TeamUP educational enhancement throughout their undergraduate education. My focus is on what they've learned about teamwork and how and if they are applying that learning in the workplace. I've also asked for their feedback about the various aspects of TeamUP. Their input is an important part of ensuring that TeamUP is an effective program enhancement for Universities to use for developing much needed teamwork skills in undergraduate health students.
Project - Birth Territory
Just completed a chapter with midwife Dr Celine Lemay from Canada on "Holding Space for Birth" in the upcoming book, Spirituality and Childbirth: Meaning and Care at the start of Life, edited by Dr Susan Crowther and Dr Jenny Hall. This fascinating and important book is due for release in September, 2017 and can be pre-ordered through Amazon. Here's the link: https://www.amazon.com/Spirituality-Childbirth-Meaning-Care-Start/dp/1138229415/ref=sr_1_1?ie=UTF8&qid=1495953439&sr=8-1&keywords=Spirituality+and+Childbirth
I've pre-ordered my copy!
Question - How do you approach the design of a group task in higher education?
I've really enjoyed reading everyone's responses to your question Katherine. I appreciate the link that Andrija gave, the papers by those ECU researchers are excellent, thank you Andrija. The link to the page on reviewing from Chris Dalton is very useful too. We struggled with teamwork projects in our course too, Chris is right, it is a very troublesome issue in HE and whilst graduate attributes include teamwork skills, there is very little work done on how to assure these skills on graduation. In the health field, teamwork skills are also a very big part of health professionals' competencies. Both educational and professional bodies want these skills developed. That teamwork skills are always cited as components of adverse outcomes in health care and also associated with bullying is a motivator for us to ensure our students gain these skills. My interest in growing students' teamwork skills stems from the suicide of a beautiful young midwife in the middle 90's - I've also written about that dreadful loss - the link to those articles is provided below.
We have taken a whole of course perspective and developed a teamwork skills development strategy to teach and assess teamwork skills. We have developed a teamwork skills rubric which is used to teach and assess the students' development of teamwork skills. That paper is available on this site, as is the paper on the expert validation of the rubric. Students also peer assess teamwork skills. One of the students nicely noted that she didn't think the content was the important thing in the teamwork projects, it was about the skills they were learning. I'm in the process of analysing the students and new graduations evaluations of the strategy to teach and assess teamwork skills. I also have another paper about to be published on the students interactions in their teams, so it is a rich and rewarding field of enquiry and I'm very happy to talk to anyone about what we are doing.
Article Dying for the cause
- Dec 2015
Background: Teamwork is a ‘soft skill’ employability competence desired by employers. Poor teamwork skills in healthcare have an impact on adverse outcomes. Teamwork skills are rarely the focus of teaching and assessment in undergraduate courses. The TeamUP Rubric is a tool used to teach and evaluate undergraduate students’ team- work skills. Students also use the rubric to give anonymised peer feedback during team-based academic assignments. The rubric’s five domains focus on planning, environment, facilitation, conflict management and individual contribution; each domain is grounded in relevant theory. Students earn marks for their teamwork skills; validity of the assessment rubric is critical. Question: To what extent do experts agree that the TeamUP Rubric is a valid assessment of ‘teamwork skills’? Design: Modified Delphi technique incorporating Feminist Collaborative Conversations. Participants: A heterogeneous panel of 35 professionals with recognised expertise in communications and/or teamwork. Methods: Three Delphi rounds using a survey that included the rubric were conducted either face-to-face, by telephone or online. Quantitative analysis yielded item content validity indices (I-CVI); minimum consensus was pre-set at 70%.An average of the I-CVI also yielded sub-scale (domain) (D-CVI/Ave) and scale content validity in- dices (S-CVI/Ave). After each Delphi round, qualitative data were analysed and interpreted; Feminist Collaborative Conversations by the research team aimed to clarify and confirm consensus about the wording of items on the rubric. Results: Consensus (at 70%)was obtained for all but one behavioural descriptor of the rubric. We modified that descriptor to address expert concerns. The TeamUP Rubric (Version 4) can be considered to be well validated at that level of consensus. The final rubric reflects underpinning theory,with no areas of conceptual overlap be- tween rubric domains. Conclusion: The final TeamUP Rubric arising from this study validly measures individual student teamwork skills and can be used with confidence in the university setting.
