Ep 65 Jane Houston on redefining midwifery through quality improvement and research (PART 2)

Ep 65 (ibit.ly/Re5V) Jane Houston on redefining #midwifery through #qualityimprovement and #research (PART 2)

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When you think about midwifery, you're probably not seeing the full picture. Today, join us as we take a fascinating deep-dive with Jane, a pioneering midwife and Doctor of Nursing Practice (DNP) program graduate. Jane sheds light on her journey, revealing how the DNP program empowered her to elevate midwifery to a whole new level, and the critical roles research and quality improvement played in bettering patient care.

Our conversation takes intriguing turns as we explore the challenging yet rewarding journey of the DNP program. Jane enlightens us about projects such as introducing a water birth policy, contributing exciting insights into American and Scottish practices. We also delve into her current role in a residency program for Obstetrician residents where she emphasizes respectful care, effective teamwork, and the importance of physiologic birth. 

But it's not just about the learning; it's about the achievements. Our graduate guest recounts her joyous graduation moments and the pride she feels in her accomplishments. We also discuss the importance of advocacy work in projects and organizations, and how these endeavors contribute to advancing the midwifery profession. From participation in the Virtual International Day of the Midwife (VIDM) conference to promoting disability inclusion, this episode is a celebration of the monumental strides midwifery is making in the healthcare field. So, ready to discover the unexpected? Tune in!

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 finish listening. And now, in part two, we continue with the rest of Jane's story. What got you into the DNP? So we're very used to the and this is a thing the level 10 qualification, which is the terminal qualification, academic qualification in Australia. Quite commonly it's going to be the PhD or the educational doctor at the proff doc. You've also then got the DNP, which is in some places but not in all places, but the Doctor of Nurse Practitioner that can cover obstetrics, maternity, women's health, but it's just the DNP is the overarching. So what got you into that pathway?

Speaker 2: 1:31

Another excellent question. I saw that was always really interested in education because I've got lots of siblings and essentially arrogant, I thought. I thought everyone went to university but my dad's dad drove a bus. I didn't know that people didn't go to university. So in the 1970s and 80s most nurses, for example in Scotland, were doing a diploma. It wasn't a degree. So they did all these studies, all these great studies, and one of my sisters is a midwife and she had done her bachelors in Edinburgh in nursing. It's absolutely going on to do her midwifery qualification and then her PhD. So I had seen the value of even when I was a nursing student. You think you're something special like you're getting a bachelor's degree. It sounds ridiculous now but I could see the value of having actually an education within a university environment and it was very broad. It was good.

Speaker 2: 2:48

We were in university with other students, not just specifically nursing students, and then my midwifery obviously was straight midwifery but then going on to do my masters and learning more about human physiology in the sense of non-pregnant people and learning more about menopause and other stuff like that. But to your point, the main reason, I saw the development. I mean I was very lucky, I was kind of at the forefront of the Doctor of Nursing practice or DNP degree and there is also in Americano the DNP, the Doctor of Midwifery practice, and that basically came about because we know that for many people, you know, my sister already had a PhD in midwifery and nursing practice in relation to lactation. But having thought about it, I spent a long time wondering about why and I'm well, she's not practical, but the practicalities of it is the understanding of applying all this wonderful researchers, that research like the great studies that you're doing for us and every other PhD scientist is providing. But as someone that's seen so much great data, so much great research come out but then it dies, does it have legs? That's what I was saying. So you know it's more about quality improvement how do we improve care, and that's it's also to do a lot with my soul as a midwife, you know, about levelling the field and trying to get every an approximately equivalent level of provision of care.

Speaker 2: 4:37

So when I saw the you know that they were mooting having one at the university, but they were only going to admit people that had a master's from the University of Florida, from the first class I jumped. I jumped at it because I was I was at that point in my career was tired, was really tired, and you know, I think when I talked to midwives now I acknowledged that I probably wasn't the safest practitioner when I'd been up for hours. But I thought, well, I'd really like to get into teaching because we were also able to do electives. So I did electives in classroom teaching and learning about how to write objectives and things like that, and also then went on because we had to provide a quality topic, which my topic was about understanding water use and labour and birth in a comparison between Florida and Scotland and looking at how do we, how do we affect change? How do we, how do we allow I hate that word how do we, how?

