Ep 70 Megan Arbour From Music to Clinics to the Classroom

Ep 70 (ibit.ly/Re5V) Megan Arbour From Music to Clinics to the Classroom

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Have you ever been so captivated by a story that it altered the course of your life? That's precisely what happened to Megan Arbor, a nurse midwife with an inspiring journey from music education to the heart of midwifery. Her tale is one of remarkable dedication and transformative education, and she's here to share the challenges and triumphs she encountered as she pursued advanced degrees by her late twenties while balancing family life. Her experiences in under-resourced clinics and her academic evolution offer invaluable insights into the rigors and rewards of midwifery.

Imagine the complexities of navigating not just one, but multiple demanding roles in midwifery and academia. Megan Arbor does just that, as she peels back the layers of her diverse career which sees her juggling clinical duties with teaching responsibilities. Her expertise illuminates the nuances between a PhD and a DNP, and she introduces us to the exciting prospects of the emerging Doctorate of Midwifery. Megan's story is not just about the individual journey but also about the broader implications for policy and practice in the evolving field of midwifery. 

We wrap up with an honest look at the current landscape of midwifery, where Megan confronts the issues of misinformation, burnout, and the critical need for supportive environments within the profession. She's not afraid to dream big for the future of midwifery—a future that values diverse contributions and ensures the well-being of those who have dedicated their lives to this vital work. Join us for a conversation that's as enlightening as it is heartfelt, shedding light on the resilience and adaptability required to make a lasting impact in the world of midwifery.

Transcript

Speaker 1: 0:27

Thank you very much for joining me, as per usual. Can you introduce yourself, please?

Speaker 2: 0:32

Sure, my name is Megan Arbor. I am a nurse, midwife and a certified nursing educator, and I have my PhD in nursing from the Ohio State University. I am faculty at Frontier Nursing University, which is a distance based institution in the United States. It is housed in Kentucky, but we have students all over the United States and in some military installations abroad. Not cool, yeah. Where our students come, we only teach graduate nursing students, and midwifery in the United States is a master's degree or higher. So the program I teach in currently is the DNP, the Doctor of Nursing Practice Program, and my specialty is evidence based practice.

Speaker 2: 1:19

So I'm delighted to be here today, yeah.

Speaker 1: 1:22

Excellent. We're going to have possibly lots of chats, maybe not necessarily on the one episode. So, jane, as you know, jane was one of your co-workers. We ended up doing a double episode for her because, especially in the American system, it is so different to what a lot of us are used to in the healthcare system, but also the education system as well, in particular for midwives. So I think that was kind of quite interesting to get a basis on. Let's go right back to the beginning. How did you get into midwifery?

Speaker 2: 1:50

Well, let's go back even further than that. My bachelor's degree is in music education and I was a music teacher. I taught K5, k5 elementary general music. And when I was doing my music education degree I knew it wasn't really the right fit. I didn't want to do it, but I did want to be able to graduate, get a job and not move back home with my parents. So I proceeded with music education.

Speaker 2: 2:20

I did get accepted into a prestigious midwifery education program for right out of my undergrad, but they wanted way too much money and it was just not a financially sound choice. So I went and taught for a year at a school in rural South Carolina, in the Dane South, and every morning I prayed that an alligator would be on my doorstep so I wouldn't have to go in. Oh, that would happen. Yeah, it was that awesome. It was so fabulous. In the evenings I would take prerequisites anatomy and physiology and such so that I could apply to a variety of other programs. And then I applied to the Ohio State University and they said we would like to pay for you to come to school.

Speaker 2: 3:09

And I said I would be delighted to come. Yeah, we not only want to pay for you to go to school, but we want to give you a stipend and I said it's old, yeah, so that was really good.

Speaker 2: 3:21

So how did I know midwifery was the calling for me? I actually lived in Scotland for four years when I was growing up. My dad was a dentist with the Department of Defense, with the US Navy, and I'm one of four. My mom had a birth in Scotland with the midwives and it was her best birth and so I remember her talking about that.

Speaker 2: 3:44

When I was growing up and would have, you know, career day at school, I would always come home and say I'm going to catch babies, this is what I'm going to do, and my parents were like, okay, you know that, when the family doctor had come on, or or, you know, come to talk to us or different things. So I was passionate about it from a very early age. In high school I had absolutely horrendous biology teacher who made me doubt myself and believe that women can't do science. I went on to win, like, the high school science award and I was a salutatorian of the school and you know, like I. But he changed my career trajectory from sciences to music because I was also good at music. So I did music and then, like, I listened to my heart and I went to midwifery.

Speaker 2: 4:33

so my midwifery education program was the graduate entry program because I already had a bachelor's degree in another field. It was a three year program. A year and a half would take me to the nursing degree and then a year and a half after that the masters. So it was a busy, busy program and for somebody with very little. I mean, I'd done a lot of volunteer work in hospitals and I'd spent as much time in the birthing spaces I could, but I didn't get all of those degrees and credentials and things until my master's degree.