Background: Lack of teamwork skills among health care professionals endangers patients and enables workplace bullying. Individual teamwork skills are increasingly being assessed in the undergraduate health courses but rarely defined, made explicit or taught. To remedy these deficiencies we introduced a longitudinal educational strategy across all three years of the Bachelor of Midwifery program. Aim: To report on students’ experiences of engaging in team based assignments which involved mark-related peer feedback. Methods: Stories of midwifery students’ experiences were collected from 17 participants across the three years of the degree. These were transcribed and analysed thematically and interpreted using feminist collaborative conversations. Results: Most participants reported being in well-functioning teams and enjoyed the experience; they spoke of ‘we’ and said ‘Everyone was on Board’. Students in poorly functioning teams spoke of ‘I’ and ‘they’. These students complained about the poor performance of others but they didn’t speak up because they ‘didn’t want to make waves’ and they didn’t have the skills to be able to confidently manage conflict. All participants agreed ‘Peer-related marks cause mayhem’. Conclusion: Teamwork skills should be specifically taught and assessed. These skills take time to develop. Students, therefore, should be engaged in a teamwork assignment in each semester of the entire program. Peer feedback should be moderated by the teacher and not directly related to marks.
Background: Postpartum haemorrhage (PPH) rates continue to rise in the developed world. A recent study found that any skin-to-skin contact and breastfeeding within 30min of birth was associated with an almost 50% reduction in PPH rates. Improved oxytocin release is the biological reason proposed to explain this. The combination of skin-to-skin contact and breastfeeding within 30min of birth is termed 'Pronurturance'. Midwifery theory and research claims that optimal third stage care is more holistic than simple Pronurturnace which suggests that further reductions in PPH rates may be possible. Question: What can midwives and women do to minimise blood loss in the third and fourth stages of labour? Method: We present a new theory that describes and explains how to optimise the woman's reproductive psychophysiology in the third and fourth stages of labour to ensure a well contracted uterus which inhibits excessive bleeding regardless of risk status or whether active management was used. In developing the Pronurturance Plus theory we expand upon what is already known about oxytocin in relation to simple pronurturance to integrate concepts from birth territory theory, cognitive neuroscience, mindfulness psychology and the autonomic nervous system to develop an holistic understanding of how to optimise care and minimise PPH. Conclusion: Pronurturance Plus is a psycho-biologically grounded theory which is consistent with existing evidence. It is free, natural and socially desirable.
- Sep 2015
Objective: to examine the effect of skin-to-skin contact and breast feeding within 30 minutes of birth, on the rate of primary postpartum haemorrhage (PPH) in a sample of women who were at mixed-risk of PPH. Design: retrospective cohort study. Setting: two obstetric units plus a freestanding birth centre in New South Wales (NSW) Australia. Participants: after excluding women (n ¼3671) who did not have opportunity for skin to skin and breast feeding, I analysed birth records (n ¼ 7548) for the calendar years 2009 and 2010. Records were accessed via the electronic data base ObstetriX. Intervention: skin to skin contact and breast feeding within 30 minutes of birth. Measures: outcome measure was PPH i.e. blood loss of 500 ml or more estimated at birth. Data was analysed using descriptive statistics and logistic regression (unadjusted and adjusted). Findings: after adjustment for covariates, women who did not have skin to skin and breast feeding were almost twice as likely to have a PPH compared to women who had both skin to skin contact and breast feeding (aOR 0.55, 95% CI 0.41–0.72, p o0.001). This apparently protective effect of skin to skin and breast feeding on PPH held true in sub-analyses for both women at 'lower' (OR 0.22, 95% CI 0.17–0.30, po 0.001) and 'higher' risk (OR 0.37 95% CI 0.24–0.57), p o0.001. Key conclusions and implication for practice: this study suggests that skin to skin contact and breastfeeding immediately after birth may be effective in reducing PPH rates for women at any level of risk of PPH. The greatest effect was for women at lower risk of PPH. The explanation is that pronurturance promotes endogenous oxytocin release. Childbearing women should be educated and supported to have pronurturance during third and fourth stages of labour.
