Ep 63 Sara Kindberg on midwifery, perineal suturing, creating a business and becoming a business angel for femtech

Ep 63 http://ibit.ly/Re5V Sara Kindberg on #midwifery , #perineal suturing , creating a business and becoming a #businessangel for femtech

@PhDMidwives  #MidTwitter  #research @GynZone  

https://gynzone.com/
https://www.researchgate.net/profile/Sara-Kindberg

Ready to uncover the complex world of midwifery, politics, and research? Get ready, as we sit down with Sara, a Danish midwife turned researcher and business woman, for an enlightening chat on her incredible journey.  She shares her experiences of juggling her PhD, work, and personal life, while providing insights into the multifaceted roles of a midwife - it is not just about helping women birth babies, it extends to governance, leadership, education, and even research.

Ever wondered how surgical skills and personal strengths factor into midwifery?   From her international PhD defense to her future goals, Sarah shows us how technology is redefining healthcare. Not one to ignore the human aspect, Sarah emphasizes the importance of patient and consumer involvement in research, and how supporting each other can empower us all.

Finally, take a peek at the future of healthcare through Sarah's eyes. She shares her experiences with emerging technologies like virtual reality, and it's potential to revolutionize medical procedures. With Sarah's unique lens, dive into  how female health investments can impact our society, and how it is being leveraged in her current research.

Transcript

Speaker 1: 0:15

And welcome to Through the Pinard, your conversational podcast talking to midwives around the world about the research they are doing to improve midwifery practice. This research can range from small quality improvement programs and projects to those starting partway through or just finishing their postgraduate studies, and to those that have been there, done that and got the t-shirt. So settle back and enjoy the conversation and remember you can continue the conversation on Twitter after you've finished listening. Thank you very much for joining me, as per usual. Can you introduce yourself please?

Speaker 2: 0:52

Hello Liz. My name is Sarah. I'm a Danish midwife. I'm 48 years of age and I've been a midwife since 1999.

Speaker 1: 1:02

So what got you into midwifery in the first place, then?

Speaker 2: 1:07

I think I wanted to do something where I was sure what I was doing. As a young person I was very much into politics and I thought I would be the prime minister and I might be eventually. But as I was studying politics I faced a situation where I didn't like politics. I didn't like the power struggling and people not being nice to each other so they would advance in their careers. I hated that power battle.

Speaker 2: 1:34

So I rested my soul, did a lot of knitting for half a year and then I thought I need to do something else. So I went into midwifery because I wanted to do something with my hands that might help other people. I thought I would be going into a developing world and work with less fortunate women, and for now I haven't been able to because I've been caught up in research and making a business. But I really like the fact that midwifery can be a service that you can provide anywhere in the world with very limited resources. Yeah, and I was looking into nursing or becoming a teacher and that wasn't that attractive. I like that we live on the edge sometimes as midwives and that it does make a huge difference to people what we decide to do and how we do it.

Speaker 1: 2:23

And I find that there's just a wee bit of irony in that you do like politics and go into midwifery, when we know how political midwifery is from the independent personal politics to kind of like state, national and international politics that that background would have held you in very good esteem.

Speaker 2: 2:42

But I think as midwifery profession, we always have a positive agenda. We want to bring better lives into the world and more safety around childbirth, whereas as a politician sometimes you have to make tough decisions, saying, okay, do we take care of the elderly population or do we make new infrastructures in our countries, and such decisions are hard to make. So I have a huge respect for people who are politically engaged and who take the burden of fulfilling our democracies, and I'm currently married to a member of parliament in Denmark and I see their discussions and I think, oh, I'm glad I'm not a member of parliament having to make these decisions. So I feel very well in midwifery. It's a big part of my identity. So I always present myself as a midwife currently running a business and helping midwives globally in getting better in their suturing skills. I never identify as a businesswoman or a researcher. That has been built on to build on my capacity as a midwife to do better.

Speaker 1: 3:43

So that's something because we've both been at the Australian College of Midwifery conference this week in Adelaide and I think there's a very common theme amongst some of the plenaries that midwifery is broad. That does take any call. It takes the governance, it takes the leadership, the educators and the researchers. We're all midwives but we're doing different jobs and all of them are just as critical as each other to advance midwifery, to ensure that we do and can do the best for the women, for pregnant persons and for families and babies.

Speaker 2: 4:17

Exactly. There would just be different professional pathways, so we could either be doing. I've been doing a lot of postnatal work with women looking after their wound healings and if the sutures had become undone, we implemented a rather large program in Scandinavian countries where we offer early secondary repair. So even though I'm a midwife and a researcher, much of my work has been very clinically relevant to a lot of the women that we take care of in a very small part of our scope of practice, which is the three centimeters between the vagina and the anal opening. But that has been my scope of practice for 25 years and I've had the opportunity to engage with clever people. So each time I've had a question, like when I started my midwifery education, I was asking myself do we need to suture all perineal lacerations or could we leave someone sutured? And I've been met by beautiful midwives Each time I've reached out.

Speaker 2: 5:12

In the beginning it was two Swedish midwives who did a randomized trial is it necessary to suture all perineal lacerations? Yes, I know. So I went to Sweden, to Stockholm, and asked these people how did you go about this trial and how are your findings and what would you prefer for your daughters? Because sometimes as researchers. We might not see a difference in the clinical outcomes that we're investigating, but we might have a feeling this is relevant at another scope of practice. So, even though the women were healing and they were in less pain without sutures, the researchers told me well, if it was my daughter, I would have preferred that she was sutured, because the perineal height or the perineal body was becoming less and the vagina was more open if you had not sutured.

