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40 © 2012 The Royal College of Midwives. Evidence Based Midwifery 10(2): 40-44
Steen M. (2012) Pushing boundaries and making it happen. Evidence Based Midwifery 10(2): 40-44
Pushing boundaries and making it happen
Mary Steen PhD, MCGI, PG Dip HE, PGCRM, BHSc, RM, RGN.
Professor of midwifery, Faulty of Health and Care, University of Chester, Riverside Campus, Castle Drive, Chester, CH1 1SL, England. Email: m.steen@chester.ac.uk
This paper is part of a series celebrating the contribution of professors to the midwifery profession.
Abstract
This paper describes and discusses one midwife’s journey of becoming and being a professor of midwifery. The main
focus is on pushing the boundaries and making it happen. The author’s nursing and midwifery career is the case study
and the past, present and future are the three destinations en route that are explored through personal reflections and
aspirations. The content will demonstrate that ‘the journey is the reward’ and enjoying the adventure and having creative
ideas and vision helps along the way. Nevertheless, the journey can be challenging and sometimes the path chosen is not
the most direct route. It highlights the important role that others can play when supporting and encouraging you to find
your way and, ultimately, meet your goals. It also discusses how you will meet people along the way who will join you on
your journey and some who will not. People make systems work, so you have to know how to motivate and encourage
others. Research has played an important role throughout the journey and the author demonstrates how the dissemination
of research findings can ultimately make a difference. In addition, the importance of communication, collaboration and
networking should never be under-estimated, as these aspects will help to push the boundaries and make it happen.
Key words: Research, professorship, communication, collaboration, evidence-based midwifery
Introduction
Through personal reflections and my continual aspirations,
I will describe and discuss how pushing the boundaries and
making it happen can occur from a bottom-up and then a
top-down approach. My own personal midwifery career will
be explored metaphorically as a journey. I have enjoyed the
journey and become very aware over the years that having
creative ideas and vision helps you along the way. I have had
my ‘off the track’ moments, but that is part of the learning
process and if you embrace your wrong turns positively, it
helps you to ultimately achieve your goals. I am looking
forward to continuing the journey, with the support and
companionship of other midwives and, as the midwifery
profession evolves, also the mentoring of student midwives
to become calm, caring, confident midwives. One of my
aspirations is to be a role model for some of these midwives
and to encourage and inspire them to become researchers
and undertake midwifery-led research. Together, we can
achieve the ultimate goal of providing the best possible
midwifery care, based on the best available evidence.
The past
I have spent 26 years working for the NHS. In 1982, I
undertook registered general nurse training and upon
qualifying, I gained some experience as a staff nurse at
Shotley Bridge General Hospital, Co Durham. During
this time period I became a mother for the first time and
little did I know the impact this birth, which involved a
Keilland’s forceps delivery, would have upon me becoming
a researcher and researching the care and consequences
of perineal trauma. However, I knew very early on in my
career that I wanted to be a midwife. In 1986, I began
midwifery training at the School of Midwifery, Manygates,
Wakefield. I then proceeded to become a qualified midwife
in 1988 and was employed for 20 years in Leeds, initially
spending six years in hospital settings (where I worked on
both sides of the city; in the west at the Clarendon Wing of
the Leeds General Infirmary and in the east at the Gledhow
Wing, St James’s University Hospital). During this period,
I gave birth to two more children. In 1994, when my
youngest child started nursery, I applied for a community
midwife post and spent the next 14 years in the community
responsible for a caseload. So, I would say my grassroots are
in community, but along the way I was successful in being
awarded research fellowships and secondments to enable
me to undertake research and test out some of my creative
ideas. I was, however, reluctant to give up my caseload as
that was where my heart was, but I also had a strong desire
to improve care for women, their partners and families,
which needed to be based on the best available evidence.