Speaker 2: 5:44

do we let you know when I it breaks my heart. You know, one of the first questions we'd ask when patients came in New Zealand, in Wellington have you had any thoughts about birth position or what you want to do? But when you came to my unit, be like do you have a car seat and air conditioning? No, seriously, no, it's not. It's not, it's completely on its head. So, you know, looking at how health systems adapt to changes and how do we, how do we affect change within health systems that need to change? But how do we, how do we do that? And I'm not just talking about water birth, I'm talking about water use, having women up, having them walk around, having providers understand that patients should be upright as much as possible and being listened to again, even if there's their high risk, but understanding how to effectively communicate.

Speaker 2: 6:44

So we had, I learned a lot. I really, I really valued my time in the program and I mean it's and one of the greatest joys was the people, the other, my colleague students, not just as midwives there was four of us midwives, but most of them were nurse practitioners but they were bringing this advanced knowledge and trying to also level the playing field with positions, and I'm not meaning about being called doctor, I mean that we're asked, invited to the same tables, that we understand how to apply research, you know, and we've probably actually read a lot more research than you have and then we can, you know we can, we can actually be at the boardroom table and saying I'll be on this committee, I'm qualified to be here, and just it is really. It's, you know, it's been really life changing for nursing in America, the development of the Doctor of Nursing practice. It's. I can't tell you how it's elevated our profession and then given us also the ability to be top level teachers, going forward as well for the next generation and the next generation as well after that.

Speaker 1: 8:04

And it's such a new, a new area because I say you're one of the first within the Florida University, the first people to get these qualifications and even, in midwifery, the first people internationally to get the midwifery qualifications, are still alive, like our, our kind of like research side of midwifery is quite young and it we're still fighting to get that recognition. But we do when any table needs to have a midwife there who can ask those questions from midwife point of view but can also speak the same language as what they're talking about by being able to use the evidence. And we know it takes 15 to 17 years for practice to change and that's what we've got to decrease. Some trials, unfortunately, can change practice overnight, not necessarily for the better, especially once in about another five years they get critiqued as being incorrect. But we have to change that that time and we have to decrease that time because it is costing lives, is costing sanity, it's costing people kind of like so many different ways by not changing faster.

Speaker 1: 9:13

The DMP what was the structure like? Because I know that you then went on to actually teach and lead the DMP program. So what is that? Is it a coursework type program? Is it a thesis, research type program?

Speaker 2: 9:28

Yeah, so we do coursework, you know like statistics and social policy and things like that, but also developing your question. But you're going to be applying research. You're not doing specific quantitative analysis, you're not developing a hypothesis that you're having to demonstrate something. So you're maybe looking at a clinical question and you know like, say, for those cardiac specialists out there, like you know, from admission to the emergency room to when you get your, you go to the cath lab like how do we look at that? And about quality, quality measures, so decreasing UTI, or something like that. What is important to you and it is very varied, I mean there's definitely you can do different ones, management and all this, but you do generic topics.

Speaker 1: 10:23

So what was yours on?

Speaker 2: 10:24

specifically Well about it was looking at how to introduce a water birth policy.

Speaker 1: 10:30

What surprised you by doing that project, by looking at that topic? What surprised?

Speaker 2: 10:36

you Well the comparisons, so I'll just give you a laugh. So all the clients I was able to care for that agreed to be fallen in their birth that were pursuing water birth, all the clients, even though they were low risk, in America and in Florida at that time there was only one hospital that offered birth fully submerged or not fully submerged, but your proper water birth. All these patients were on continuous fetal monitoring, which I found stunning. And then, of course, it goes to Paisley. Thank you, paisley. In Scotland, of course they're not on fetal monitoring, they're being monitored effectively and they're low risk. So that, and also just the.

Speaker 2: 11:33

It's just we don't understand the importance of listening to women. You know, I start like when you talk about empowering women and they're like, oh, okay, and the things that patients request here. You're like, yeah, no, that's automatic. But when I came here, like the babies still were going in this wee room called a nursery and been taken away and it's now changed. I mean, talk about the changes. It's fantastic. Like the early cutting of the cord is actually the intervention of a published paper on that. We always provision for stuff like that, so trying to recognise the importance of applying stuff. But yeah, it was just stunning. And then to be cut off.