Speaker 2: 5:56

But those questions were not the questions addressed in the trials. The trials addressed pain. So sometimes we need to rethink after our trials or during our trials. Are we really measuring what is important for women, or are we just measuring pain, because that has been the relevant question for 15 years or 20 years, mostly defined by medical doctors, and when I see midwives are doing research, they ask more clever questions. Do you feel that your vagina has the same function as before birth, which is a very relevant question for a woman, whereas pain on day two or day ten is only relevant for the first 10 days, and I mean we have pain medications to treat pain, but the feeling that your body has changed a lot is a very important outcome.

Speaker 1: 6:37

I think there's a frustration too, when we're still fighting for the recognition of qualitative research in a lot of places, that it's still not everywhere we've got it that we have fabulous qualitative research but in some areas it's still seen as secondary to quantitative. When you're looking at, as you said, the pain level, that's all they're measuring. But I think that mixed method opportunity of studying and if we're dealing with humans, we need to look at the human, the humanistic side of it as well, and how are they experiencing? And quite often we're just looking at very narrow but the rich data that comes out of those interviews or how did you find this or the information that comes by chance out of those interviews can be completely life changing, as you've just said.

Speaker 2: 7:25

I like your thinking and as I went into research, my supervisors. They were medical doctors, because I started my career in 1999 with my bachelor of midwifery and then rather soon in my career I went into a master of health sciences. There was no master of midwifery at that time point in Denmark, so the the entire postgraduate education for me and my master's program was defined by medical doctors and they made us think randomized trials was the answer to all questions in the world. So I did my career within randomized trials on perineal repair of second degree tests. We've been looking at suture materials and suturing techniques and resuturing opportunities and all questions had to be answered by trials. But, for example, some of the trials that we have been conducting in Europe on early secondary repair, they have been underpowered because we couldn't get women into the trials. They didn't want to be randomized to no treatment. They said please don't leave my vagina open. If you sutured in the first place, why would you not resuture when necessary?

Speaker 2: 8:31

if I had other surgical procedures on my body and they were unsuccessful, we would usually attempt to do it better yeah so women were refusing in the UK to participate in the trials because they wanted the active treatment, and that's a very interesting tendency that sometimes we also see that patients have preferences, yeah, which is important and but makes it difficult for us when we develop new methods and we want to investigate them under a rigorous trial design. How can we make people participate in something we don't believe in?

Speaker 1: 9:04

and still maintain the absolute ethos as women-centered care of women, having kind of choosing the option that they want. Yeah, that we're dealing with humans, it's and that stuff that can't be done in simulations and computer labs because there is so much attached to it what we also find in some of my.

Speaker 2: 9:24

In my PhD we randomized 400 first-time mothers into either continuous or interrupted stitches and what we found as a surprising finding was that the midwives did not feel qualified to participate in the trial because they said I'm not quite sure what you mean with a continuous method or with interrupted. Oh wow, which not? Would you prefer that I use which suits your materials? So we had to to do workshops in our local facilities before we started the trial to ensure that the staff were able to perform both techniques equally good. Yeah, and that is a very strong belief if you think a clinician can do two techniques equally good, because we can't, we will always have a preference. It could be also in the trials on hands off or hands on the perineum. We would often have a strong preference and be better at one than the other. Whereas the randomized trial design is very well for for placebo controlled medical interventions, but for the clinical art of delivering babies or performing surgical repairs, it is rather difficult to do this trials.

Speaker 1: 10:25

I think that's that's really important for people to remember that are requiring midwives to war for anyone to actually do the intervention. Is that part of the the strongest kind of like internal validity of the studies, to make sure that those doing the intervention actually can do the intervention and do it repeatedly, so that you've got that level of I have no security, not security, but that level of commonality. So what got you into your masters in the first place?

Speaker 2: 11:00

1999,. I just have to reflect a bit what happened in my life. I was a midwife, I was looking into non-suituring and I went to see those Swedish professors and the UK professors who had been doing the trials and they said well, this is not the important question anymore. The important question is if we are to suture, should we use quickly absorbable or standard absorbable sutures? So I think I stepped on the shoulders of others and said okay, what are the next things we need to investigate?

Speaker 1: 11:28

Are you still a clinical issue that you wanted to explore?

Speaker 2: 11:33

Yeah, maybe not as much a clinical issue, because we were suturing and we were quite confident in the fact that we were doing well. So I was more into how do women actually heal after childbirth and do we affect how they live their lives more than just two days? Because the scope of practice in a Danish situation would be that we look after women during the internatal period and then their delivery, and then two hours after birth we will say goodbye and nurses will take over. That is what happened when I graduated. Nowadays midwives are more into the postnatal wars as well and visiting women in their homes the first week after childbirth. But as I graduated last century, we were limited to the knowledge of two hours postbirth. So we were looking at how should we help the placenta, how should we help la la la, but it was very much just surrounding the childbirth.

Speaker 2: 12:25

So maybe some of my master's thesis came out of a convenience thing that I wanted to work day shifts and I wanted to be able to do a PhD. I think I took it as a step on my way into PhD, so I knew I would be going further. I didn't know how it would happen, but I have always been able to say yes to opportunity. To quote another clever person at the conference. So you know, vice president of the Asian. So and I had supervisors during that journey who supported me very well and those were medical doctors and they made sure that I would have grants available once I wanted to do a PhD. So it was an option to go that route and I had a very supportive employer who said we'll pay your salary for three years for your PhD. Wow, and you even have retirement funds and all the things I would have had if I was just continuing my clinical work.

Speaker 1: 13:21

Yeah.

Speaker 2: 13:22

So if I had a fortunate time, that people believed in what I did and that I would be able to make changes with my research and that it was important for the entire Danish population, because I was employed in one hospital and the PhD was actually conducted in another part of Denmark and it wasn't supposed to.