With this in mind, I negotiated my workload and for most
of my midwifery career, I have been balancing clinical,
educational and research practice. I’ve enjoyed linking up
these three components, which helps to bridge the theory/
practice gap. My work has received several awards for
original research and clinical innovation.
Along the way there have definitely been challenges and
some setbacks. Finding funding can be an arduous task and
differences of opinions can delay progress, but you have
to remain focused and believe you can make it happen.
Sometimes, things haven’t worked out as planned and
sometimes things have happened by chance. As an example,
while I was undertaking my first randomised controlled
trial (RCT) in 1993/94, which involved the development
of an assessment tool and the designing of a new localised
cooling gel pad to alleviate perineal trauma (Steen, 1998;
Steen and Cooper, 1997, 1998, 1999; Steen et al, 2000),
I under-estimated the length of the pad. I based my
measurements on the standard length of a sanitary towel,
but when the pads were manufactured for some unknown
reason they were an inch longer than I had requested.
Strangely enough the extra length made an unexpected
© 2012 The Royal College of Midwives. Evidence Based Midwifery 10(2): 40-44 41
Steen M. (2012) Pushing boundaries and making it happen. Evidence Based Midwifery 10(2): 40-44
difference and women reported that the cooling gel pads
also helped to relieve painful haemorrhoids.
While undertaking this research, I enrolled onto a part-
time degree course in healthcare studies and my passion
for research then lead me to undertake a post-graduate
certificate in research methodology. In 1996, with the
support of two obstetricians, James Walker and Martin
Griffiths-Jones, former head of midwifery Jean Cooper,
health scientist Keith Cooper and statistician Paul
Marchant, I was successful in applying for an NHS executive
research fellowship. This gave me an opportunity to study
for an MPhil/PhD part-time and undertake a larger RCT
in 1998/99 to investigate further the efficacy of localised
cooling to alleviate perineal trauma and pain (Steen and
Marchant, 2001, 2007; Steen 2002). This research has led
to numerous articles being published (Steen, 2010, 2008,
2007a, 2005, 2003, 2001a, 2000a; Steen and Roberts,
2011a) and a patented product known commercially as the
femépad which is now available in many countries around
the world. I underestimated the amount of work and time
needed to complete my PhD studies and could not resist
leading and being involved in other projects when asked
to do so. Fortunately, I was successful in being awarded a
Smith and Nephew Nursing Research Fellowship to spend
time writing up my PhD thesis (Steen, 2004).
In tandem with my PhD studies, I was asked to take the
lead and collaborate with the Leeds Inter-Agency Project
(LIAP) for violence against women to develop an education
and training programme to enable midwives to meet the
needs of abused women during the childbirth continuum
(Steen, 2000b; 2001b). In 2001, this programme was
accredited by the University of Leeds and 360 midwives
attended two study days, kept a reflective diary and then
submitted a reflective assignment (Steen and Bharj, 2003).
In 2001/2002, I was asked to participate in the higher
level practitioner programme, which was being piloted
by our regulatory body at the time, the UKCC. I had to
demonstrate evidence that I was working at a higher level
than was expected of me. This involved completing a
portfolio of evidence which led to a leadership in midwifery
masters qualification and also membership to the City and
Guilds Institute (MCGI). This enabled me to apply for and
be awarded three discretionary points above my grade.
In 2003, I saw some funding advertised by the local health
authority to undertake small community-based projects
and I applied for a small grants award to enable me to
undertake baby massage training through the International
Association of Infant Massage (IAIM.) The following year,
I then applied for some Health Action Zone (HAZ) money
to support other midwives to undertake the training. This
lead to collaborating with the Leeds Community and
Mental Health Trust and a joint project was undertaken
to train midwives and health visitors. I regret to say, I
never managed to write a paper about this project but have
utilised the knowledge and skills I gained to enhance my
clinical practice and also to further develop another project
entitled ‘Maternal health and wellbeing’.
