Ep 71 Tomasina Stacey Evolution of a Midwife into a Maternal Health Research Leader on Stillbirth

Ep 71 (ibit.ly/Re5V) Tomasina Stacey Evolution of a Midwife into a Maternal Health Research Leader on Stillbirth

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When Tomasina Stacy first set her sights on the profession of midwifery, little did she know her path would take her from London's urban pulse to the windswept beauty of the Outer Hebrides, and beyond. Join our enlightening conversation with Tomasina as she entwines her personal tales of growth, from a novice nurse to a pioneering researcher in midwifery. Her stories whisk us away to the dynamic midwifery scene of Sydney and the adventurous realm of providing healthcare by helicopter in the Torres Strait. It's a narrative rich in depth and diversity, shaped by leadership and groundbreaking research.

Venture with us as Tomasina delves into the intricacies of postnatal care, a topic close to her heart and the focus of her Master's research. She shares the sobering realization that issues she uncovered years ago still echo in today's wards. Yet, it's her personal journey amidst these challenges that captivates, as she navigates the demands of motherhood, academia, and international moves. Tomasina's reflections on her transition to a PhD highlight the courage and resilience it takes to balance family, research, and the passion for enacting change at the bedside and beyond.

The episode culminates with a candid discussion on the invisible burden of imposter syndrome that many face in their careers, including within academia. Tomasina Stacy offers a beacon of guidance for PhD students wrestling with doubt, emphasizing the power of mentorship and the transformative nature of research that listens and learns from those it serves. Moreover, Tomasina's work on stillbirth and modifiable risks exemplifies the profound impact that collaborative research can have on maternal health — an inspiring testament to the importance of persistence and community in the pursuit of knowledge and improvement.

Transcript

Speaker 1: 0:27

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

Speaker 2: 0:33

I'm Thomas Nina Stacy. What else do you want to say?

Speaker 1: 0:36

Well, we can go straight into questions from there. How did you get into Midwifery?

Speaker 2: 0:41

Oh Lordy, I got into Midwifery in the early 90s. I'd trained as a nurse in London. At that stage it was quite difficult to do direct entry in Midwifery. I think UCLan was the only place or somewhere somewhere in Preston even, I don't think UCLan was it universities at that stage was the only place where you could do direct entry in Midwifery in the 80s. And I had thought I'd seen an advert for a job in the Outer Hebrides for a nurse midwife who did the whole patch in the Outer Hebrides. So it was when I was at university. I was at university in Edinburgh at that time doing a history and philosophy degree.

Speaker 2: 1:27

I started off doing that. I decided that it wasn't practical enough for me. I saw this job and thought that would be the most amazing job and apparently there was a possibility of actually you did your visits by flying around the Outer Hebrides. So I thought that's what I want to do. So I went and trained to be a nurse. I wasn't sure I'd go straight into Midwifery but after about a year and a half of nursing I found it a little bit frustrating and then decided to do Midwifery. So I started Midwifery in the early 90s and then I didn't end up going working the Outer Hebrides and I never did nursing again. I got stuck with a bug of Midwifery. But I did do a brief period up in the Torres Strait and did some visits by helicopter which was tick some of those boxes of visiting Outer Islands but I never did nursing again.

Speaker 1: 2:26

That would have been kind of challenging. So after you finished your Midwifery Quoals and your education, where did you then work?

Speaker 2: 2:35

So I did my Midwifery education in East London at the Hommerton Hospital in a Newham. So in East London, which was actually partly on the recommendation of Nikki Leap. I had been part of ARM Association Medical Midwives and had contacted her as to where was the best place to do Midwifery in London or in the south at that time where I was working, living and she recommended City and that particular unit to train in, which was great and actually I really enjoyed it. It was the early stages, it was the 18 months time. It was busy and multicultural and fantastic.

Speaker 2: 3:16

But I had a partner at that stage who was from New Zealand and had moved back to your side of the world and had moved back to Australia. So about it's less than a year, about 10 months after I qualified, I moved to Sydney and worked in Sydney for well, via New Zealand, actually because I needed to get a visa. So I stopped in. I was able to get a work visa in New Zealand. So I worked in Middlemore in South Auckland for about six months while I was waiting for a visa for Australia and then moved to Sydney in late 96, early 97, and worked there until 2000,. Until after I had my first child and then moved back to New Zealand.