Speaker 2: 13:40

You were supposed to have your supervisors from the place where you were working and I was working in a place where they did not have much research. So they said okay, we will fund your research if you do a clinical trial in our unit and we know that you will be supported by people in the academia in another region. But all my three supervisors during my PhD they were medical doctors and there are professors, so I wanted to have the highest level possible of advice and support from people who had been doing randomized trials. So it wasn't making too many mistakes and I was very supported by them. We didn't have midwives at that time in history who could supervise midwives in Denmark and I think that was a shame, because I was not asking the right questions. I was asking, only paying questions. Those were the primary outcomes of my research.

Speaker 2: 14:27

Different questions, not necessarily wrong questions, but different questions and if I had been trained in Sweden, they would have used a mixed method approach to a PhD. They would need to publish qualitative data as part of their PhD and I know that midwives doing those trials and data studies have been struggling with qualitative data. It's not easy to analyze 12 interviews and get a certain amount of data and publish. And what did you experience? I am very respectful of people who do qualitative research because it's hard to do and you need to be wise and do it with a methodology that is transparent, whereas it was a rather easy fix to do the randomized trials because you can just follow a protocol and do the dutch and two years after you have your data.

Speaker 1: 15:13

And tick, tick, tick. So, thinking back to that now, what were some of the? So you had support from your supervisors. You had support from your employer and from the people around you. Yes, did you find that you still had episodes where you wanted to give it up, that you struggled with your mental health, that you couldn't find the balance? How did you keep the balance between sanity and having a life?

Speaker 2: 15:42

I do have a family, but I don't think my family will say I've been much present in the lives. So if you think that you can balance everything, you might be struggling a lot in your successful life. And I've been choosing to work many hours and I've had the capacity and I've never been ill. I've been ill two times in my life. I had COVID for three days and I was sick with a flu for one day in my life. So I've had a health of an elephant and also the mental health. I've been horse riding and I enjoy that tremendously. So once in a while, two times per week, I go horse riding and that has been my mindfulness or my place to be happy, and then I could work for the rest of the time. But I have the capacity of working 15 hours per day and that wasn't needed during my PhD, but that has made it possible to have family issues as long as I was doing my research as well.

Speaker 2: 16:35

So it takes a lot of effort, but I was never suffering from mental health issues or struggling. I felt supported and hardworking. There were never any people who were against my research. So I never faced or I never experienced or never discovered if anybody thought that I was wrong doing research.

Speaker 2: 16:56

So midwives in my surroundings were also supportive and they recruited all the patients in the trials and they found it nice and funny that we were doing the trials and we were doing small gimmicks around the trial. So each time we had recruited another 50 participants we would have a gathering and a party in the unit, so there was always some kind of positivity around. This is what we do to support each other and I don't have many doctors feel that way during their research. I see a lot of lonely doctors and I'm a supervisor for PhD students in the medical field and they're not enjoying life. They are struggling and I think we need to be kind to one another, no matter what we do, if we're having night shifts or if we're doing research, and in the Danish Midwifery profession we seem to be very supportive of the choices that we make.

Speaker 1: 17:46

Yeah, and if you kind of enjoy going to work, then that's a huge advantage.

Speaker 2: 17:53

And I've had supportive partners, but I've also been divorced twice in my life and I'm now on the third marriage and I think I didn't put that effort into family life that other people would need or would prioritize. My daughter has never been sick either. I've been very fortunate that she didn't have learning difficulties and having supportive husband who would be just as good as parent as I could have been and I must say he is probably an 80% of the parent and I've been 20% of the parent and that worked for us.

Speaker 1: 18:23

And I think that's it. It's finding what does work for you and not still trying to expect to do everything the same, and it has been a lot of the conversations that I've had in this podcast. It has been about supporting partners and how they've had to readjust everything or working out how it's been flipped, or, quite often, single moms who've gone yep, daytime is for the kids and then working in the hours and the afternoons and the evenings or when they're at schools, or doing night shift for a couple of years, because then you could actually earn some money and then still study while they're at work, but having to modify to what actually fits with them and their lifestyle.

Speaker 2: 19:01

But I didn't like research as much as it wasn't my pathway in life. It was a method that I used to answer some specific questions, but I got more caught up in the fact that midwives who didn't like to sue you we asked this question before our trials do you like to sue you and do you feel confident? And those who said no to those two questions, they had poor outcomes even though they had a better suture or a better suturing technique which was evidence-based. But if you provide care that you don't feel qualified in providing, you probably poured it. So when I graduated, we had a grant from the Ministry of Innovation and Research in Denmark and they said Sarah, can you please make midwives confident and confident in suturing in a two days course, just like you did in your trial, and could you make this a program that would be available to other hospitals and maybe also to colleagues in Norway and Sweden? So I had a rather large grant to implement what was not the primary outcome of my trial, but some of the secondary findings. Okay, we need to train, we need to qualify, we need to step up in surgical skills, because we had been trained poorly in diagnostics and surgical skills. I had the opportunity of a two hours course in the midwifery education and then I had to see one do one and now you're on your own.

Speaker 2: 20:17

That was kind of how I was trained and I thought this is not a proper way to treat the female in Italy.

Speaker 2: 20:23

I'm also a feminist and I'm a political person. I thought if the male population had our babies out of the penis and the penis fell off and it was put back on, and maybe by somebody who didn't know what they were doing and probably never had a course with the male population put up with this, and I found myself seeing no, they probably wouldn't. So why would we as a female part of the population say this is okay and why would we, as midwives, provide less quality of care than what we would expect if we really thought, if I want to have a whatever surgery, I would prefer that the person had trained. Like if I fly, I hope that the pilots have been training somewhere and doing their simulation skills. So we started building this program of hands on clinical skills training with students and midwives. So that was the outcome of my research. That was actually we need to improve these basic things. And then I stopped doing research independently on my own, but I've been supervising others.

Speaker 1: 21:23

But I never felt so.