In 2004, I approached the local authority in South Leeds
to undertake some collaborative work to develop and
facilitate antenatal and postnatal exercise classes. The local
authority awarded me a funded place to undertake an OCR
to become a qualified aerobics instructor to enable me to
teach exercises. This led to the development of a holistic
health and fitness programme specifically designed to raise
awareness of the health benefits of normal birth and the
general health and wellbeing of women, their babies and their
families (Steen, 2007b). While I was piloting this project,
a homeopathic student approached me to supervise her to
undertake a qualitative study. She inspired me to undertake
a certificate in homeopathy for midwives and this led to a
study being undertaken in 2005/06 that assessed the usage
and impact of providing a self-administered childbirth kit
of homeopathic remedies. The data demonstrated that
women and several birth partners experienced positive
emotional, psychological and physical benefits (Steen and
Calvert, 2006, 2007; Calvert and Steen, 2007).
When I finished my PhD studies, I was unsure as to which
path I should be following. Within the NHS, there were
limited opportunities for a midwifery researcher. I was
happy in clinical practice, projects were keeping me busy
and I was an RCM council member, but I needed more.
In 2005, I applied for a joint RCM/UCLan secondment
opportunity for a research fellow position. I was successful
and I must say I have never looked back. My research
journey progressed and I had many opportunities to
undertake collaborative research and to network nationally
and internationally. Joint appointments can be a challenge
and you certainly put in the hours but, nevertheless, they
can be very rewarding. I had an opportunity to be involved
in the Perineal Assessment and Repair Longitudinal Study
(PEARLS) and the Academy of Nursing, Midwifery and
Health Visiting while being a member of the learning
research and practice development (LRPD) department
based at RCM headquarters. I worked alongside the RCM
regional officers and also the editor/deputy editor of the
RCM journal. While at UCLan I was part of a research team
including Soo Downe, Tina Lavender, Denis Walsh, Grace
Edwards, Sheena Bryom, Fiona Dykes, Carol Kingdon,
Vicky Moran, Annie Dixon, Tilley Padden, Kenny Finlayson
and David King. While I was part of this team, I developed
a greater understanding of qualitative research methods
and became interested in how to undertake structured
reviews and meta-synthesis. I published several joint papers
while being on this secondment (Steen et al, 2006; Walsh
and Steen, 2007; Steen and Macdonald, 2008; Steen and
Kingdon, 2008a, 2008b). The internet is a powerful tool
to disseminate your published work. In 2006, midwives
from Mashhad Iran contacted me to collaborate with them
to undertake another RCT to investigate the efficacy of
localised cooling treatment to alleviate perineal trauma.
The language barrier was a challenge to overcome but with
passion, patience and persistence, this research study was
published in English (Navviba et al, 2009).
Over the years, I have travelled extensively to present
at both national and international conferences. Attending
conferences is vital if you want to disseminate your research,
42 © 2012 The Royal College of Midwives. Evidence Based Midwifery 10(2): 40-44
Steen M. (2012) Pushing boundaries and making it happen. Evidence Based Midwifery 10(2): 40-44
collaborate with others and network. I’ve lost count of
the number of presentations I have given. I was nervous
when I first started presenting at conferences but I guess
I got used to it and now enjoy the discussion and debate
that often follows. I have also had many opportunities to
gain experience of supervising postgraduate students to
undertake research and during this process I have continued
to learn alongside them.
‘It is not the strongest of the species that survives. It is the
one who is most adaptable to change’
Charles Darwin
The present
University of Chester
In 2008, I joined the midwifery department, which
is part of the Faculty of Health and Social Care, at the
University of Chester. I work alongside head of department
Andrea McLaughlin, deputy head Jane Harris and five
senior lecturers, Kim Gibbon, Jo Bates, Taniya Roberts,
Gillian Hughes and Karen Lunt. The department works
in partnership with five NHS trusts in the North West of
England and is involved in the education and training of
undergraduate nursing, child health and midwifery. It offers
a BSc (hons) in midwifery education, a return-to-practise
course for midwifery and several level six modules midwives
can access, such as neonatal nutrition (full BFI accreditation),
family planning, sexual health, learning and assessment and
change management. In addition, postgraduate courses,
such as a PGCert in sexual and reproductive health and an
MSc advanced midwifery practice/MSc professional studies,
which incorporates work-based learning on ventouse, fetal
blood sampling and clinical decision-making, are offered.