Speaker 2: 12:20

Trying to introduce water birth is still an ongoing. I don't like the word battle, I don't like to battle with anyone anymore. Yeah, but just being given a case report and no, no, jane, you can't do that, it's dangerous. You know we've not. I would like to see the randomized control trials for epidurals among women in labour, because there aren't any. We just introduced this very life saving, very effective, very good but also very dangerous intervention without any RCTs. And then there was no, no, this. This baby drowned, baby drowned. It says it here and I said well, that was actually a case where it wasn't a license, any kind of license midwife, it was a lay person and they didn't realise you actually bring the baby, or the mom brings the baby up to her chest and up and out. So you know, and this understanding of how you apply data like then, so getting back to like, that was the joy of the DNP, that I could understand.

Speaker 2: 13:26

Now, how to change, how to affect change, and I would like to say I have been effective in changing the unit. You know, the nurses now go to spinning babies and they understand we have all the birth balls and we have all the squat bars and we have all the understanding of physiologic birth. We still have a super high, super high epidural rate. But again, you know, valuing the birth. So I think, I think the challenges were myriad and not solvable within, especially in this is actually called a private, private hospital setting.

Speaker 2: 14:01

So but just knowing that things are better where I work, you know, do I am I satisfied? Never, I'm never satisfied with the progress. I mean, you still, when you still get women, you know that just, and you see, when you observe obstetrical violence in a live setting and you try to I can't even tell you the stuff, I've seen them just, you know it's heartbreak and it's heartbreaking, it's heartbreaking enough for us as providers. But actually seeing it and then attempting to address it within the correct channels of power, and being told that that's normal, and knowing in your heart that that's complete abuse of women and babies, and knowing that things aren't right and that can, that can be a huge challenge for me as somebody now that has I'm now called an esteemed midwife, but just to say actually no, it's funny though, as so just to get up to speed, but we'll talk about this in a minute, but I do now work is called the University of Central Florida residency program for Obstetrician.

Speaker 2: 15:17

Residents are coming and I had a beautiful, beautiful birth a few months ago and I was so empowered and it was just lovely just me and the family and it's lovely medical student who's helping me and it's just beautiful, so went into the. We have a workroom. I saw the normal birth and one of the senior, so we have them all the time Just because the baby comes out your vagina does not mean it's normal.

Speaker 2: 15:49

So, but get into the understanding that you know respectful care is really important. It doesn't matter how bad a day you're having. You have to put yourself off to the side just because you're not feeling great, you're tired, you're at party and with your boyfriend you were, you're tired. That's not appropriate. And how do you conduct yourself as an effective member of the team? Always, and that's you know it sounds, doesn't it sound? So easy, though, but it's not like people could be. Yeah, but it's you know, and not I'm sitting down.

Speaker 2: 16:24

So it's really interesting that I teach medical students as well. The you know some of the residents walk into the room, computer in front of them, blocking their standing up, not feeling, not sitting down, not putting the women at the centre of her care and listening, and I, honestly, I always run on time. But you create this atmosphere where the patient feels that she's being heard, that she's had plenty of time and that you listened and you tried to problem solve with her. But this thing of rushing in you don't even know her name, you forgot her partner's name because nobody bothered to try to get the thing she's upset. You forgot their last baby had passed away, or you're rushing and it's just like how do you promote this atmosphere of care? You know, and it is, I can tell you it's exhausted, but it's always the right thing to do and just say no, I've got, this is your time and this is sacred time, and you tell me what I can do, you know, for you.

Speaker 1: 17:28

You mentioned earlier that you were doing youth. You had struggled because you had to be on call, to have your days off for your DMP classes. So, with that tiredness which gets right into your bones at the best of times, when you're trying to then do something that involves brain cells actually functioning, how did you maintain your sanity?

Speaker 2: 17:50

Well, I'm not sure. I'm not sure I have a cohesive answer I think you know having. When you look at the studies on sleep deprivation you know at least if you have one night sleep deprivation, your mental health diagnosis has got exponentially. And I'm not sure I have a great answer to your question. I was very tired for many years and I'm not sure I was effective as a human being, let alone a provider. So I'm not.