Speaker 1: 5:09

So what kind of still resonates in your, I suppose, mind and heart about your training course, your education in becoming a midwife?

Speaker 2: 5:20

Looking back on that one, Well, yeah, so I really I had an in person midwifery education program, so I teach at a distance based program now. I work from home and I am not clinical right now and teaching is my jam and I think I knew when I was doing the music ed that like I liked the teaching part of it but I didn't like the subject area right. So, but the educational psychology and methodologies and things like that they transfer very nicely. But my midwifery education program was a small cohort. I think we had like eight students and I'm still very close friends with a couple of those midwives.

Speaker 2: 6:03

I think being together, learning new things face to face, was essential for me and I've come to realize that if I were confronted with a distance learning opportunity versus an in person opportunity, my brain would work better for the in person opportunity. But I certainly understand that our current students they have so many competing obligations and responsibilities Like work, kids, family, all the things they wouldn't be able to do it. So the other thing is is that I compete completed all of my formal education by the time I was 29. I graduated in December and had my first baby in March, like. So I was pregnant at graduation. So like I got the PhD done, I got the midwifery degree done, like I got it all done, because I knew like it would be impossible to come back.

Speaker 2: 7:00

Yeah like not impossible but really hard to come back after. So but I I think I look back on my midwifery training and I realize how much of the education really depends on the quality of your preceptor. Yeah and the relationship between the student and the preceptor, and whether the preceptor really understands you as a person or are they teaching you in a way that reflects the way that they were taught? And because I had excellent preceptors and then I had others that I struggled with.

Speaker 1: 7:36

Yeah. So looking at your undergraduate, well, it's not because postgraduate, because it's in masters. In Australia we have for whether, regardless of what level it is, whether it's undergraduate, whether it's a grad, cert, postgrad the leading body for us, which is the Australian nursing and midwifery accreditation council. We have to do a certain number of births complex vaginal births, postnatal, anti natal visits, things like that. We have a prescribed amount that everyone's, regardless of whether you're doing it in one year or three years, everyone has to meet the same. Do you have the similar thing going through for then, for the midwifery that you have to attend, certain number of births and types.

Speaker 2: 8:20

Yeah, so we have the accreditation commission for midwifery education ACME, acme, and oh, that's a really bad, that Well right.

Speaker 2: 8:31

It's a really good one, I know, I know. So ACME is our accrediting body and midwifery education in the United States is competency based. So the idea is that you need to do enough pap smears until you're deemed competent. You need to do enough vaginal births until you're deemed competent. However, they have suggested numbers, suggested minimum numbers, that you couldn't possibly be competent in a vaginal birth until you've had this many vaginal births. You can't possibly be competent, you know, with a breast exam until you've done this many breast exams. But the idea is that you shoot for more than the minimum right.

Speaker 2: 9:18

You get as many experiences as you can. But I had one clinical practice that I worked with that through no fault of the midwives own just politics in her office she I would drive up two hours to go spend a clinic day with her and she would have three patients on her schedule for the whole day. And that was like really challenging for me to get any of my quote unquote numbers, because I'm driving two hours up to spend a whole day and I get three patients.

Speaker 1: 9:48

Yeah.

Speaker 2: 9:50

That was, and I think that contributed to her stress too, because working with me, because she wanted me to have the best experience, but she didn't have the patients herself, let alone.

Speaker 1: 10:00

Yeah.

Speaker 2: 10:04

She didn't have the experience that she wanted to teach me with, so that was challenging. But I live in Ohio and I went to school in Ohio and the midwifery space in Ohio we have. Case Western University in Cleveland has a midwifery education program, the Ohio State University in Columbus and then the University of Cincinnati. Those are three midwifery programs in addition to frontier. They have two programs competing for preceptors in Ohio and that's part of the challenge of being a program director. For sure is finding good preceptors for your students, because it really does significantly impact the quality of their experience.

Speaker 1: 10:45

Do they have the same preceptor for the whole of their placement clinical time or it's just dependent on the venue that they go to? They get matched up to one.

Speaker 2: 10:56

And I think the our accrediting body doesn't care. Each school is kind of different. So I teach now at frontier nursing university. Previously I taught at the University of Cincinnati and then of course, I went to Ohio State. So they all have different ideas of what the expectations are and I think that's really good to have more than one preceptor because then you get to learn.

Speaker 2: 11:19

Yeah, you get to learn what you want to do as well as what you don't want to do, and you get more than one role model and more than one network experiencing, a network experience. And then you also get the opportunity to you know, perhaps see some out of hospital birth which we have very, very very very little of here, comparatively so.

Speaker 1: 11:41

Oh. So where did you end up working then after you finished your initial midwifery qualification, or did you go straight up with the H3? Sure.