Objective: To examine the effect of skin-to-skin contact and breastfeeding within 30 minutes of birth, on the rate of primary postpartum haemorrhage (PPH) in a sample of women who were at mixed-risk of PPH. Design: Retrospective cohort study Setting: Two obstetric units plus a freestanding birth centre in Australia. Participants: After excluding women (n=3671) who did not have opportunity for skin to skin and/or breastfeeding, I analysed deidentified birth records (n=7548) extracted from the electronic data base ObstetriX for the calendar years 2009 and 2010. Intervention: Skin and breastfeeding within 30 minutes of birth. Measures: Outcome measure was PPH i.e. blood loss of 500ml or more estimated at birth. Data was analysed using descriptive statistics and logistic regression (unadjusted and adjusted). Findings: After adjustment for covariates, women who had neither skin to skin contact nor breastfeeding were almost twice as likely to have a PPH compared to women who had both skin to skin contact and breastfeeding (aOR 0.55, 95% CI 0.41-0.72, p<0.001). This apparently protective effect of skin contact and breastfeeding held true in sub-analyses for both women at ‘lower’ (OR 0.22, 95%CI 0.17-0.30, p<0.001) and ‘higher’ risk (OR 0.37 95%CI 0.24-0.57), p<0.001. Key conclusions and implication for practice: This study suggests that skin to skin contact and breastfeeding immediately after birth may be effective in reducing PPH rates for women at any level of risk of PPH. The greatest effect was for women at lower risk of PPH. The explanation is that pronurturance promotes endogenous oxytocin release. Childbearing women should be educated and supported to have skin contact and breastfeeding during the third and fourth stages of labour.
Teamwork is a ‘soft skill’ employability competence desired by employers. Poor teamwork skills in healthcare have an impact on adverse outcomes. Teamwork skills are rarely the focus of teaching and assessment in undergraduate courses. The TeamUP Rubric is a tool used to teach and evaluate undergraduate students’ teamwork skills. Students also use the rubric to give anonymised peer feedback during team-based academic assignments. The rubric’s five domains focus on planning, environment, facilitation, conflict management and individual contribution; each domain is grounded in relevant theory. Students earn marks for their teamwork skills; validity of the assessment rubric is critical.
Significance Statement Postpartum haemorrhage (PPH) is a major contributor to maternal illness and death – particularly in the developing world which lacks life-saving blood transfusions and intensive care facilities. The vast majority of cases of PPH are caused by inadequate uterine contraction during and after the birth of the placenta. The main approach to preventing PPH is to routinely use artificial oxytocin at birth. In this situation oxytocin acts by fitting onto the receptor sites on uterine muscle cells and stimulates them to contract strongly – thus preventing PPH. In spite of artificial oxytocin, or similar drugs, being routinely given to women in the West, the rate of PPH has been steadily rising from around 5% in the early 80s to around 20% in obstetric units now. There is some evidence that when women experience calm birth with midwives and have skin-to-skin contact and breastfeeding at births there are far fewer PPHs; lower than 5%. This paper provides the physiological explanation of why a warm, calm environment and immediate, uninterrupted and sustained skin-to-skin contact and spontaneous breastfeeding at birth optimises the women’s reproductive physiology to produce all the natural oxytocin she needs for her uterus to contract properly and thereby prevent haemorrhage. This type of midwifery care, which we call ‘pronurturance’, also minimises the woman’s fear and that is crucial because adrenaline blocks the uptake of oxytocin on the uterine muscle cells. Pronurturance is a free, ‘non-intervention’ that has the potential to improve women’s health and save lives; additionally pronurturance is associated with reduce rates of postnatal depression and increased the rates of successful breastfeeding. If pronurturance was a drug it would be aggressively marketed internationally. Available at: https://globalmedicaldiscovery.com/category/key-clinical-research-articles/
Background Poor teamwork is cited as one of the major root causes of adverse events in healthcare. Bullying, resulting in illness for staff, is an expression of poor teamwork skills. Despite this knowledge, poor teamwork persists in healthcare and teamwork skills are rarely the focus of teaching and assessment in undergraduate health courses. Aim To develop and implement an assessment tool for use in facilitating midwifery students’ learning of teamwork skills. Methods This paper describes how the TeamUP rubric tool was developed. A review of the literature found no research reports on how to teach and assess health students’ teamwork skills in standing teams. The literature, however, gives guidance about how university educators should evaluate individual students using peer assessment. The developmental processes of the rubric were grounded in the theoretical literature and feminist collaborative conversations. The rubric incorporates five domains of teamwork skills: Fostering a Team Climate; Project Planning; Facilitating Teams; Managing Conflict and Quality Individual Contribution. The process and outcomes of student and academic content validation are described. Conclusion The TeamUP rubric is useful for articulating, teaching and assessing teamwork skills for health professional students. The TeamUP rubric is a robust, theoretically grounded model that defines and details effective teamwork skills and related behaviours. If these skills are mastered, we predict that graduates will be more effective in teams. Our assumption is that graduates, empowered by having these skills, are more likely to manage conflict effectively and less likely to engage in bullying behaviours.