Speaker 2: 18:27

I can't really sit here and be a paragon of virtue and say I went to the gym and I did my yoga and I did my mindfulness and because I didn't, I just remember being really tired and no, no, and actually my last job in New Zealand it was on call a lot as well, cried a lot. I remember driving into my driveway and I had been up I can't remember how many hours and then they called to say lady had been admitted with twins and I would just have to come back to the hospital. I mean I hadn't washed my two days. So the solution is to understand that that's not good health care for yourself or your patient and working to change it. But you know I shouldn't have been put in that situation, you know, by whichever system I was in. But also when you're young, don't you think, not that you're invincible, but I'm the best, I'm the best provider I could possibly no one else can, and I have the best training. I mean it's sort of I have the best training. You think that in your mind like, and also it's very, it's very egotistical profession. Yeah, it really is like the patient like, oh, thank you. So you know, they're very grateful. It's like, oh, you're the best, you know the best. You know I was like, oh, am I? Well, maybe I'm not after, you know, maybe I'm not safe. You know, I would say the patients all had good outcomes. I just want to state that for the record. But maybe I wasn't the most effective. I was not an effective, you know, I don't think I was probably a very, a very good friend during those times. I don't think I was the most effective human being because I was obsessed with working. I was working all the time. I was on call all the time. I couldn't go out for a meal, I couldn't go anywhere, I couldn't, you know, work on my own health and my own mental health.

Speaker 2: 20:25

So I think the advice to folks listening is you know, think about boundaries, I think about. You know, look at the safety. And just because you think you can do it, because you're 28 and not in my fifties, just because you can or you think you can do, it doesn't mean it's the right thing to do. And I wish, I wish sometimes I had realised that a lot earlier. But I don't.

Speaker 2: 20:54

I haven't got a panacea. Or you know, how do you? Because you have to achieve your objectives right when you're in nursing school, midwifery school, objw, and you have to achieve all your numbers and your objectives and your hours and make sure you've learned how to do this and that safely and competently. But how do we get there? And allowing, you know, the student to say I remember when I was teaching at Frontier, we, you know, we come up with some, just a nebulous number, how many hours that the students could be at work for, yeah, or up for until they had to take a break. And I don't know about Australia.

Speaker 2: 21:35

But but then say the baby's about to get born or you think it is.

Speaker 2: 21:39

You know, that's like.

Speaker 2: 21:40

You know, when I was a student, you'd be like Mrs Lady, she'd be like oh, jane, will you just stay?

Speaker 2: 21:46

Of course, I've been with you all day we've really bonded like I should stay, but then it'd be like 7pm and you're going to be back at work at 7am but then oh yeah, oh yeah, I think she's about to deliver, have her baby and just stay, and then it'd be like midnight and then she'd have maybe an intervention to deliver the baby.

Speaker 2: 22:05

It'd be like 1am and you get to bed at like 2 or 3. And then you have to be up again and you have to be just as effective the next day but you're exhausted because you only have like three hours or four hours sleep. So yeah, trying to write policy about that and one of my dear friends actually has done lots of researching into safety and related to midwifery students and I know a lot of them work in different settings that it's not safe to be up all night and up all day and then think you can make coherent decisions about anything, let alone another human being's healthcare, in a very acute setting. May I say so sorry, I know you're all waiting for the answer, but the answer is acknowledge your limitations and know that the next person could be even more effective than you could, especially if they've slept all night and are in a good mood and have had a shower.

Speaker 1: 23:07

That's always good. You feel amazing after that. No, but that's it. There is no one panacea for anything. It is about how everyone individually kind of copes, doesn't cope, how anything they are able to have the insight, and sometimes you don't, because you're so. The life just doesn't allow you that flexibility. But let's go on to something happier. How did you celebrate when you finally finished it, you graduated? How did you celebrate it?

Speaker 2: 23:35

Had a big party. Excellent, it was great. So then. And so I said, oh, my friends, we were all local to Gainesville, so we all, and we all were doctor named tags and there was a lot of people that were also doctors about everything and anything, whatever their doctorate, their terminal degree was in. And then my neighbour he's got many honorary doctorates because he's a physicist, so he had this massive big hat. So I was talking about wearing the big hat, big velvet hat. So for those of you who don't know, typically it was recognised whether you have a doctorate. You can wear a velvet hat. So this massive. So I walked around all night wearing this massive velvet hat and I have a velvet hat now. So I do like, for those who don't know me, I'm a, you can't see me, I'm sorry, but I'm a fashion victim, as they say. So I like to dress up, so I do like a bit of velvet on my head. So we had a massive big party for all of us and our professors came and it was the first class. So, unfortunately, parents were no longer with us when I qualified, because I know that I think they would have been proud, even though they are very eminent children, other children and siblings, but I was very I was very full of joy. I'm still full of joy. It's one of the best decisions I've remade was to do my DNP, so and it's helped me a lot.