Speaker 2: 11:53

So I did my initial midwifery and I worked at a federally qualified health center in Columbus Ohio. So I worked. It was a series of six clinics in the scariest locations. When I think back on it now, the buildings were not sound. You look across the street and see drug deals going down like gang violence in the area constantly. When I think about now like yeah, I left there at 5.30pm and it would be dark outside in the winter and are you kidding me? Like I actually worked there.

Speaker 1: 12:34

Did the clinic have any trouble from the gang members or from criminals, or was there a default respect?

Speaker 2: 12:41

For the most part we were like, yeah, we were like a safe haven kind of place that we didn't get. We didn't have trouble or violence there and you know, people came to us, even if they were fearful of immigration control people, because we were that safety net clinic. I did lose, like I had a headlamp that I would use because we didn't have a goose neck lamp. So I had a headlamp and I had set it down in like after I had taken it off because I was sweating and it was a hot day, no AC in the space and I, after I had done an exam and I was doing something else, I had taken it off and put it on the counter and then I left the room for the woman to get dressed and when I came back it was gone and they're like no, it's not. And I'm like I know I left it here, but really they probably needed it more than I did and they probably sold it or used it, you know, but it was.

Speaker 2: 13:46

That was the environment where you couldn't really trust that what you would leave there would still be there. And what I really struggled with was I. You know, once I had my feet under me as a new midwife, I wanted to be able to take on students, but the rooms that we were seeing patients in were barely big enough for me to walk around the bed, as you know the table, then to have a student in there as well, so that was challenging. But yeah, that's where I worked and I and I worked there full time while I was working on my PhD, and I knew that I wanted to get my PhD, and Ohio State said we will, we have this money and we'll keep paying you. And I was like I would be foolish not to do this right now.

Speaker 2: 14:37

I would be foolish not to do this right now. Yeah, so, and I met my would be husband during the PhD program, so he was with me during my whole PhD and then we got married and we're pregnant, and then I graduated and then we had the baby and all the things and I and in my clinic job, I had asked them for six months off and they said absolutely no way, absolutely no way. And I said, okay, well, that's fine, they're like you can have three months off. And I said, well, fine, and at that point I had been teaching adjunct online for the University of Cincinnati as a professor and I upped how much I was teaching and I was able to cover our mortgage and our gas bill and several of our.

Speaker 2: 15:31

And so then, when six months past, the clinic called and said, are you coming back tomorrow? And I was like, are you kidding me? Like no, no, had you been willing to work with me from the outset, that might have been a thing, but now I'm making enough money and I'm home with my child and no, I'm not coming back. So at that point I transitioned completely to teaching and I got full time jobs and you know it proceeded from there. So so my clinical, my full time clip clinical career was very short, but I think it was what it needed to be for me and for our family.

Speaker 1: 16:12

But you also would have seen quite a lot in that time when you're thinking about that type of clinic. A lot of, from my understanding, not insured people, lower socio economics and people who were struggling in day to day survival, but also in health equity, in the poor end of health equity said, the experience that you would have got and seen right is still completely valuable.

Speaker 2: 16:37

Absolutely, absolutely yeah.

Speaker 1: 16:41

So then you kind of float. So you've already mentioned that I were extremely generous and I wish all places were like that, because that would make life a lot easier. Yeah, getting into your PhD. Had you thought about doing your PhD while you're doing your masters? Or was it because they said, look, we can support you to keep on going Well?

Speaker 2: 17:04

interestingly, during my second year of my master's degree, my job, my assistantship, was with the Graduate Recruitment Office and graduate admissions, and so I worked with giving tours to prospective students and talking to people and going to fairs. And you know, I recruited for the, for the, for the graduate programs, and so my bosses in that office were always looking for PhD students and so they're like come on, megan you know, you want to and I'm like, but I need to practice.

Speaker 2: 17:40

And, interestingly, part of my clinical experience was in Maine, which is where I grew up, which is like it was like a 16 hour drive from where I was going to school, but I went and I lived at home with my parents and I did clinicals, precepted with a midwife who was the mother of one of my schoolmates growing up and yeah, so she offered me a job upon graduation but she was only able to offer me a point six FTE. Yeah, and I. So I was faced with do I take this point six FTE and get all kinds of good experience, but really it's not a full time job? And you know, like how do I live on my own with not a full time job and I'm a single person and all of these things? Or do I take this fully funded PhD with a stipend and the FQHC? So it was kind of hard, but I think I made a good decision and proceeded with the PhD and, and you know, it served me well. It served me well throughout the years here.

Speaker 1: 18:56

Yeah, there's so many sliding door opportunities where one decision and like I'm sure there's somewhere there's multiple parallel universes where, whichever decision we didn't take, there's a version of that living off somewhere. So I'm going to bring a thesis component or a research component for your masters.