Question - Can anyone help me find work, published or unpublished, that addresses child cortisol response (baseline, reactive, recovery) as an outcome variable?
Hi George, along with the work on attachment mentioned by Martin, above, there is interesting work being done in regards to painful neonatal procedures as well as prenatal stress and subsequent infant cortisol response. I put the search terms in Google scholar to give you some indication of the fields. Hope these links are a good starter for you.
Question - Why does society have such negative perceptions about breastfeeding in public?
Great question Hailie! So many aspects curled up in that question. You may find this article (attached) a useful read as a start:
Boyer, K. (2011). “The way to break the taboo is to do the taboo thing” breastfeeding in public and citizen-activism in the UK. Health & Place, 17(2), 430-437. doi: http://dx.doi.org/10.1016/j.healthplace.2010.06.013
- Oct 2013
- 18th Biennial Australian College of Midwives National Conference
Background: The importance of optimising maternal/baby psychophysiology has been integrated into contemporary midwifery theories but not in the detail required to really understand the underpinning biological basis. Method: The functioning of the autonomic nervous system, as it relates to the uterus is reviewed. The physiology of myometrial cell contraction and relaxation is outlined. The main focus is on the factors that affect the availability and uptake of oxytocin and adrenaline/noradrenaline in the myometrial cells. These are the two key neuro-hormones, active in the 3rd and 4th stages of labour, that affect uterine contraction and retraction and therefore determine whether the woman will have an atonic PPH or not. Discussion: The discussion explains and predicts the physiological functioning of the uterus during the 3rd and 4th stages of labour when skin-to-skin contact and breastfeeding occurs and when it does not. Conclusion: This biologically based theory hypothesises that to achieve and maintain eutony and eulochia, midwives and birthing women should ensure early, prolonged and undisturbed skin-to-skin contact for mother and baby at birth including easy access for spontaneous breastfeeding.
Question - What highly ranked journal would be good to report on an antenatal educational intervention that doubles breastfeeding rates at 6 months?
Women and Birth of course! That journal would get the information out to the midwives and service providers in an expedient manner, especially now it is online access.
Question - How do you teach the History of Midwives in your countries?
Writing your article in English allows it to be read by people all over the world. Your decision on what language you write your article in and where you seek to publish it depends on your target audience.
Question - How do you teach the History of Midwives in your countries?
Sounds good Lola! I look forward to seeing your article - will you produce your article in English? I hope you do as it would be wonderful to have that resource for our students. Did you find my article here on ResearchGate? What did you think of it? kind regards, Carolyn
Question - What is the recommended time frame for vaginal delivery of the placenta?
Interestingly we found, for women with low risk pregnancies, that active management of labour increased their risk of PPH
we have published a paper offering a theoretical perspective on this result. Please see:
There are more recent studies from NZ with the same result. I was talking recently to a midwife who has been working in a poorly resourced African country with women who would be considered high risk for postpartum haemorrhage and with the approach to third stage care as outlined above, they have helped 200+ women give birth with no PPH. I worked in PNG (in 2011) where there was often a lack of exogenous oxytocics - the midwives there knew to put the babies skin to skin with their mothers to reduce the rate of PPH. If you are interested in talking to the midwife who is working and teaching in Africa, please email me on Carolyn.Hastie AT scu.edu.au and I can put you in touch with her.
Question - How do you teach the History of Midwives in your countries?