I teach both undergraduate and postgraduate students. I
am the programme lead for the undergraduate research
dissertation module and I supervise at this level and also
at masters and PhD level for midwives and other health
professionals (nurses and dentists) to undertake research
and complete a thesis.
I spent 18 months as a reader and then successfully
met the criteria to become a professor of midwifery
in 2010. My main focus since I arrived at Chester has
been writing (chapters, books, articles) and increasing
research/knowledge transfer activities within the faculty.
My research journey, discussed in the past section of this
paper, led me to write a book proposal, which would help
midwives to understand and undertake research. I enrolled
my colleague Taniya Roberts to help with this task, which
led to the Handbook of midwife research being published
in 2011(b). I felt it was necessary to give midwifery-led
examples for both quantitative and qualitative methods to
demonstrate that midwives have the knowledge and skills
to undertake all types of research and take the midwifery
profession forward. I have had opportunities to write and
contribute to several Dorling Kindersley books which I
thoroughly enjoyed, these being Ask a midwife (2009),
Day-by-day pregnancy care (2010) (highly commended
BMA award) and Day-by-day baby book (2012). I am
the author of Pregnancy and birth: everything you need to
know (2011a) (now translated into several languages). Very
recently, as my grassroots are in community midwifery, I
have edited and contributed to chapters of a book entitled
Supporting women to give birth at home: a practical
guide for midwives (2012). This book is evidence-based
and clearly demonstrates how research evidence support
midwifery education and clinical practice.
I’m presently working in collaboration with Duncan
Fisher who is an honorary fellow at the University of
Chester on studies involving fathers in maternity care.
We are both members of the Perinatal Health Services
Research Collaboration, which is led by Dr Leroy Edozien,
a consultant obstetrician based at St Mary’s Hospital,
Manchester. As part of a programme of work researching
Engaging Partners in Childbirth (EPIC), I have led on a
metasynthesis to critique published evidence that explores
fathers’ views and experiences of maternity care (Steen
et al, 2011) and presented this work at the Midwifery
Doctoral Society Conference (2011), the International
Confederation of Midwives, (2011) and, very recently,
at the RCOG annual conference, ‘risk management and
medico-legal issues in women’s health care’ (2012). This
work led to my involvement in the development of the
recently funded Department of Health national guidelines
Reaching out: involving fathers in maternity care published
by the RCM, RCOG, and Fatherhood Institute (RCM,
RCOG, FI, 2011).
For the last three years, I have been an external examiner
for the masters in midwifery at Trinity College Dublin and
found the similarities and the differences in clinical practice
described and discussed by midwives fascinating. I have
also examined midwifery PhD students’ theses (nationally
and internationally) since becoming a doctor of midwifery
and I am very proud of their individual achievements.
Being the professional editor of the RCM’s Midwives
magazine, online papers and student e-news helps me to
keep abreast of what is happening in clinical practice and to
guide midwives and students to write about their interests
and initiatives. I also contribute to the RCM magazine
and have written articles entitled, When food becomes
the enemy (2009) and, more recently, How to encourage
women to remain active in labour (Steen, 2012).
As part of my professorial role, I have a responsibility
to seek out funding opportunities to undertake service
evaluation and research. Presently, I am working with two
colleagues, Professor Alun Jones and Professor Elizabeth
Mason-Whitehead, to undertake the Integrated Teams
Around Schools and Colleges (iTASC) project, which
involves investigating whether the collective resource of
several services that provide care and support to young
people within the school community is adding value and
making a difference to students’ health and wellbeing needs.