Speaker 2: 19:16

No, my master's. I had a comprehensive exam for my master's, so there was no thesis for the master's. It was an exam, but certainly I did a dissertation for the PhD.

Speaker 1: 19:27

So let's talk about that? What? Since they offered you a position, fully funded and stipend, which is absolutely the golden kind of egg to get, did you have an idea of what you wanted to study? Or was it because of the people who were there who could supervise that helped direct you into that area?

Speaker 2: 19:48

Yeah, that's a great question. So a lot of people who choose to do their PhD after they've been out practicing for a while, they are passionate about a particular area of research and they know that without a doubt that's what they want to do, and so they look at PhD programs where somebody is doing research in an area that may be able to fund them, etc. So I came out a different way because I was still relatively green, certainly, when I applied. I was I mean, I was still relatively new to this environment, but I was passionate about maternal morbidity and mortality and I was passionate about numbers and crunching numbers and using the evidence and looking at reasons for why. So I had a math minor in my undergrad, so I knew that I wanted to work with a large data set to be able to do this. I didn't want to be like some of my friends who were in the basement of the College of Nursing doing their PhDs and they were like in year six, seven, eight and they're like I got another participant this week and I'm like, oh man, I don't want to do that, like no way. No way did I want to do that.

Speaker 2: 21:09

So I hooked up with Dr Betsy Corwin, who is a physiologist. She's a family nurse practitioner and she does physiology. I think she's at Emory University right now and she was my advisor. And then I had my midwifery professor was on my committee and then Dr Pamela Salisbury was also on my committee. Marcia Atkins was my midwifery professor who was on my committee. So I had this team and Pam Salisbury was great at the large data sets. So I had the physiology, the large data sets and then the midwifery. And so then we started working on it and looking around, and in one of my classes we used the NHANES National Health and Nutrition Examination Survey data out of the CDC and looked at douching patterns in women, and I was like wow, like we can answer a question about douching patterns using this secondary analysis of the data.

Speaker 2: 22:09

And who knew that there was a data set that asks women about douching and how much and all of that? But I thought it was so brilliant, like because I wouldn't want to recruit women to ask them about douching, but there was this like data set that already existed that talked about, you know, their socioeconomic status, all these other measures that maybe would contribute to their desire to douche or not to douche, and it turned into a manuscript. So that was really kind of like, oh, I could totally do this. And so then I learned about the theory of allostatic load and how different stressors in our lives and in our bodies can contribute to poor health and how our bodies have worse health. So I created a measure looking at blood sugar I think I had A1C's and blood pressure and BMI. You know several different measures race, ethnicity, socioeconomic status and I looked at those measures using a logistic regression to predict whether these people would have been at risk for a preterm birth or not.

Speaker 2: 23:17

And yeah, it was pretty interesting. So it's no surprise then that, yeah, people who were in worse health were more likely to have or birth outcomes. I didn't have birth outcomes in the data but I did have. You know, different racial and ethnic groups had worse health. So it was kind of a theoretical tie. And then the idea would have been to go do some other like real boots on the ground kind of work to make.

Speaker 2: 23:49

But I didn't follow through with that line of inquiry specifically, certainly within my midwifery education and teaching people, midwifery. That was certainly in the background but I didn't publish then significantly on that topic. And you said you know you mentioned talking with Jane Houston. So a lot of the work that we we worked together quite a bit and a lot of the work that we've been doing recently relates to trauma, informed pedagogy and nursing, nurse, midwifery, teaching strategies and educational and that was really. You asked me why did I get the PhD? Like that was really one of the reasons is because I wanted. I knew that I wanted to teach and the DNP was not yet a thing when I was doing my degree and I knew that the PhD was a universally understood doctorate degree that would enable me to seek that kind of career.

Speaker 1: 24:47

Which brings me to a question, because the DNP is something that a lot of people don't know what it is. So what can you explain the difference between a PhD and a DNP, please?

Speaker 2: 25:02

Sure. So the PhD you have a degree in research and you're trained in how to conduct research and generate new knowledge, and I'm excited to talk to you about that. Thanks. It is a degree that is known across disciplines. My brother has his PhD in psychology, for example, but there are also clinical doctorate degrees In psychology. It's like the Psi D right In pharmacy you can be a pharmacy PhD or you can have your Farm D. So in nursing, we have the PhD in nursing or we have the DNP, the Doctor of Nursing Practice, and so the DNP utilizes the research that's already out there to improve the care of people, whereas the PhD is trained to generate the research, generate the knowledge.

Speaker 1: 25:52

And they're both level 10, so they're both deemed as terminal qualifications. You can't get any higher, so they're kind of equal at that rate.

Speaker 2: 26:01

I think it's kind of some people get both and I think, oh man, but yeah, some people get both.

Speaker 1: 26:06

It's like really do you want to? Well, I suppose it gives them credit for some work that they're doing or an excuse to focus on something if they want to get a second one. And Jane mentioned that there's also now the DNP, so Doctor of Nursing Practice is starting to raise its head.