Speaker 2: 25:00

I do a lot of advising now, career advising for many people actually, and not just in midwifery but other walks of life. How do you write your personal statement? How do you think about what you want to do? What are your goals? Thinking about that, how do you? I mean the life coach, but I'm not really. I just do it because I love to put people together. That's my thing. For those who don't know me, I have my own roller decks in my head like who would work well with this person and writing and how do we write effectively in our career? And how do we affect change as academic, academic midwives? How do we? How do we change the world for the better and get sleep at night? That's the key, yeah.

Speaker 1: 25:45

That's the elusive thing. So you've been involved in quite a lot of things since. So what are some of the things that you're really proud of being involved in or that you feel have made the most impact since your DNP, apart from the fact that you've now got more midwives that you're working with in your area?

Speaker 2: 26:05

Well, you already referenced, the main thing is that we actually are able to provide midwifery care at the hospital where I currently am back working again. So when I took over the nurse midwifery program at the University of Florida, it was actually the program I'd done my master's in. I was very proud that I converted that program to fully online in three months, which is pretty amazing considering I got no help and except I had a great IT guy that would help me. But that was a big achievement. And having a very good program within the state, which unfortunately was closed. He's constantly looking to better the profession of midwifery. So, working a lot with the state and National American College of Nurse Midwives, working on policy. I'm very proud of the things I achieved on that level Writing professionally, being published, making changes, like you know, writing about things that interest me and then and editing, reviewing, being immersed in midwifery and maternity care and thinking deeply, being involved in policy in the state. I'm one of the leaders also. I was a leader at the. There's a very famous school here for the licensed midwives. It's called Florida School of Traditional Midwifery. So for many years I did that. I was the board chair there to improve midwifery standards within the state and nationally.

Speaker 2: 27:44

So thinking not just and again it's backed by for the common good, dedicating your time, you know, as somebody that views themselves as a human in the world, not just within Florida but internationally. How do we, you know, for our sister and brother midwives, how do they have get the advantage? I mean, I had so many advantages as someone with my education that was able to, you know, you know read and write and all these things. I was already ahead of the game when I went to university. How do we, how do we, assist colleagues to publish and write and knowing that? Again getting back to the point of fact about maybe you know that maybe the patient it would like if their midwife looked like them, you know, came from a similar culture.

Speaker 2: 28:45

Acknowledging that I'm quite proud of, you know, working within a very diverse setting. Now, most of the OBGYN residents and midwives maybe, well, none of them sound like me because I'm not Scottish, I know, but I'm quite proud. I just actually got a teaching award. I'm very proud. When my I think I'm quite a good clinical teacher I was, you know, I often referenced my former teacher in Scotland but she taught me so much about, for example, palpation, palpation of the abdomen. Oh, thank you, but things like that, just acknowledging that you know my work within the community, like you know, trying to talk about the importance of community care, I mean that would be my one of my ambitions. They're a lot like I want to restart a midwifery program within a floor. I want to be an effective friend and teammate.

Speaker 1: 29:56

I would like most of our clients to achieve the birth that they would prefer and you're also working with international colleagues too much and helping them and mentoring international colleagues with their research in other countries.

Speaker 2: 30:10

Well, that's right, that's right. So if you think about us, like we're very lucky, we have stable internet, look, we're looking. You're talking to me in the middle of the night, you know, and we can because of Zoom and all these great things. But acknowledging that, it's okay if somebody asks you for help, like you need they may not know how to set up a research study, and that's things I can do to help because I know how to do that. I know how to how to analyze data, I know how to present, I know how to say look, this in this setting, this is what's effective because I don't know like. So we have a project in Peru that's been very effective. It's about hemorrhage calculation of postpartum hemorrhage. But just being approached and it's such an honor to be approached by colleagues to say could you help me problem solve? And I think I'm quite, I'm quite good at problem solving If somebody comes to me and says I have a really good example. Even, how do you speak to patients?

Speaker 2: 31:13

We had a patient that came in that was given a medication the day before that she wasn't supposed to get because she's pregnant and it was not, and the poor young lady had never really, and this patient was quite angry. She could you come and help me. And I said, of course, and then just sitting with this patient and and you know, drawing the boundary that you know I know you got that medication yesterday but unfortunately we're not providing that shouldn't actually be given. But these are the other things that we can try for you. And also she was exhausted.