Speaker 2: 21:25

And I never felt a great pleasure in writing articles and having them rejected and then resubmitting and waiting for three months because I wanted to scream to the world these are the results. Yeah, how we should implement. I'm more an implementing type than a waiting personality, and with research you have to be rather patient, because you might have a great idea and then, 10 years after, you're able to say what the results were of your efforts and I would like to do something and then change the world tomorrow. And, out of respect to research, you need to be more patient than what is in my personality.

Speaker 1: 22:02

Which is important to actually know where your own strengths and hidden. Okay, here's a question for you which may be on the right or wrong track. So we know the power of the plus CBOE effect. I think he can have a big difference. Yes, so do you think that there was with those midwives who didn't have the confidence? Do you think that that was an example of the NOS CBOE effect, of if you don't believe something's going to work or if you believe it's going to be bad, that that then also manifest itself, similar to the plus CBOE effect?

Speaker 2: 22:41

Interesting question. I'm turning my mind around the question.

Speaker 1: 22:49

It's a bit left.

Speaker 2: 22:50

Yeah, it's just if I was. I've been, I've had the fortune to observe a lot of colleagues undertaking perennial repair and when I've observed people who said they did not feel confident, I don't actually not think they were competent either. So I think I think it's like if, if I have a car and I like my car and somebody will like I'm very open to people borrowing my car, but I do I do prefer that they like driving a car and that they have skills in doing that. And my mother is a very poor car driver and and she doesn't like it and I would rather not drive with her in any car because she knows herself and I think maybe it's a female thing or maybe it's a person thing, but often we have the insight as to our competencies. So if you do not feel competent, you're probably not good at it either. I think if we did clinical trials and told people that you are poor and you're good, they would probably perform differently. We see that in schooling of our children. The children are not supported and they're told that they're being bad. They will perform worse than those that are very well supported. I've never thought of it in misreferring, but I think I have a colleague from Sweden no, from Norway and she graduated with her PhD two days ago and unfortunately I wasn't attending her defense because usually a defense will be public, so we can come and listen and enjoy and we can even ask questions and celebrate and we usually do that in a Scandinavian setting that we will celebrate each other, especially if it's in our field of interest and also a Valdom.

Speaker 2: 24:27

She did a very interesting trial on pain management during instrumental births and she's relaunched the mid-riff free ability to apply a potential block during delivery for pain management, before the doctor would apply a four steps or a vacuum. So that was her trial. Could we improve pain management during instrumental birth? And yes, we can. And she asked her clinicians before she started her trial four simple questions and they had to identify as one out of four and the green population would be those identifying I am able to apply a potential block and I can teach another person to do it. They would be the ones that she felt confident in the trial could manage and they could. She would observe three times and say, yes, you're a skilled person. And then there would be other people saying I might be able to apply a potential block, but I wouldn't be able to teach, or I have seen it during my education, but I never performed it or I don't know what you're talking about.

Speaker 2: 25:25

So she could. She could identify where she needed to put her efforts in training with the staff. So she didn't provide the same course for everybody. She provided that everybody would have the same competence when they started the trial, and some needed to train a lot. I see that with surgical skills as well. Some need five repetitions of a certain exercise until they feel confident and others say okay, I know what you mean after one exercise and they are competent in doing it. So we need to address the issue that we have different learning pathways in our career and not all midwives are skilled surgeons.

Speaker 2: 26:01

I wanted to be a pilot when I was younger. Before I wanted to become a famous politician, and when I wanted to become a pilot, I was trying to do some of the simulations that you do as a pilot, and one of the things is you need to be able to turn your head upside down and find your way back. So your head is upside again and I wasn't able to, and that's apparently in 3% of the population. We are not able to figure out where we are in the world if we turned upside down.

Speaker 1: 26:29

Well, that's kind of important if you're flying a plane, yeah.

Speaker 2: 26:32

Yes, or if you're a diver. I wasn't good. I was never good at diving either, and in the midwifery scope of practice in a Scandinavian setting we've thought that when you are grad, when you are midwife, you will be an excellent surgeon because you have high marks from your high school. So you're a clever person and you can attend the midwifery course and you're born natural surgeon as well, and I think we are making an assumption.

Speaker 1: 26:57

Yeah.

Speaker 2: 26:58

Yeah, because I do see that about 5% to 6% of the midwifery workforce are not very competent, even though we've been doing a lot of training on surgical skills and we see the same when we do medical training and we try to teach doctors to do laparoscopic work. Laparoscopic work, yeah, interuterine, extrauterine, whatever when they do their laparoscopic procedures, 7% of the doctors are never able to do it in a safe manner. They will, under simulation, keep introducing unsafe surgical procedures and even though we train and train in virtual reality scenarios and simple scenarios, some of them will never have the competence where we would allow them to go in the operating theater because they would be dangerous to people and their surroundings, because they're not three dimensional. Yeah, and you need that insight.

Speaker 1: 27:55

You need a spatial awareness.

Speaker 2: 27:57

Yes, and that is an important factor, and we've had situations in my unit where we were unable to make some of our colleagues able to suit you and we said this is okay, you are probably good at something else that I will never have the patience to do, like counseling on genetics or stop smoking. I would just say, stop smoking, and apparently that's not the way to do it anymore. So we have different competences, and the surgical competence is one that I am very keen that we can make sure is established before we let anybody do surgery on other people.

Speaker 1: 28:34

Because perineal? Because when you're looking at the anatomy, if you're doing closing of abdominal surgery, for example, you're looking at more commonly horizontal layers, so you're more, you're still in 3D but you can visualize it in 2D, but when you're doing perineal you have to be able to visualize it in 3D to be able to make sure that you're laying it down correctly so that when it does heal you can still allow the natural functioning to occur. Yeah, and if you haven't got that spatial awareness and you can't visualize that 3D effect, then you've got to be causing lots of trouble if you're suturing the wrong way, because you're going to decrease the kind of range of movement and the functionality. So then this is now kind of becoming your life work, that through that program that you are asked to develop what's kind of like how did that grow and how has that grown?