Speaker 1: 4:03

What areas did you work in in Sydney?

Speaker 2: 4:06

I worked at St George's Hospital and I completely landed on my feet is what I would say People had said from England at that time when I mean I find it really interesting because I think in the late 80s, early 90s, midwifery was fairly strong in the UK. There was a strong identity. We had been fighting the beginning of the medicalization of childbirth from the Peel report in the 70s but there was changing childbirth that has come out in early 1990, and it felt like there was a strong sense of identity and midwifery. We did a lot of postnatal care at that stage.

Speaker 2: 4:50

I remember going around on my bicycle in East London doing a number of visits postnatally and I got people saying why are you going to Australia, australia and midwifery, you're an obstetric nurse in Australia.

Speaker 2: 5:03

There isn't the same sense of autonomy and I got a bit of that when I applied for a job in Newcastle, I think, and I didn't get the job and the feedback was that one of my responses to what would happen if someone was in, if the labor was slowing and the contractions are slowing, that I talked about different ways of helping to increase the contractions and that ultimately I might consider doing an ARM and they said that that was completely out of my scope of practice and I would need to have consulted with an obstetrician to do that and therefore I couldn't get the job. So I'm very glad I didn't get that job, because I got a job at St George's where at the time Pat Brody was working and Caroline Homo was working was just doing her PhD, starting her PhD. So it was a relatively small hospital in South Sydney which had this incredible energy for research and for inquiry and for looking at doing things differently because of some of the leadership that was there. So I was fantastic. As I said, landed on my feet.

Speaker 1: 6:16

Excellent, and then you just kind of slipped in there. Before that you did some time up in Tyrone's Strait, which is north of Australia, up in Northern Territory. Yeah, how did you find you? Because that's a long way from Sydney town.

Speaker 2: 6:27

It's a long way from Sydney. So, again with the kind of vision, I guess, of the head of Midwifery whose name escapes me at the time at St George, I really wanted to do some remote area work and so I took a six month kind of sabbatical and went and worked up there for six months. But I then came back to my substantive job at St George's and that was fantastic, it was eye-opening really working up in the tourist rates on Thursday. The hospital was on Thursday Island, I think it's there about 2000 people on Thursday Island and then another thousand spread across the other islands. And we did. It was over Christmas period.

Speaker 2: 7:15

So my biggest, the best day possibly, was Christmas Day. There was a call out from one of the outer islands that someone had gone into preterm labor so I needed to go and pick them up. It was absolutely terrified. So I'd only been qualified about two and a half, three years possibly by then. So I was terrified that I knew that it was a 35 minute, 40 minute helicopter ride out to this island and I was thinking what am I going to do? I don't, you know, she's 33 weeks in labor, apparently.

Speaker 2: 7:45

Scary trip. Didn't even look out of the plane across all these islands when I was going there, got there and realized that she'd been on a little bit of a pre-Christmas bender and I had actually it wasn't broken waters, which what they thought it was, it was the result of a slightly too much alcohol and stomach cramps. Because of that and after the different smell in the room, noticing that it wasn't rupture membranes, and settled her down, got her back to sleep, stayed for a few hours to make sure that everything was stable and then I got back in the helicopter and had the most amazing ride back to the base hospital looking at turtles swimming in the sea. This is the life, this is the job, the right job. So you were living in community at that time.

Speaker 2: 8:33

No, I was just living in a kind of accommodation associated with the hospital, so that's all. The sort of facilities were within Thursday Island and connected to the hospital and there would normally be one midwife on shift and one midwife kind of on call and occasionally you'd need a third midwife if someone else came in in labor. But there were. I think there were about six midwives on the eye and that that's where women came to birth, so they didn't. It was complicated issue that there was not the facilities to support women to go out to them to birth on their Island. So generally they would be. They would come in at 36, 37 weeks and there was a kind of hostel near the hospital which is where the women stayed in the last few weeks of pregnancy.

Speaker 1: 9:26

You'd made them have to end up getting an in-shift down to Darwin.

Speaker 2: 9:29

A few did so. We did a couple of transfers and we'd have women who came in from Papua New Guinea. They'd get the boat because that's actually nearer from the western part of Papua. To get the boat down to Thursday Island was quicker than them trying to get to facilities within Papua and also that they got different care. So we'd get people who had been in obstructed labor, been on a tinny boat, coming down and that for them really horrendous stories. But for some of them there was a need to transfer to Darwin Because that was our nearest secondary unit. Then all towards Brisbane. I've completely forgotten what's the city right Townsville.