Speaker 2: 26:26

Yes, so that is a new degree. It is not well understood or described yet. There's just a few cohorts of graduates. Jefferson University, I think Jefferson University in Philadelphia is offering the Doctorate of Midwifery and so it is just midwifery students and all of the work is focused on midwifery, as opposed to a PhD in nursing where you have to take a lot of nursing theory and nursing methodology and nursing research or the DNP, which is nursing. The DM is another version of a doctorate degree. That, again, is not well understood.

Speaker 2: 27:15

And I think, at least in the United States and I don't know how it is in Australia in the United States nursing has too many iterations that people don't know who they're working with or what you are. They don't have any idea if you're a certificate nurse, if you're a LPN, rn, associate Degree, rn, bsn, if you're an RN with your master's degree, if you are a nurse practitioner or a nurse, midwife or a doctorly perpetrator. They have no idea. They have no idea. There's too many different versions and I think a DM just adds to that mix, though the thought of midwifery specific cohort and I'm not sure if it's a clinical degree or a research degree. That's enticing, but I think there's still a lot of ambiguity there.

Speaker 1: 28:09

I think our system in Australia at least, is a little bit cleaner, that we've got midwifery. For us we've got one level and you're a midwife, but we also then have the level above that, which is an endorsed midwife, and so they're the ones that can prescribe medications, so probably similar to a nurse practitioner, so almost a midwife practitioner. And they're the ones who can also have do private practicing and do full care in private practicing and higher-up at home births and things like that.

Speaker 2: 28:42

So midwives, dnms in the United States, depending on which state you're practicing in can do private practice and we can all prescribe, but each state has their own regulations and that's what we're looking at the moment.

Speaker 1: 28:56

There's a big national survey going around to midwives at the moment looking at scope of practice and what they can and can't do, because, whilst there's certain things we can do straight from graduation and the scope of practice has been curtailed by venues about what you can and can't do, so we don't. A lot of midwives are unable to work to their full scope of practice because of the regulations that the venues and hospitals will have on and it's not without registration, because our registration is fairly clear in what we can do and we're slowly increasing, and so this is going to be the start, I think, some amazing changes in Australia in the scope of practice and recognition of midwifery, because we are still fighting probably the same as many countries that midwifery is a separate qualification and separate discipline to nursing and so many people see it as a subspecialty of nursing, and I think we were the Australian, new Zealand were one of the first regions in 2020 to actually get our research code separated from nursing, so our actually research code is no longer underneath. We actually stand alone as a separate discipline, which means we're going to fight for everything again and rebuild, but it means that the future is actually going to recognize because, as you're saying so many people don't understand the differences in the level, the terminal qualifications, and even internationally there's so many this advanced practice midwife or advanced practice nurse. A lot of people think if you do a PhD in midwifery you have to go into academia. They don't understand the clinical role.

Speaker 1: 30:30

Uk has now got an advanced practice clinical role which is looking at for midwives of PhDs but they're obviously kind of ahead in a lot of countries and a lot of areas. But it's fine to be able to do that. But it's finding that keeping those midwives who want to be kind of clinicians, who want to change practice from the ground floor or from whatever level, but not necessarily in academia, and we need to explain what those roles do and what the qualifications need to do better. So that could be a nice little bit of a joint activity that we could do, kind of like working out explaining what they do so that people can kind of understand.

Speaker 2: 31:08

Yeah, it would be hard at all right, yeah, no, just public information campaign, right, yeah, I think culturally people are like I need to go to the doctor. So they look for a doctor, right, they say I need to go to the doctor and they don't know necessarily what the differences are. And then until very recently, in Ohio you can they license and acknowledge certified nurse midwives, but not certified midwives which have the same training but aren't nurses. And they don't acknowledge in the legislative code certified professional midwives or other midwives who are practicing in Ohio and calling themselves midwives and perhaps doing home births or birth center births, but they're not regulated. And so people think of midwife and they think of this person down the street who really doesn't have any business doing what they're doing because they don't have the training, the insurance, the backup, all the things, the safety nets, and so that's really a challenge.

Speaker 1: 32:13

I think that's one of the things that we've got here is to call yourself. It's in law that to call yourself a midwife you have to have a recognized training and be registered with the health board.

Speaker 2: 32:27

It's interesting and I know people are still trying to get around it and we have a lot of maternity care deserts in the United States where you have to drive 40 minutes to an hour to two hours to find a maternity care provider or a hospital.

Speaker 2: 32:41

There's a new practice that's not a new practice, it's probably as old as time itself practice but it's called free birthing. We're birthing without anybody there with you at all, and so the question is is that better, or is it better to be free birthing, or is it better to have some marginally qualified person there with you? And I don't know the answer to that question, but that's kind of the situation that exists.