Hi Lola, in our midwifery curriculum (Bachelor of Midwifery, 3 years full time study) we have an hour lecture in a first year unit (subject) of the course called "Midwifery Foundations". I give this lecture and I trace the first written mention of midwives (in the Bible) through the various epochs to modern day midwifery work; plus artwork - ranging from a figurine of a birthing woman from 8,000 BCE that I saw in the Beirut Museum to modern paintings; we have a book about midwifery in NSW, Australia called "Courage and Devotion" available here:
and two articles;
one by Professor Kathleen Fahy
and one by me on Australian midwifery "Midwifery: women, history and politics" which is available on my site here on ResearchGate. I could email you the powerpoint presentation that I present during my lecture if you are interested. You can email me on Carolyn.Hastie AT scu.edu.au. (insert the @ symbol for AT in my email address). Hope this helps.
Martha, your Deontology lesson sounds interesting.
kind regards, Carolyn
Background Preterm birth is a significant global health problem with serious short and long term consequences. This paper reviews the research literature to answer the question how effective are the medical interventions that aim to reduce the rates of preterm birth?
Question - Can thought alone change what genes are expressed?
This article is along the same lines:
Med Hypotheses. 2010 Aug;75(2):218-24. Epub 2010 Mar 12.
From alpha to gamma: electrophysiological correlates of meditation-related states of consciousness.
Fell J, Axmacher N, Haupt S.
Department of Epileptology, University of Bonn, Sigmund-Freud Str. 25, D-53105 Bonn, Germany.
Meditation practice is difficult to access because of its countless forms of appearances originating from the complexity of cultures it has to serve. This makes a suitable categorization for scientific use almost impossible. However, empirical data suggest that different forms of meditation show similar steps of development in terms of their neurophysiological correlates. Some electrophysiological alterations can be observed on the beginner/student level, which are closely related to non-meditative processes. Others seem to correspond to an advanced/expert level, and seem to be unique for meditation-related states of consciousness. Meditation is one possibility to specialize brain/mind functions using the brain's immanent neural plasticity. This plasticity is probably recruited by certain EEG patterns observed during or as a result of meditation, for instance, synchronized gamma oscillations. While meditation formerly has been understood to comprise mainly passive relaxation states, recent EEG findings suggest that meditation is associated with active states which involve cognitive restructuring and learning.
Copyright 2010 Elsevier Ltd. All rights reserved.
[PubMed - indexed for MEDLINE]
Preterm birth is a significant global health problem with serious short and long term consequences. This paper reviews the research literature to answer the question how effective are the medical interventions that aim to reduce the rates of preterm birth? A systematic search was carried out in CINAHL, Cochrane, Medline and Embase in relation to following medical treatments aimed at preventing preterm births: anti-infective medications, tocolytics, progesterone and cervical cerclage. The research underpinning each type of intervention is critically analysed in order to establish the validity of knowledge claims that are made for each type of intervention. In relation to reducing the rates of preterm births, anti-infectives are only effective in the presence of known infection. Screening for infections during pregnancy is ineffective. Tocolytic agents are not effective in decreasing the preterm birth rates. Progesterone seems to be effective in a select group of pregnant women at higher risk of preterm birth. Cervical cerclage plays a small and an occasional role in preventing some preterm births. This literature review demonstrates that medical interventions aimed at preventing, not just delaying, preterm birth, are not effective at a population level. Providing holistic, antenatal midwifery care for women living in socio-economic disadvantage and/or with an increased risk of preterm birth seems to be a promising strategy to address the negative effects of the social determinants of disease and thus to reduce the rate of preterm births at an individual and a population level.
Wisanskoonwong P, Fahy K, Hastie C. International Journal of Nursing Practice 2011; 17: 628–635 Reflections on the practice of facilitating group-based antenatal education: Should a midwife wear a uniform in the hospital setting? The first author of this paper, a Thai midwife, conducted a feminist action research project aimed at collaboratively developing a model for group-based antenatal education in Thailand. Should a midwife wear a uniform when facilitating midwife-led group-based antenatal education sessions in the hospital setting? This paper reports on a single example of reflection in and on midwifery practice that aimed to answer the guiding question. The practice and reflection occurred over a number of months at the beginning of the feminist action research project. The midwife should wear normal clothes when facilitating group-based antenatal education as a symbol of equality in power relationships within the group. When power relationships between women and the midwife are equalized, women are more able to take responsibility for their health as they are less likely to defer to the ‘expert’. Reflection in and on practice is a powerful tool to allow the midwife to understand and change her own practice as required to meet those goals. Self-change is a critical first step because there can be no change in the way maternity care is provided without each midwife being willing to be self-aware and open to appropriate self-change.