Speaker 1: 10:25

No or.

Speaker 2: 10:25

Campton, cairns. Is that Cairns? That's further north, so there was a secondary unit there, but occasionally, sometimes to Darwin, sometimes Cairns- so then how I'm there for six months.

Speaker 1: 10:41

Then you came back down to Sydney, and so where did you work after you came back? Still staying at St George.

Speaker 2: 10:49

So I was still at St George and worked in their continuity team that was part of Caroline's PhD at the time and so in the birth centre and part of their continuity team and got the opportunity there, as I said, to be kind of exposed to a range of people doing research, which was fantastic.

Speaker 1: 11:13

Then that's where interested into your Masters came.

Speaker 2: 11:16

It is. Well, I had started to do my Masters in Public Health because I was interested in Public Health that's partly the interest in going up to the Torres Strait and it's something I'd always been interested in and so I'd been doing that along the way. And then I came to my project that I needed to do for Public Health, which at that stage, the Masters. We had quite a lot of torch work and then you had a I think it was a 30,000 word dissertation. So it was a pretty substantial dissertation and I was, as I said, incredibly lucky to be at St George because they just made some links with UTS or they're trying to establish a links with Leslie Barkley. So Professor Leslie Barkley was there and they were developing, seeing how they could develop clinical academics, I guess sort of in the early, in the early time so that was in the late 90s and they developed these internships, so six month research fellowships that you could apply for, and I was lucky enough to get the first one that they put out there. So I got a six month fellowship to do, basically to do research. So we sat in on meetings, on some of the research meetings, and I was able to develop my projects as part for my PhD sorry for my Masters kind of during that time and I did an ethnographic study of postnatal care because I was really interested that.

Speaker 2: 12:54

My memory from the UK was that we did a lot of home based postnatal care and in Australia, certainly in Sydney at that time unless you went home within 24 hours you got no postnatal care whatsoever. So the hospital period seemed really important. So I did an ethnographic study on the postnatal ward where I worked at St George's and that was fantastic, really amazing. I mean it was interestingly Leslie Barkley-Marks was one of the examiners for the Masters and did say, if you've done it, if you've done a few months longer, you might have turned this into a PhD. And it did feel like it. I think I must have done 30 or 40 hours of observation just sitting on the wards and then we did interviews with the women who were on the ward and some of the midwives. But it was fantastic and really gave me huge respect for quantitative researchers.

Speaker 1: 13:57

So now that there's been a fair bit of time that's gone past for that, what still sticks in your mind about doing the masters, what is still kind of quite, because you're obviously still passionate about the process, but what's one thing that kind of surprised you or sticks with you the most of that project?

Speaker 2: 14:18

I would say there are two things, liz, in different directions. So one is that I swore that I would never do qualitative research again which hasn't come about. But when I finished it I was like I'm never doing this again. I can't cope with the gray, I can't cope with these uncertainties. I need something solid, which is why you'll see later I, in terms of education, I chose not to, but haven't I come right round and still incorporate qualitative research in that? So that was about the process and, as I said, you know, it gave me huge respect and the kind of complexity of doing an ethnographic study.

Speaker 2: 14:59

And in terms of the research, what I find interesting and sad perhaps, is that I see the same issues now in postnatal care that I saw then. So one of the key findings was the busyness of the postnatal ward, the fact that people that there was no time for rest. People were in and out. It wasn't the woman's space she couldn't, there was no, you know, she was in someone else's territory trying to be a mother and kind of create her own kind of culture of parenting and identity as a mother, and most of the people who were there for a while would knew you know first time mothers and that this clash between the, the, the institution and her role felt really strong. And it was something that we wrote about in the in the masses, what we know, one of the kind of key findings that came out from that.

Speaker 2: 16:02

And yet I see that exactly the same certainly in the UK now, particularly now that we've cut back on a lot of the home visit, and you see that that's sort of disjunct between what's needed at that time to be in a calm space where, which really kind of facilitates her growth as a new mother, compared to the needs of the institution to come in and do this test and that test.