Speaker 2: 31:46

She had another little baby there with special needs and she was hungry and she was angry and then we got to a point where we could actually all not be friends. I mean, it's not, that's not the point, but just be just hearing. So trying to trying to allow folk to understand how to hear, because it is exhausting to absorb the hurt and the trauma and the everybody else's needs, and then analyzing and then working out what would might be the best solution for this issue right at hand, right now, acutely, but I'm sorry I got way off the point there, but it is just a good example of the reality of it, but also leads me to the next question is how did you get involved with the Virtual International Day of the Midwife Conference, because you've been involved in that for quite a few years too, so how did that come across your radar?

Speaker 1: 32:46

And then, what made you step up to actually be on the committee?

Speaker 2: 32:50

Well, that's another great question. So I maybe I shouldn't I shouldn't tell the answer. It's kind of a wee bit. It's a wee bit circuitous. So for those of you who don't know Linda Wiley, linda Wiley is an amazing editor. So we've got a wonderful journal called Midders and Linda was the full time editor and I had approached her when I finished my DNP. Of course we all like to get published. We like to see our name in lights. I've never published anything. And she said this is a great topic, we could turn it into two articles and blah, blah, blah.

Speaker 2: 33:29

So that time Linda was involved in Virtual International Day of the Midwife, vidmorg. Check us out, I'll put the link in the mind. Sent in an abstract. Yeah, please. So this is. I don't know how many years ago was that. That was 15, probably. She said this would be a really good presentation. You should submit an abstract. So I said, all right, that's fine. So it got published. And then she said you should present on this. It'd be a really good topic. So probably 13,. Was it 13 years ago? Yeah, it'd be 13 years ago. I presented, actually at VIDM as a presenter, loved it.

Speaker 2: 34:06

And then, when I was a current member of VIDM, dr Cecilia Jevitz had been my mentor. She was one of my professional mentors when I was at University of Florida. She was an adjunct teacher, so we'd all stayed in touch and became quite good friends. And she was taking her sabbatical she was actually teaching and she'd gone on sabbatical, so she actually suggested a temporary replacement for a year while she was away. So I guess the committee took her recommendation and I never left. So so, but again, about six degrees of separation.

Speaker 2: 34:55

Being an international midwife, I do know quite a lot of useful people and I know how to put people together. So I think that's been really helpful for VIDM. How do we make these relationships with people that can then have, you know, like educational experiences or learning how to present, or learning how to write or do anything like that? So yeah, that's how I joined the committee. It was kind of like because I never left, they never asked me to leave, so obviously doing a good job. So, yeah, seal came back. So anyway, I just love it. What is?

Speaker 1: 35:40

it about the format, because it's a 24-hour live format and I do have to put a disclaimer that I'm also now on the committee, having worked for as a facilitator for a couple of years. But what is it about the format of having a live free conference that keeps you engaged year on, year out to? Actually, because it's a lot of organization, it's a lot of stress for the 24, 36 hours that it's actually happening. So what keeps you still involved?

Speaker 2: 36:13

So I mean, it's a million dollar question, right, because we don't get paid. Fyi, this is purely for the love of Midwifery, it's purely for the passion of what we do. And you know, I would say, look, midwifery has given me a lot more than I ever gave her. She's a very demanding task, mistress, but once you get involved in Midwifery, I think it's in your blood and you know something like the IDM. As I said, I was very lucky. I was able to learn to present and edit and write. And then I think again about the common good, about giving back, so being able to facilitate, like we have farmers from Kenya or our mothers from London who are our facilitators you don't have to be a Midwife. So if you're listening to this and you're like, oh, this is fascinating, please, please, please, you can. If you have an interest in women's health or birth specifically, you can, you know, be involved and it's great, and I think it's.

Speaker 2: 37:21

You know, I found that I'm very good at facilitation. I really enjoy the back and forth, like now. So now when I go to conferences, I'm hypercritical. Like when I go with, there's poor moderation. Like you know, I'm going to be speaking in a couple of weeks and I'm hoping there's good moderation, because I think a set and up, setting the room up, having the conference you said, is, you know, about having utility, that the speakers are heard, like their microphones, at the right level, the audience is focused on them, they have good slides, that kind of stuff, like like effective learning.