Speaker 1: 33:10

We saw an increase in free birthing around COVID, especially with the restrictions in COVID and who could come in and support people and partners not being able to stay. But yeah, and when you look at the conversations that are happening online and you look at some of the research that comes out about the women's experiences of being in health care settings, of obstetric violence, of the birth trauma and of the levels of PTSD, it's easy to understand why women choose that route. If they're not going to be respected in the people that they're supposed to trust, then why would you go back? They're a second time.

Speaker 1: 33:50

But then you've got the extreme free birthers who are going oh, I'm going to go give birth in a river or a creek which looks pretty and looks all mystical and magical, but then you just sit there going that water's cold, that baby's come up your cold, and then you just think of all these kind of physiological things that poor baby's going to go through in that first few minutes because they're kind of taking photos or whatever. It's just like just get that baby warm. But yeah, so you've got the same issues. But OK, we see an awful lot about government politics changing of rules. We won't get into Roe versus Wade overturning, because that's a whole conversation in itself and the after effects of that. How do you deal with that as a practitioner, but also as an educator, when you know that you're trying to teach students best practice, evidence-based practice, and then you're hearing all this basic kind of garbage that is anatomically impossible being spoken to people who are making laws? How do you?

Speaker 2: 35:03

keep saying. So I have a few things that I juggle on a regular basis. One is that, like, the practice environment you're going to is not an evidence-based practice environment. How can I teach you to be smart and use the evidence to take care of your patients? How can I teach you to impact change in your clinical environment to reflect the best evidence? That's one.

Speaker 2: 35:28

The second thing is that I struggle with is that midwives are leaving practice Like it's a problem, and it's not just a problem in the United States, but midwives are leaving practice after not long of practicing, and so we're busting our humps to really get midwives trained and get them licensed and credentialed and out in practice for them to burn out and fall out of the bucket within five years, and I have a major problem with that, empathetically, like we're not teaching them for the real world of what their job will be. And so how do we practice midwifery in a way that meets the demands of the people who need midwives the women and the families and how do we change the culture of clinical practice so that we don't lose all these baby midwives and all these new midwives from clinical practice? That's a huge issue, but certainly teaching evidence-based practice. One of the big things that the students learn in my class is that everything that's published isn't necessarily true or good, and just oh yes.

Speaker 2: 36:48

Right, like that's one of the big things.

Speaker 2: 36:50

You think that because it's in a journal and an editor reviewed it and it's been peer reviewed and it's published, that doesn't mean it's any good at all. And we spend a significant chunk of time looking at the methodology and they're like just get to the results. Well, the results don't matter if the methodology sucks right. And that's really hard to digest because we all have those stacks of journals that are piled up on our bedside table or in the restroom or wherever and you might read an article here and there, or you might just read the title, or you might just read the abstract. But we can't practice by just reading the title or the abstract. You have to really think, and so really turning on that critical eye is really what I try to do. But then they go beyond my class and they have to learn what their preceptors are teaching them, and it may not be the evidence that's best. But, as I said, you learn as much what you do wanna do as what you don't wanna do, and I think that's important to recognize.

Speaker 1: 37:50

And it's not just the professional journals that they need to be able to critique as well, and we've been having some fabulous conversations with students here that are looking to do their honors next year and we're gonna have a fabulous research.

Speaker 1: 38:03

The topics that they're wanting to do are just so exciting but also social media and looking at the influence of social media, because that's where women are getting increasingly getting their information from, and especially when you go okay, you've got Facebook, then you've got Insta, but then you kind of look at, the younger ones are going to TikTok, and it's really cool to see an increasing amount of health professionals who are taking the jump in to TikTok by refuting the evidence and there's a couple that I kind of follow as well and so they'll end up doing stitches. Somebody will put up with this information and then someone will come across and stitch it in and go right here's the real truth about this and this is where you're gonna do it. Here's the evidence to it, and it's like nutrition and exercise. So it's really cool to see this counter kind of community happening that is kind of coming from truth-free to now credibility of information coming back again.

Speaker 2: 39:01

But also in the language that the consumers are communicating in, which is really essential. Yeah, TikTok is you know, I think it's taking our attention spans down significantly, like the reels and the TikTok. I think it's really so. When we're teaching, we can't give an hour lecture, we can't give a half an hour lecture. No, like, the attention span is no longer there, which is really interesting.

Speaker 1: 39:28

And it forces us to look at who we're teaching to. They all grew up with Google. They grew up with like internet, where of, and now it's like it's just secondhand knowledge. And yet they've got so much knowledge that they difficulty in actually working out how to bring it down to what's actually real and what's not, which adds to stress and sanity. So let's kind of go back to your PhD time. You talked about your supervisors and how that they were relevant to different areas. So doing that three times three for three years, full time, meeting your soon to be husband and then kind of getting married and having a baby. How did you balance your sanity during all of that time, when we know that PhD is the hardest time for a lot of people? Right, I didn't.