Speaker 2: 29:26

As we started um Gynestone, we founded a company because we had the opportunity to get a grant if we had a company, yep, okay, okay, I can do trials if I'm a PhD student. Okay, I will become a PhD student so I can do my trials. But, okay, you have to found a business to get this grant. Okay, a bit, and we never knew if we were going to be a sustainable business. Right, and 98% of what was supported by the state had failure and were not in business within three years. So we are amongst some of the few companies that were sustainable at some time point. But in the beginning, the first three years, I didn't get salary that was better than working part-time as a midwife, because I wanted to be able to employ people that were better than me, and that is the interesting thing in doing your own businesses you can employ the people that you like and you feel are good at their job, whereas working in the hospital, you need to balance between what is available as a work resource, and I've been able to afford to hire the people that I felt were very qualified in helping us getting on the way. So I've had people working with our website and apps who know a lot about apps and websites and nothing about perineal repair. But we have grown over the years.

Speaker 2: 30:43

So in the beginning we did a Danish website where we included small video tutorials on how to do labia repair and second-degree repair, because that was the trial questions we had. And then doctors asked could you please do the third and fourth degree repair as well, because nobody told us and we can't remember what we did in the course 20 years ago on a pig model, so could you please make it possible to repeat the exercises and look at it again and again? Then the Norwegian midwives and doctors said could you please translate into Norwegian? And then we went to Sweden and suddenly during conferences I've been meeting wonderful midwives in my perineal repair workshops that I've always been offering for the conferences as part of a three-year post-conference activity. And I met Peggy Sehar, for a beautiful German midwife, and she asked if she could have the program for free for one year for her school in Hamburg and translate everything into German. I said, yeah, that's a very nice deal, let's do that.

Speaker 2: 31:41

And so we have been moving into languages by opportunity and not by business plan or any. I've not been very strategic, I've been working as good as I could and I've had a lot of energy and met extremely nice people on the way. So eventually we also translated into English and we met somebody who was married to an Englishman and he could do the narration and that is what brought it into a broader audience than just the Scandinavian audience. So today we are celebrating our 15th year of anniversary now. Congratulations, thank you, and the minister who handled me the grant at that time. He has now retired, but he's coming to make a speech for us at the reception One for.

Speaker 2: 32:26

And he's very proud that we can. We succeeded in making export of Danish know-how. So the story of you can do your research. But sometimes you need to think can you improve more lives by doing something else than continuing doing randomized trials? And that is what I have felt I've been doing. I've been having effect on many, many women's lives because we implemented this program in Scandinavia and now maybe we can help meet why succeeding in this clinical skills as well internationally? And sometimes we are challenged by people who say, well, we have similar programs and say that's excellent. Can I have a look at your program because maybe we can improve ours? And most people that I talk to they have made a program which is available in their institution only and the intellectual property rights are unclear and they're unwilling to share because they're not quite sure if it's according to evidence, and I think that's such a shame. Let's share what we have and improve what we have on the way. So that has been our way of growing our business we meet with more clever people and then we improve.

Speaker 1: 33:27

And ideally, every resource that is made as an education tool or instruction tool should be based on evidence, and I know that's one of the.

Speaker 1: 33:36

Coming from a university, it's kind of automatic for us. But we know there's a lot of people who will just grab whatever they can have and don't have either the time, the capacity or the desire to fully critique it and go well, this is just convenient, so we're going to use it. So having something that is known to be evidence-based, that you can easily look up the evidence, is something that I think is critical, because there are a lot more consumers' demand for information as well. So they're coming in educated and what, if I know this, this is kind of part of what it is and to be able to have that discussion, to have informed consent and shared information, but kind of women consent. But you mentioned trying to get the videos onto smartwatches and I think that's just fine, sitting there waiting for someone to come up and you just kind of hitting your watch doing a little video Yep, that's right, remember how to do it and kind of refresh through, especially for those that are nervous and don't do it as often.

Speaker 2: 34:32

We see that some of the medical doctors they are they might do an anal sphincter repair once a month, or maybe once every half a year, and some of those who do not do it on a daily basis, they might need just a three-minute introduction. This is how we do it in an evidence-based way. We will put ends back together, end to end, and we use a standard absorbable suture and three or four interrupted stitches, and that can be displayed in an animation or any model of teaching within two to three minutes. So that is how doctors use our online resources for very small instructional tutorials, whereas the midwifery students? They spend hours and hours on watching slow videos. And can you make it slower and slower?

Speaker 2: 35:15

And I think oh, how boring could it be. But they need the time to absorb. This is how you handle a needle and this is the needle tip and that can be dangerous to your finger. Okay, that is why we use it. So we have different learning needs and the Garnsland resource supports everything from a novice to an expert and you can choose which pathway you want to be on.

Speaker 2: 35:36

Be having a conversation with Vanskop, who might think of implementing our program for obstetricians in Australia, and it's a very nice and honorable time for me to be helping so many people with our program. I like that a lot. So I think my impact in the world and in female health has been maybe different than what I would think 15 years ago, but I like my pathway better and I know that some researchers would say well, sarah, you could have become a professor, why didn't you choose that? And so well, I wasn't very happy doing articles and I could have written maybe the 50 articles by now that would make me be able to apply to become a professor and I could have supervised 20 PhD students. But I'm more happy with the impact that I have and, for example, I like traveling and I like meeting new people and I enjoy getting new ideas and questions from you, like Nosebel and placebo. Oops, I'll be thinking about that for a few days.

Speaker 1: 36:37

No, no, no, no. You got a weekend off. Enjoy your weekend and then later on fly back. Yeah.

Speaker 2: 36:45

And I've had the fortune to make businesses and invest in businesses that we have sold. So one of the businesses was sold to a British company one year ago and it made me have enough money to buy a house and a nice car and then I could retire. But I think no. Why should I retire? I have too much to do and I like my work. I really enjoy my work. So I chose to invest in other companies instead.