- Jun 2011
Reflections on the practice of facilitating group-based antenatal education: Should a midwife wear a uniform in the hospital setting? The first author of this paper, a Thai midwife, conducted a feminist action research project aimed at collaboratively developing a model for group-based antenatal education in Thailand. Should a midwife wear a uniform when facilitating midwife-led group-based antenatal education sessions in the hospital setting? This paper reports on a single example of reflection in and on midwifery practice that aimed to answer the guiding question. The practice and reflection occurred over a number of months at the beginning of the feminist action research project. The midwife should wear normal clothes when facilitating group-based antenatal education as a symbol of equality in power relationships within the group. When power relationships between women and the midwife are equalized, women are more able to take responsibility for their health as they are less likely to defer to the 'expert'. Reflection in and on practice is a powerful tool to allow the midwife to understand and change her own practice as required to meet those goals. Self-change is a critical first step because there can be no change in the way maternity care is provided without each midwife being willing to be self-aware and open to appropriate self-change.
Midwives are becoming more engaged with social media and electronic communications in both their professional and personal lives. We explore some of the pitfalls, precautions and powerful possibilities that social media offers to midwives in this article
Communication problems between clinicians are the most common cause of preventable adverse events in hospitals. In spite of these known risks the 'turf wars' between midwives and doctors continue unabated. What factors affect inter-professional interactions in birthing units? 9 doctors and 10 midwives from 10 Australian maternity units. Interpretive Interactionism was the research design. Probing in-depth interviews were conducted to elicit stories of inter-professional interactions and their perceived effects on birthing outcomes. Analysis resulted in two theoretical models of inter-professional interaction: one positive and the other negative. Midwives and doctors agree that positive interactions are collaborative, include the woman and her partner and are associated with the best possible outcomes and experiences possible. In contrast, they agree that negative interactions involve power struggles between the professionals and these are associated with adverse outcomes. All participants are able to demonstrate emotional and social competence when interacting and applied those skills sometimes. Factors related to the organisational culture within the 'birth territory' of a particular maternity unit seem to be predictive of the type of interactions that are likely to occur there. Interventions to enhance inter-professional collaboration should be directed first at changing organisational structures and policies to promote easy opportunities for natural dialogue between doctors and midwives.
Is 'holistic psychophysiological care' in the third stage of labour safe for women at low risk of postpartum haemorrhage? Although there have been four randomised trials and a Cochrane Review on the safety and effectiveness of care during the third stage labour, no previous study has focussed only on women at low risk of postpartum haemorrhage and no previous study has tested a form of physiological third stage care that is provided by skilled midwives in an appropriate setting. Retrospective cohort study involving a maternity unit at a tertiary referral hospital and a freestanding, midwifery-led birthing unit. All low risk women who gave birth at either unit in the period July 2005-August 2008. 'Active management' of the third stage of labour compared with 'holistic psychophysiological third stage care'. At the tertiary unit, 344 of 3075 low risk women (11.2%) experienced postpartum haemorrhages (PPH). At the midwifery-led unit, PPH occurred for 10 of 361 women (2.8%), OR=4.4, 95% CI [2.3, 8.4]. Treatment received analysis showed that active management (n=3016) was associated with 347 postpartum haemorrhages (11.5%) compared with receiving holistic psychophysiological care (n=420) which was associated with 7 (1.7%) PPH OR=7.7, 95% CI [3.6, 16.3]. This study suggests that 'holistic psychophysiological care' in the third stage labour is safe for women at low risk of postpartum haemorrhage. 'Active management' was associated with a seven to eight fold increase in postpartum haemorrhage rates for this group of women. Further prospective observational evaluation would be helpful in testing this association.