Speaker 2: 38:06

So we get back to the actual nexus of the original question perhaps is about because I feel I'm a good teacher so how do we effectively learn to be facilitators and presenters and you know having our ideas? So it's back to QI again, right, how do we get these essential questions which you know when you think about it, we're still asking very similar questions for the last thousands of years how do we birth, how do we birth effectively and how do we return from this journey, this greatest journey in humankind as to parenthood, motherhood and fatherhood? How do we come to that understanding of that? Whatever way we get there? But the point of the IDM is that it's accessible anywhere. You know we've had people from Iran, china. We've not really gotten to Eastern Europe so much, but South America, north America, western Europe, asia, australia, new Zealand. How do we have this global reach and allow or not allow, but Enable, yes, allow. We have. Enable, that's a great word, but hearing these voices that I haven't had. You know, can't afford conferences. I mean conferences now on this side of the pond are ridiculous. A lot like, maybe over a thousand dollars.

Speaker 1: 39:32

Conferences. Attendance at conferences is for the privileged, absolutely it's for the privileged to be able to go to a conference.

Speaker 1: 39:39

afford the conference that was. I think one of the good things about COVID was when the conferences went virtual. It opened up the audience to so many more people, and I think I attended so many conferences and online sessions during 2020, because I could do it from my study here and I could sit at my top. Granted, most of them were in the middle of the night for me because of the Northern Hemisphere. But now we're going back to face to face and we're stopping the hybrid, so we, once again we're becoming elitist in who can actually attend.

Speaker 2: 40:12

Right, right, and that's also a really good point. I mean, you think about educations for the rich, you know especially. I think about America. I mean, you know the currently, where I now work, the residents are paying a lot of money and I have to sign a contract. It's funny, but it says blah blah, you're now associate professor, blah blah for zero dollars. Yeah, we actually signed contracts for you know. Again, devaluing stuff, but that's my role. Now I feel myself as a elder.

Speaker 1: 40:51

Yeah.

Speaker 2: 40:51

I feel myself as a midwife that my role now is to pay it forward. Yeah, back to the you know, because, well, I'm probably never going to retire. I'm going to be like my hero of all time, my heroine, ms Phyllis Lynn, who's been a midwife for over 50 years and she's running the Midwifery Service at Monodys, which is not a small place in New York. Amazing, midwife, and thinking about your commitment to your craft, I think it's like I don't know. You know, when you think about people and like famous people and all that, like, oh, they're so committed to their craft, like a famous actor, a sports person or an artist or. But the commitment to your profession, I think, is something I try to really, just because you know, oh well, it's terrible here, and like, well, it's not terrible here, and these are the reasons why you're providing really good care for women. You have really good outcomes, the patients are satisfied, you know we're having joyful births, the moms and dads, the families and the babies are healthy and well and they're going to be effective members of society. So we're doing a good job.

Speaker 2: 42:03

And again, getting back to the basics, it's really basic, but just saying this is how we can move our profession forward and knowing that we have the research, the data, we have the science, we have the art, and it's exhausting and, yes, it is really tiring and it's OK to say I'm tired.

Speaker 2: 42:25

Could you, could you sub in for me, because I've been up for a day and I'm not being effective now and knowing that the health system can deal with that. But until we get proper resources and acceptance that birth is important and it's so important, especially for our populations and I'm sure for your populations, that there's lots of inequity and uneven outcomes and all that, but getting to more equity, the understanding of humanity, that we are all part of this human race. We are all here, we're all just trying to do our best and I think that's the acknowledgement that we need to make as providers, that it's not about us. It's about listening and hearing and getting getting to that OK idea that that we should have yes, exactly, and that the patient should be birthing whatever way that they would choose.

Speaker 1: 43:23

So what's next for you? What projects have you got going at the moment, or what projects would you like to kind of look into in the future?

Speaker 2: 43:34

How long have you got? Never stops for me. So I think you know I talk a lot about trauma, informed care. So when you hear about perhaps second victim trauma for those of you who haven't heard about that we do know from the data now that from our constantly exposed trauma, for example, as we know, obstetrical emergencies are real. There are problems. You know we've. You know we've seen patients and babies, you know, not make it and it's terrible. You know we come in and the ladies baby has passed away in utero and you've got to go in and deal with that, but then you've got to go into the next room and be oh, yeah, great.