Speaker 2: 40:16

So one of the things that my body does when I'm stressed is I sleep, walk and talk. Oh, wow, and it's really fun. So when I was living on my own, I ended up putting one of those. The apartment that I lived in had like an interior hallway and then you open the door, you close the door, the door's locked because it had like a key card and so you can't get back in. So I put an alarm like a door chime on the door, so that if I opened the door I would write, because more than once I would go to bed in my bedroom and wake up in my living room there are only two rooms in my apartment.

Speaker 2: 40:59

I would go to bed in one room and I'd wake up in another room. No idea how I got there. One time I went to bed in my bedroom and I woke up and I was throwing all of my pajamas out of my pajama drawer, no idea why. I remember vividly in our first home we rented a home together after we got married my husband and I and I remember vividly waking up and snakes were coming out of the ceiling at me, like terrifying, like falling out of the ceiling, like snakes coming at me. When I finished my PhD, all of that stopped.

Speaker 1: 41:35

Wow.

Speaker 2: 41:36

That was my brain saying, hey, woman, this is too much. Like this is too much. But I would talk in my sleep. He would say, hey, did you know that? You were? No, so anyway, my undergrad roommate I had the same roommate all four years and she would say, hey, I wrote down what you said last night because it was hilarious, Right. So like school. Yeah, great, Right. So that's what my brain and body do when I'm stressed, as I sleep, walk and talk, and it's kind of weird. And if I'm sharing a room with somebody, they it's obvious to them. But that has stopped since, Since I finished my PhD. So I would say finishing the PhD was harder than a protracted birth with a giant baby and no epidural.

Speaker 2: 42:27

Tom took me to a baseball game and I had my comps or something the following week and I could not relax at the baseball game At all. I was just like, oh, they took me to the gym. I was like, oh, I'm going to be in the gym. I was like, oh, I'm going to be in the gym. I was like, oh, I'm going to be in the gym. I was like, oh, I'm going to be in the gym At all. I was just like, oh, I need to get home and study, Like, oh, this is yeah, it was awful, it was not fun. So I really really really worked hard and I I was glad to be able to. You know, I was practicing but I was and I was doing school stuff, but yeah, it was really hard. It was really hard. It was a degree of perseverance, more than anything else.

Speaker 1: 43:21

And I think that's one of the things that has come across in almost every interview that I've done or every chat that I've done is it's PhDs are not about intelligence. It's about determination and perseverance and stubbornness and the people that you have around you. It is that all encompassing thing that, unfortunately, people still think that they're not intelligent enough to do, and that's the issue with it. So how did you celebrate when you finished, apart from getting ready to give birth?

Speaker 2: 43:55

Right. So I graduated in December and we had moved into our new home like in August and so we had a big Christmas party and had lots of people to the house and it was like a graduation slash Christmas party. It was really. It was fun. And then I had a baby a couple months later.

Speaker 1: 44:15

So you, know you went back to, stopped at the clinic then and then started teaching full time within that. So how have you? How has your PhD? Did you think it changed practice, it changed information, or how did that impact on you from what you learned from doing that area?

Speaker 2: 44:38

I think it gave me a much broader perspective. It gave me more insight into the way that nursing academia works, in the games that are played within the institutions of nursing. Because I was working during my degree clinically but also working with the faculty and taking nursing education courses, I got more of an backdoor look into the workings of university. Because as a clinician, as a master's student in nursing, you don't necessarily know all the things that are going on with the faculty role. But then when you're talking to the faculty about grants and publishing and this and that and the other like and the various roles of faculty, I think doing that degree really helped solidify solidify my knowledge about the role. I did conduct a big job search then before I finished my PhD because we figured if we were going to move then that would be the time before we bought a house would be to move and go to a big job. But I knew that. I think and my husband says it's my neurodivergence and it probably is that I knew from a very early on that I wanted to work from home. I really struggle with working in an office or in an environment where I hear people around me all the time. I can't focus at all. I can't focus at all. So I sought out a work environment that worked for me and the way my brain works.

Speaker 2: 46:21

I taught at the University of Cincinnati for 10 years in a distance capacity that was two hours away from where I lived. I would drive down once a month for meetings and I'd come back, and that was fine. I was program director of the Midwifery program for several years in the middle in there and I had two children and blah blah blah, the dean there. She got rid of all of the offices for masters and graduate faculty and put in cubicles because she wanted us to collaborate. But you weren't allowed to talk to people because other people can hear you. You weren't allowed to talk to students. You weren't allowed to record a lecture. You had to go into a secret space to do that. So it was horrible for me when I would go down there. I couldn't get anything done because all I hear is all of the noise around me, and it was supposed to help with collaboration.

Speaker 1: 47:15

It doesn't, and the research has shown that open offices actually decrease collaboration. They increase frustration and productivity actually goes down because of those distractions.