Speaker 2: 37:13

So some of the money is reinvested into fimtech or female technology, and some of the things that I'm looking into right now are the which can we get information from menstrual shown blood? So for the sanitary pads that we wear during our period, can that blood be analyzed and be of important screen? Could that be part of important screening programs for cancer? And it can. And there's a medical student from Denmark who did the theoretical work and she's now working in Silicon Valley with some of her technology. Wow, yeah, and I think we need to work out smarter ways to detect whether we have breast cancer or not, instead of having our boobs popped into this machine by on kind people and saying and again, if male population were to have their scrotum examined the way that we have our breast examined, I think somebody would have found a machine or blood analysis or something else to get our minds around. How do we detect cervical cancer or breast cancer or whatever kind of cancer in more kind and clever ways than what we're exposed to currently? So I will be very happy to support women or people who will be looking into better female detection technologies.

Speaker 1: 38:31

So and that's kind of called an angel investor, where you kind of come in and be able to help, support, and I like the angel investors because it's less traumatic but you actually get to explore and put beliefs in.

Speaker 1: 38:48

I know there was one that I saw many years ago. I don't have a lot of capital, but I donated what I could at the time to increase the use of solar lights to women in Africa and it ended up that they end up then selling the lights and because of the solar lights it allowed nighttime activity and the thing that got me involved it enabled kids to study after the sun went down. So they're actually improving their education because they could study longer instead of having to sit out on the road or on the street lights or if they had nothing like that. So simple things like that. But it involved the women then selling, so they got the money to improve their lives, to improve their communities. So, yeah, little things like that have a massive impact. Quite often you don't actually realise the impact that they have by investing and supporting somebody else's idea.

Speaker 2: 39:37

And I find a great similarity between doing research and doing business, because as a researcher, you need to make a protocol saying this is what I will investigate and get somebody to support it and the ethics committee to be okay, and patients and clinicians, so you get a lot of people involved in supporting you in your work. And it's the same with doing businesses. So we will have a pitch of presentation saying we would like to approach this problem with this technology and this is what it will cost and this might be the impact, and what I help people doing in the building businesses is the same as I would do with a PhD student. So I would question is this the right idea? Is this the right methodology? Is this the right technological approach? Are you supported by people who will help you throughout, because this will be five or ten years of your life?

Speaker 1: 40:28

if you're lucky.

Speaker 2: 40:31

And some of us. I've spent 15 years in Guyantzone and we're not ready to sell the company, and nobody really wants to buy it either, because it's teaching midwives how to do specific things and that is not a big business. It's not a great revenue in doing workshops because we use sutures they're disposable. We use medical models that are worn out after two repetitions of a perennial repair, so it's a rather costly thing to do workshops. And those who make great money currently are those who develop single use equipment that are not necessarily very environmental friendly or who are that might be available to a poor population. So we are developing things and instruments that are relevant for rich part of our population and then we become rich from that. But it's not really gaining much health for womanhood or for reproductive health. So if we find ways to support reproductive health improvements, I'm more into that kind of the sector.

Speaker 1: 41:33

And a lot of this backing. We know that research alone into women's health is so far behind research into men's health. Where in Australia, only in the last few years have they actually put up a substantial amount of money Like less than $10 million into researching endometriosis, like there's all of this kind of when we're fighting for funding for women's issues, it takes a long time to kind of get it, because we're still unfortunately globally fighting for that equality. But yet to get that equal kind of footing up on the stage and to get seen as justified in spending the money and the return on investment is quite often seen as we won't make money on it because it's women and they can't afford to buy it, or this is only focused on kind of low income or middle income resource countries and we don't want to do it because we want to spend it to the higher resource money because we can make capitalism.

Speaker 1: 42:28

And there was a guy, a billionaire, here in Australia, who just said an article who said basically he wants the unemployment rate to double because it's employees have to remember it's a privilege to work for the employer, not the other way around, and he wants to make it. So people are afraid to do their job. So they'll ask for less demands. And the system is and it's basically the capitalistic system it's all to make him profits, it's not to do for the good of the company. And I mean, why would you have a billion dollars? You can't spend that in a lifetime Whereas you could solve quite a lot of the world's kind of issues with even part of that.

Speaker 2: 43:05

When I had the fortune to have a lot of money, I also invested in getting into networks of other women who were able to invest, because I was seeing a lot of investments going into male ideas and also sometimes to female ideas. But the female idea might be could we make jewelry or could we make children's clothes that are more, whatever green or yellow, and I really don't care. So I think I'm more into green investments and investments in health than into just investing in women. It should have a purpose that serves a larger and broader perspective than just green or yellow blouses, and I met with a lot of women who were around my age Some of them were probably 10 years older, so somewhere in their 50s or in the early 60s and they've been running successful businesses, building houses in Dubai or making pillows for Scandinavia or something.

Speaker 2: 44:10

Well, it's not rather interesting what you've been doing, but they left the companies and they were bought out or sold the companies and they had so much money they didn't have to work for the rest of their life and many potential coming lives. They could support villages and they did yoga retrieves in Bali and polished their nails, and then after three months, they were so bored by doing nothing that they said. Now we want to invest what we have learned in other women so that we can help women at the age of 25 becoming successful in their businesses, instead of us having to fight until we're 50 and then suddenly we understand what is business all about. So we will make it easier for other women to enter the scene. And that is what I like in female investors is that we want to help other people improve, whereas male investors are always looking at return of investment and how fast and how it's like a penis. How fast will it become erected? And I don't care. I want it to be vibrant and alive and welcoming.

Speaker 1: 45:10

And have a moral soul to it.

Speaker 2: 45:14

And sometimes we do not see a return of investment within the first five years, but we think it might have had a huge impact on that person. So if she's successful in her next business, then we have been successful business angels.