Speaker 2: 44:19

Like everything's great, everything's so talking about that. So that's one of my research interests is caring for the carers. So accepting that, but how? And I think it's really, it was really pressing. You asked me the question about how I looked after my health, but I found that, especially as you get older, midwifery is very for those of you out there news flash it's basically demanding, especially as you get older. So, being healthier, you know doing yoga, doing mindfulness, but acknowledging that I want my career to be a long one and already it's been quite long, but you know how to be an effective carer. So you know trauma, informed pedagogy, like you know talking to students. How do you learn effectively when you've got severe trauma and that you can't hear what the professor's trying to say, because there's something that we don't really actually sort of trigger anymore, but there's something that we're talking about that's a very sensitive topic for you. How can you hear when you've maybe been through a similar situation? How can you learn so that and we're also looking at that generally among nursing students as well about equity for nursing students and effective learning for nursing students and not just midwives and OBGYNs, because we are also.

Speaker 2: 45:50

Disability is a big thing, whatever we term. How do we you know we can think about, there's very few midwives I'm aware of that. You know have a visible, let's say a visible disability. But how do we, how do we have access for people that you may not know they could be a midwife? Well, they could be. That would be fine, just because maybe you have a mobility aid. How do you, how can you be an effective provider if you have limited mobility, like so? We're getting more into that. I'm also still pursuing my pipe dream of water birth and you know, having. We still don't have. I don't even know what to say. We still do this nitrous. I mean, things have changed.

Speaker 2: 46:38

My eminent sister was doing a study in the 1970s at Edinburgh University. It was called the Hoop trial. You may have heard of it. It was hands off or hands poised and her whole population study. After two years of very hard work, one of the doctors she worked with decided he wanted to look it. I think it was some something adjunct to that. So her whole study went down the tubes.

Speaker 2: 47:05

So I think acknowledging that midwives can do at least as good scientific studies as doctors is really important to address as well that our data, especially if you think about the qualitative data from Canada, about listening to mothers, I'm thinking about all that. You know the qualitative studies in maternity are essential. We want to hear from mothers. It's fine to say, well, I think you know slight apesia to me when I it's that long ago it was, we weren't automatic, but we did a lot of apesia to me and all the things we shouldn't have done. But, you know, having applying the data because we have, as you said, so much good data that we should be using her brain I say I'm sorry, my dad, I don't know what to turn my dad, you're returning to our parents Before, before you do something.

Speaker 2: 48:00

But you know, I say that you know why are you doing that? Like, think about, I just remember in Scotland it was really interesting when ever before you did a examination of a patient cervix, you had to write an objective reason why Nice? And then I go well, I go to Jacksonville, Florida, and they're like oh, it's two hours since we checked her. And I'm like wait, what? Oh, yes, that's what we do here. And I'm like why? Geez, at least before hours. It's like why, why? Yeah, like I love asking why. I'm just like why, why are you doing that, Like you don't need to do that. I must be rather annoying to work with because I'm always I'm like a little two year old why, why, why, why, right, I was like you know the why, but the rationales are important.

Speaker 1: 48:49

The rationales are important, of course they are?

Speaker 1: 48:51

Of course they are.

Speaker 1: 48:52

You need to know the reason why you're doing it or, more importantly, you need to know the consequences of not doing it and you need to be able to ask, to be able to explain that to somebody.

Speaker 1: 49:03

And that's not bullying, that's actually knowing that you actually are safe to do your, to do that task and to do your role.

Speaker 1: 49:10

I remember talking to Franka Carey when she was still the ICM president, when I did her interview for the podcast, and this was 2020 was the year of the nurse and the midwife, and then COVID exploded, showed to the world how important we were, just in case they didn't know. And then 2021 became a second year of the nurse and midwife, and then Franka said that she actually felt that this is the decade for midwifery research. And when you think about what was happening, you think about we already had the Lancet series in 2016 that showcased the evidence up until that point. And then, if you look at what we're going to be generating now and what we can produce, we're going to sit back at the end of this decade and have an amazing amount of research and evidence, but have people like yourself who are at the tables, who are actually using that research and discussing it and being able to make those changes for the profession in so many different areas.

Speaker 2: 50:09

Right, but I don't think we ever sit back, do we, as midwives are always like right in there, right you?

Speaker 1: 50:15

can't sit back. I can't sit back. Thank you so much for your time and your enthusiasm.

Speaker 2: 50:23

Well, thank you so much for all your time and your enthusiasm. You're a very dear friend and colleague and I'm so honored to know you and appreciate. And thanks to everyone out there in podcast land. You can't, you don't even know, even the youngest, the least experienced of all the all you are making a difference. So never, never, underestimate your power to make a difference in each and every one of your patient's lives. And thank you again, liz.

Speaker 1: 50:55

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.