Speaker 2: 47:27

Right, exactly, and I was talking, my husband worked from home a day earlier this week because it was snowing up in Cleveland and he didn't need to go drive into 15 inches of snow and he just stayed home to work and that was good. So I went out and I unloaded the dishwasher, I reloaded the dishwasher. It was like a five minute break. I went out, I unloaded, I reloaded and I came back and I was like so that's a brain break for me, which, if you're in an office, you might go walk around, chat with people, distract other people, have a drink at the water cooler, whatever. But I'm going and doing something productive all the while my brain is solving whatever problem I just had.

Speaker 2: 48:05

But I can also pop the laundry in or out. I can walk on the treadmill while I'm having a meeting with somebody or I'm listening to a faculty, like it's good for me, it's good for me. So I feel very fortunate that I've landed in this place where I was able to get experience, first as an adjunct faculty and then as a full time faculty at Cincinnati, to then be able to go to frontier, and where I'm respected and valued for what I can contribute, and I'm one of the. You know a senior faculty person there that I'm respected for what I can bring to the table and not shamed for what I'm not.

Speaker 1: 48:45

So I think that's something that I've seen in social media as well and with conversations with different people is what and who is a midwife? And a lot of the times it's like you are a midwife. If you are still you have to be clinically current, and it was really interesting at the ICM. So either the ICM in Bali this year or it was the Australian College of Midwives National Conference in September where Jackie Dunkley Dent bent kind of, came and gave a talk and she's now she's gone from the chief midwife of the England to now the ICM's first chief midwife, which is brilliant to have somebody up that high level and she was kind of going.

Speaker 1: 49:32

But I still do my clinical and last month I did a clinical and it was really good in COVID that even though that I was the chief midwife, that I still kind of did some shifts and I got up against this policy that I didn't kind of couldn't understand and my colleagues were telling me well, you're the one who wrote the policy and sent it out to us, so you have to kind of like follow it because you wrote it and you're telling us to follow it.

Speaker 1: 49:57

But it was really frustrating was here we have a midwife who is at a high governance level, who's had a high leadership level and yet is kind of saying, oh, but it's still really important that I do my clinical practice, which is great for her. But it shouldn't set the scene that everyone has to do clinical, because it's not possible for everyone. But we still have to respect those midwives who are in education, who are in governance, who are in clinical, who are in leadership, who aren't necessarily still physically in the clinical mode but are connected in other ways, that are still doing just as much kind of important work for the profession itself.

Speaker 2: 50:35

Absolutely. There's a lot of ways to midwife and be a midwife and contributing to the body of literature and the pedagogy and all of the policy and all of the things. And but there definitely is eat your young mentality, or even not eat your young, but you're a less than or a canceled midwife if you're not still in full scope. And, and that is one of the things with social media, it's very easy to cancel and to call people out as opposed to try to understand why they're doing what they're doing and trying to support their needs and Accepting people for what they do have to offer, rather than shaming them, as I said, for what role they don't fit in that your brain says they should.

Speaker 1: 51:22

So the last question for you, potentially one that you may not have the answer for where do you see midwifery going in America in the future?

Speaker 2: 51:30

Oh, that's kind of scary. So the American College of Nurse Midwives has taken a very turbulent ride of late. If it were a roller coaster it would be like, and it's just starting to come back up. And the American College of Nurse Midwives you know, fewer than 40% of the midwives in America are members Yet the ACNM writes the standard setting documents that all our states base our scope of practice on, and they do the lobbying work and this, that and the other.

Speaker 2: 52:04

But there's a lack of trust and so it's really hard to think about midwifery in the United States when our, when our national organization is struggling so much. So the state affiliates are strong in many cases stronger than the national organization but that's going to be divisive because each state affiliate is going to start doing their own thing, and that's not a good thing either. And where we have such a lack of understanding of what midwifery is nationally, that's still an issue. To have our national organization kind of fall out is really a challenge. So I hope within the next five years that midwifery can improve the workplace, culture and environment.

Speaker 2: 52:58

Some of the work that I've done is related to sleep and sleep deprivation in midwifery and midwifery education, which is huge and I think one of the reasons that many midwives stop practicing full scope midwifery is because their bodies can't take it, and we have this muchismo society of midwives where if you can't do the overnight, if you can't do all the things, you shouldn't be doing any of it. And I think we need to support an improved culture of midwifery to recognize all the different ways to midwife and keep those midwives that we're graduating in practice, instead of having them fall out of the bucket with their student loans still to be paid but them not practicing. Yeah, so that's my, that would be my dream. I don't know if that's my, that's what I think will actually happen, but that would be my dream is that we can work on sustaining our numbers by improving the culture.

Speaker 1: 54:05

Thank you so much for your time.

Speaker 2: 54:07

Sure, this was fun.