Speaker 1: 45:27

And also when we look at midwifery. Midwifery is dealing with intergenerational change quite often, and quite often we know that politicians in particular are looking after election cycles. So they want to see a change and something happening after three years. But quite a lot of what we do in healthcare may not be shown in this generation, but we'll have a trickle on effect for the next generation or for the next kind of cycle go through and I think that's something that we're not used to appreciating because we are used to that rapidness, that dopamine hit of yay, we've got a week and we've kind of got so many hits.

Speaker 1: 46:03

But if you can kind of stop that and then look at, well, I've started this ripple and this ripple is going to turn into a tidal wave given enough time, and if that's where your intrinsic satisfaction comes from, as opposed to extrinsic satisfaction and gratitude, we're going to have a lot more women who are going to be able to step in and make those businesses a reality. I think I agree. I want to take you back to finishing your PhD, memory back and celebrate.

Speaker 2: 46:38

I defended my PhD thesis in 2008 and it we invited people from an international community of midwives and obstetricians to participate in the defence so they could listen and then we would make a party afterwards. So we had a reception at the university with I think we were 150 people, and I was very delighted that in Denmark I have to defend my PhD publicly. So there will be three very clever people who will review the paperwork and, if it is accepted for an oral defence, that all defence will happen within three months after acceptance by the university. And we invited Christine Kettle, one of the keen researchers within Pyreneal Repair. She was a professor in the UK and she came and she was the official opponent, so she would be asking me questions like was this a clever way to look at this and would you have asked other questions?

Speaker 2: 47:30

so it was a very, very nice conversation with the person in the world I would most like to talk to, so I enjoyed the oral defence a lot and also the questions, because I really had to think. So, whoops, would I do think differently and I might do things differently, like asking, I think, for the next trials that we should do. We should ask the population who would be in the trials, what their outcomes of interest would be. So, like involving patients or consumers in designing questions would be better instead of just repeating. Pain at ten days is the important outcome. Who cares? When we ask women today, that main outcome is infection. So a lot of women fear infection. It's very interesting because we see it so rarely, but that is their main concern is whether they will be able to have a normal sex life and whether there might be infection in the wound, and those were not the questions we asked about.

Speaker 1: 48:24

So that's learning. That's how we learn is by doing, by asking somebody, asking those questions, coming from a different point of view and going yeah, actually do think of that, but that's a really good idea.

Speaker 2: 48:37

But in the UK for a long time period it has been implemented that you need consumers on both of your clinical trial units, and that's not even implemented in Scandinavia yet. So we have lots of things to learn just by looking into countries that are very nature wise and how they have advanced their research thinking. But coming back to the celebrations, we often have a party in the night after we have had our oral defence. So those who had been investigating whether I was clever and sound and did the paper work well enough, and friends and fools and family, they came to my house or our house in the evening and had a lovely celebration. Oh, nice, yeah. So it was a more informal celebration, saying my father did a speech and he showed a picture from my childhood, saying Sarah was always interested in politics and she went into this pathway and she did educational materials and she was yeah. So people got a feeling of who I were before. I was a researcher and I like the combination of family and professional friends having a nice time together.

Speaker 1: 49:44

Well, it's that holistic sense. We are whole people. Part of us wears a midwife hat, part of us wears a researcher hat, part of us wears a mother, daughter, sister. But yeah, having those put together is who we are on a day to day basis.

Speaker 2: 50:01

And then that was a Friday. On Monday I started the business. I like that, yeah, yeah. But it was an opportunity to have this grant and saying, okay, you've got a scholarship. If you have to start the business, it should be a consecutive movement, directly as a spin out of the university and within one month after your oral defence in order to get this grant. So I just moved forward. It was a natural next step and the other natural next step would have been to apply for grants for research and that could have been another career. Then I was offered to set up a research team and looking into other issues around maternal health. That I found uninteresting, so I said I can't be bothered In preterm birth, it's not of my interest. I'm sorry, it's extremely important. I'm just not interested. I have to do this period of repair just a few more years and then I might ask you something else.

Speaker 2: 50:55

Yeah, yeah.

Speaker 1: 50:57

Okay, so what's next, apart from a weekend exploring Adelaide at the moment, which is where we are?

Speaker 2: 51:02

Yeah, then I'll be going to Melbourne to do some workshops for some of our clients. The Northern Health Epping has asked us to come to do some train the trainer courses for their midwife and the midwifery educators. And then I'm going back to Denmark next week and I just come from a two week session in Iceland when I did train the trainers for their midwifery association as well. So I'm hoping that I can advance my skills into upscaling midwifery educators not only upscaling students and staff, but like getting to the next level so we will have more people working and being happy being instructors in their own countries, so I can retire maybe in five or ten years or 25 years and saying, okay, now we have an entire community of a thousand midwives who can teach in the next generations. It's not just a few people from Scandinavia. It's actually a program like Patty.

Speaker 2: 51:54

So if you want to go diving, you would need to be sitting in a swimming pool putting on and off your gloves and glasses and whatnot and not to drown, and then, when you advanced and you're supervised on this task, you can go into the water and suddenly, after a lot of training, you can dive down ten meters and I think we will see that same approach to perineal repair in the future, so that you will have basic surgical skills courses and then you will advance and do labia repair and then you will advance and do second degree repair. But you can't dive straight into second degree advanced repair without knowing how to hold a needle holder on a forceps. So we will see a stepwise approach to surgical skills also for midwives, and I think it will be based on evaluation. So we need to figure out how and who should evaluate. How should we evaluate if somebody else is competent? Because if it's today by a midwifery instructor standing next to you, that's a very expensive and time-consuming way of learning.