In addition, I’m working on the Maternity Assist project
jointly with Duncan Fisher, which aims to provide a time-
saving, cost-effective, multi-channel digital information and
support service to assist midwives to undertake their role to
achieve holistic maternity care which is family focused.
© 2012 The Royal College of Midwives. Evidence Based Midwifery 10(2): 40-44 43
Steen M. (2012) Pushing boundaries and making it happen. Evidence Based Midwifery 10(2): 40-44
Ongoing research entitled the Start treating others
positively (STOP) study, of which phase one and two have
been completed and the findings published in Evidence-
Based Midwifery (Steen-Greaves et al, 2009; Steen et al,
2011b), has led to the development of a ‘Becoming and
being a parent’ workshop, which incorporates how to
cope with emotions and relationship conflict during the
transition to parenthood, and further work on supporting
abused women (Steen and Keeling, 2012). This work has
also led to STOP workshops being offered to student
midwives, to enable them to deal with conflict in the
workplace (Steen, 2011b).
The future
I’m looking forward to continuing the journey, with the
support and companionship of other colleagues and, as the
midwifery profession evolves, also the mentoring of student
midwives to become calm, caring, confident midwives.
Some of these will become researchers and play a part in
bridging the theory/practice gap.
My future plans include continuing the work with
fathers; I am supervising a PhD student who is exploring
the experiences of bereaved fathers and I’m also planning
to do some research with disadvantaged fathers. The
STOP research will continue and phase three and four of
this study will be exploring the impact of the ‘Becoming
and being a parent’ workshop on how expectant parents
manage their emotions and any relationship conflict.
STOP conflict in the workplace workshops will be offered
to midwives as well as students and their views and
experiences will be explored.
The Maternity Assist project will be piloted and every
interaction with families will be automatically recorded
then collated and reported on. The Riverside Innovation
Centre at the University of Chester will support the project
to become a social enterprise.
Leadership will play an important role in my future. As
you will see, I have led from the bottom up, but I am now
in a position to lead from the top down, and I will always
remember my former head of midwifery Anne Geddes’s
wise words: ‘You are as good as anyone, but better than
no-one. With this philosophy you will become a calm,
caring, confident midwife.’
Recently, I attended a residential Leadership in Action
course, funded by Vitae, UK. Most participants were PhD
students and I was asked why I was attending as I was
already a professor. My answer was ‘because you are never
too old to learn’ and, indeed, I did learn a few things such
as always remember ‘task, team, individual’ (Adair, 2010:
4), who you are and what you do, you can lead from a
distance, if you want to make things happen, lead, follow
or get out of the way and remember rule number six: ‘Don’t
take yourself so goddamn seriously’ as described in The art
of possibility (Zander and Zander, 2010: 79).
Conclusions
According to Dick-Read, ‘Faith eliminates fear’ (2006: 97).
Believe in yourself and your own ability to push boundaries
and make it happen.
I think you personally need the three p’s: passion,
patience and persistence (and another three) preparation,
participation and praise for others, so they will follow you.
Always remember task, team, individual and you will make
it happen. Remember the importance of communication,
collaboration and networking. Never forget to disseminate
your research far and wide, as this will ultimately make a
difference to women, babies, partners and families.
You will meet people along the way who will join you
on your journey and some who will not. Life is all about
relationships, both personal and professional, and these
encounters can be challenging but also rewarding. People
make systems work, so you have to know how to motivate
and encourage others and this will then inspire them to
follow you.
Jean Duerden, former Local Supervising Authority
Midwifery Officer of Yorkshire and Humberside, once
said to me: ‘Mary, I wish I could bottle up your energy
and enthusiasm and give a taste of it to other midwives’.
Well, I hope this paper has done just that and inspires some
midwives to ‘push the boundaries’ and ‘make it happen’.
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