Active management of the third stage of labour is routine in delivery suites. New South Wales (NSW) Health has a policy which prescribes active management because medically designed randomised controlled trials have claimed a reduced blood loss in third stage with active, compared with 'physiological', management. In home and birth centre settings however, physiological third stage is common as women who access these settings prefer to labour without medical intervention and midwives who work in these settings adopt a holistic approach to working with women. The holistic approach is psychophysiological as the midwife engages with and supports integration of the woman's spirit, mind and body in her childbearing process. To present midwifery theory that describes, explains and predicts how women and midwives work together to enable selected women to safely experience an optimal psychophysiological third stage of labour. Key terms are defined. The literature relevant to psychophysiology and management of the third stage of labour is reviewed. An expanded understanding of risk factors for postpartum haemorrhage is presented and justified. A theoretical framework of Midwifery Guardianship is presented and discussed and applied to third stage care. A psychophysiological third stage is quite different from what has been defined as 'physiological management' in the medically designed randomised trials comparing active versus physiological care. The conditions for deciding if a particular woman, in a particular context with a particular midwife is a good candidate for a psychophysiological third stage are presented and discussed. Only if all these conditions are met it is safe to proceed with a psychophysiological third stage. Research about the effectiveness of midwifery care in a psychophysiological third stage of labour urgently needs to be conducted.
For almost 20 years it has been known that the most common cause of preventable adverse events in hospital is communication problems between clinicians (1, 2). Within maternity services, ineffective communication has a strong relationship with adverse events for women and babies (3). Despite this knowledge, the ‘turf wars’ between some midwives and some doctors are a continuing concern. Although the link between poor communications and adverse events has been well known for a long time, no real change in how professions relate to each other has occurred. This dissertation describes a project that was designed to answer the research question: What factors affect interprofessional interaction in birthing units and how do these interactions impact on birthing outcomes? Midwives and doctors from 10 geographically diverse maternity units contributed to this qualitative research project. In-depth interviews were conducted. Analysis and theorizing was guided by feminist Interpretive Interactionism. New findings, about how health services can strengthen interprofessional collaboration in maternity services, are presented and explained. I argue that organisational factors are more important than the personalities of the individuals involved in the interactions because organisational factors frame, direct and limit what discourses and therefore behaviours, are possible. The dissertation ends with some procedural guidelines that show how administrators and clinical leaders can create and maintain collaborative work settings for public sector midwives and doctors.
DEFINITION OF HORIZONTAL VIOLENCE Horizontal violence is hostile and aggressive behaviour by individual or group members towards another member or groups of members of the larger group. This has been described as inter-group conflict. (Duffy 1995). Horizontal violence is endemic in the workplace culture and it is an unacceptable and destructive phenomenon. All members of every workplace are urged to work together to address the issues of oppression and eliminate this unhealthy behaviour from the workplace. It is essential that appropriate strategies be put in place within each workplace to: 1. Recognise and acknowledge that horizontal violence exists in the workplace. 2. Address the workplace culture issues that allow horizontal violence to exist 3. Management to adopt a continuous, consistent, integrated approach to promote a culture of cooperation and address instances of horizontal violence. 4. Provide regular education for all staff on the subject of horizontal violence; for example, what it is, how to address it etc. 5. Institute mechanisms that enable and allow staff members to safely address issues of horizontal violence 6. Produce a statement outlining desired workplace culture attributes, values and behaviours and have it displayed in prominent places throughout the institution. (see appendix 1) 7. Talk to all staff members about the phenomenon, break the silence.
About 5 p m on Monday evening 17July 1995, after working an early shift, a twenty-five year old midwife ended her life. Her suicide note clearly stated her disillusionment, her frustration and her profound sense of hopelessness. Her words implicated the way our profession treats women; w o m e n as midwives and w o m e n as mothers as the basis for her decision to end her life.
About 5 pm on Monday evening 17July 1995, after working an early shift, a twenty-five year old midwife ended her life. Her suicide note clearly stated her disillusionment, her frustration and her profound sense of hopelessness. Her words implicated the way our profession treats women; women as midwives and women as mothers as the basis for her decision to end her life.
A psychophysiological third stage is quite different from what has been defined as ‘physiological management’ in the medically designed randomised trials comparing active versus physiological care. The conditions for deciding if a particular woman, in a particular context with a particular midwife is a good candidate for a psychophysiological third stage are presented and discussed. Only if all these conditions are met it is safe to proceed with a psychophysiological third stage. Research about the effectiveness of midwifery care in a psychophysiological third stage of labour urgently needs to be conducted. (12) Physiological care in the third and fourth stages of labour... When is it safe?. Available from: https://www.researchgate.net/publication/254664090_Physiological_care_in_the_third_and_fourth_stages_of_labour_When_is_it_safe [accessed Feb 20 2018].