Speaker 2: 52:51

And we have been looking into whether virtual reality might assist us in the future so that some of the learning scenarios like which medication would you choose for local energy easier. You can choose amongst three and you could actually see them in front of you and you could turn them around in your hand and you could choose. That exercise could be done just as fine virtually as in a classroom. But we're still struggling with finding out. Can we teach people to suture and hold an instrument open and close a needle holder without being present? And at the moment we can't, but I think in the future we need to scale up. Otherwise, how can we support half a million midwives every year, which could be an aim instead of just helping a thousand midwives that I currently have been doing courses for every year? We have 1000 participants in our courses, but they're time-consuming and we attend people doing that traveling all over the world and wasting energy on on airplanes and our own. Maybe we could do it in a more sustainable way.

Speaker 1: 53:45

I think technology is going to get there and I think, in particular when you're looking at the haptic gloves so the haptic gloves are still very bulky they will, I think, get down probably kind of well, the way technology is going, probably five to ten years, but they'll get down to something like the kind of water suit gloves that you've got the neoprene that will allow that flexibility, because I've got this kind of same dream in the back that we can do internal examinations or there's other things that we can do that have that fine dexterity that we have to use with those gloves.

Speaker 1: 54:22

But we haven't got the technology there enough to do those fine suture micro movements. But I think that we will get there eventually and that will be that nice. Once again, that scaffolding as you've got your pads and then you've got your kind of like your pink labial and then kind of going through, I think we'll be able to use VR technology or mixed technology is going to be a big help in preparing those skills or then kind of going on to real people. Thank you, which is exciting.

Speaker 2: 54:52

Yeah. So I feel lucky that we live in a time where we have the opportunity to develop technologically, because the industry is investing heavily into virtual realities in areas, and each time I go to conferences I see people queuing up for a virtual reality experience, but I also see one staff member assisting that person who wants to have the experience, because the technology is not very good. You need to adjust the glasses and if the person is half a meter higher than the previous, you need to reset and calibrate your scenario. Otherwise, you are seasick once you're in the scenario because you feel you are not in the right place. But in the future, I would love for people in Africa or South America to be able to have a guide which is available in their language, so I hope we will be able to translate in the future as well, and that they will have the learning experience where they can choose the person they would identify as so.

Speaker 2: 55:47

I am a slow learner, I'm left handed and I need a supervisor who is very supportive. Okay, that can be provided virtually. Then we know how you like your supervision and we know who you are, instead of today, where we just assume everybody's right handed and learned rather learn fast.

Speaker 1: 56:03

Customized learning absolutely.

Speaker 2: 56:05

So hope we'll be able to provide more individualized learning through technology in the future.

Speaker 2: 56:12

It's exciting and also you could use this scenario where you would have the person giving birth is a black person and she's at this and this weight group, so you would feel that she's resembling somebody you might look after in the clinical field, whereas now in the Gynesone teaching material, we are making most of our videos in a Scandinavian setting where most people are white, standard weight, no health issues and, just like we do all our randomized trials, they are unhealthy people who speak English or the native language in which you do your research. So we have limited knowledge about sick people how should we treat their perineum and what about the diabetic woman? And what about the person who's ill or malnutrition? And maybe we can help us learn better if we can build up those scenarios virtually.

Speaker 1: 57:02

We need to start forming some alliances with some gamers and game developers and we come in as the content experts, they come in with the graphics and the technology, and then you have those conversations and go yep, this is what I want. Here's some stills, here's a vision board of what it looks like. Now you go turn that into reality and then you keep tweaking it and eventually we'll have products and prototypes that will be able to continually develop as the games, because that's where it is. Unfortunately, the other area that does high advancements in technology is the porn industry. So they're the ones that use it the most and we've got to start kind of making connections within that to use it and develop Definitely. Yeah, you're not going to retire, you're just going to be too busy, you're going to be having too much fun.

Speaker 2: 57:51

I think so, but I'm also fortunate to have married a person who has three children that are adults, and my own daughter is now eventually an adult and maybe sometime. Sometime I might become a grandmother and I still have the fantasy that I will become a nice person when I'm a grandmother who will take care of grandchildren and baked cakes and whatever, and chicken.

Speaker 1: 58:10

Which I didn't do.

Speaker 2: 58:12

Yes, yes, yes, I'm hoping that might happen because I think that's the great fortune for grandchildren to have a present grandparent, and I'm hoping to be able to provide more joy for grandchildren maybe, but we'll see. Yeah, they are arriving on a regular basis, so I have a bonus granddaughter. She's four and I'm enjoying her company very much. You've been called for any two.

Speaker 1: 58:39

You've seen things, you've done things, you've gone on travels. You've said well, we said postcards back still, but thank you so much for your time today.

Speaker 2: 58:49

You're welcome. I enjoy talking to you.

Speaker 1: 58:52

It's been fabulously hearing A journey that is not what people commonly hear about but is just as valuable to helping and, as I said, measuring impact is really hard, but you have definitely made an impact on more lives than you could probably count and will ever know.

Speaker 2: 59:13

Yeah, I'm hoping that will be my legacy to to done my best and worked hard, and it's what I would have done in other professional pathways as well. But I see, for example, if I had been into politics, even though you work hard and you do your best, you might not survive as a politician, and especially female politicians have had so much harassment and arguments that they're not doing well and they're hormonal and they're doing what? Nothing. That would have been too hard for me. I've never had any experience of harassment as a researcher or as a business person. I've always met people who are supportive in research and in business and kind and saying we will help you advance. And if we do that to midwifery students, no matter whether they just work on their clinical skills or their research skills or whatever, I think we should support each other because that is what is is is making life worth living.

Speaker 1: 1:00:06

Absolutely agree. Thank you for joining us today. You'll find all the links on Twitter, instagram and on the podcast website. If you are a midwife and you would like to share your research, your postgraduate studies or even the quality improvement projects you are doing now, then email me at throughthepinardcom, send me a tweet or send me a DM.