Speaker 2: 16:32

And I remember that I think we find that on average there would be sort of six people, you know six to ten people coming into the room, professionals coming into the room every hour to do something, to that it was a six-page room to do something and just that kind of constant barrage of things being done and being in a, in an environment that was not was not kind of safe or supportive of the each woman to do their own thing and that's one of the issues we're still we're still actively kind of fighting with is staffing and actually having babies included in numbers in the ratio is staffing and I think Queensland are just going streaks ahead of kind of advancement within Australia.

Speaker 1: 17:20

They're definitely leading away and I'm not sure, if it's been approved yet or if it's in the process of being approved, that they've got ratios coming in Queensland that include the babies, because if they're not included you don't actually have the time to spend with the woman, to actually give holistic care, to actually sit down and not be just there with a tick, a check board and kind of going we're gonna tell you this, this, this and this and then disappearing off to the next one because you haven't got enough time yeah no, absolutely, absolutely, and what you know where I don't know if Australia's having the same issue of the kind of attrition of midwives so we've got so many leaving and therefore staffing is really, you know, is really challenging and a lot of the people who are leaving, other people who have been around for a bit.

Speaker 2: 18:06

So we have some who come and go quickly, but actually a lot of people are leaving earlier than they might, you know, as soon as they can, so that the expert midwives who are able to kind of hold the space for women are going, and so with the busyness is feels like it's more obvious, if anything yeah, and I think actually is a universal problem by from conversations that I've been having.

Speaker 1: 18:31

Yeah, how did you then go from your masters into your PhD? Was it a natural transition, was it? No, I don't want to do this study again. I'm gonna go and stay on the ward. What was that kind of journey like?

Speaker 2: 18:46

no, it wasn't a natural move, partly because I had my first son two weeks after handing in my masters and and then six months mate later moved from Australia to New Zealand so there was a big shift and when I went to New Zealand I I went back to working, partly working on the wards. So I worked at Middlemore Hospital as a clinical midwife and then worked in in White Hackeray and West Auckland doing clinical audit and kind of quality work. And I would say that from my masters I knew that I was really interested in research and really wanted to research and felt that you could make a difference or you could at least expose what was going on and have a chance to make some difference. But that, as I said, I never wanted to do quite a different such a thing. So I kind of knew in the back of my mind that I would want to take it further at some stage. But I was quite busy with a young child and starting a kind of new life there and really enjoyed doing the. The quality and audit job at White Hackeray was actually really interesting because we managed to sort of through service evaluation, we managed to to make some changes and and that kind of crossover between service evaluation and research was quite interesting.

Speaker 2: 20:21

So that you know one of the key things when I got there, they for a small unit for those that don't know West West Auckland it's. It's it's a. It's a small primary unit, had a lot of independent midwives accessing it. It covered a population that was really quite invested in, in physiological birth and also a whole range of sort of alternative approaches to life and health. I would say so really supported. Yes, it was a great place to be a midwife, to be an independent midwife, but for the unit it over the previous 10 years had had a kind of rapidly growing Cezarean section rate and when I got there one of the one of kind of my tasks, I guess, was to look at it and try and understand what was going on. So it was really with a research head to go. Well, why is this unit got a Cezarean section rate in the high 20s, which at that time, so in 2000, for that kind of unit was really high and 50, you know, 10 years ago. Before that it had been around 18 to 20 percent. So I guess I use some of the skills from, I think, or some of the things from, research in that role which first of all looks at what, what the apparent indicators were for Cezarean section, then looked at whether it changed by certain days or who was on and and actually kind of I guess the implementation was two-fold.

Speaker 2: 21:57

I worked with an amazing anisotist called Robin Youngson, who's work done some further work in in kind of safety and psychological safety and has been part of that journey and there was a. It was talking to him and talking to some of the people in the unit was realizing there was a mix of defensive practice and a sense of safety because there had been some poor outcomes as well and that this was related to, perhaps to do with communication between the unit and the independent midwives, and that this sort of combination had meant that there was a slightly toxic culture and that that then played out in in some of the intervention. So we we were, by talking to other people who who were interested in kind of not just looking at the surface, we we approached it from two, two angles I guess. So part of it was to do that Robin led was some groups to kind of facilitate communication between all the, all the people who are involved in the hospitals.

Speaker 2: 23:09

And and then I did some work looking at, as I said, at the actual indicators for cesarean and set up a regular, so every two weeks we then reviewed all the César and sections that didn't meet the kind of target. So if it was for slow progress and there hadn't been any, there's only been maybe an hour or two hours of waiting. We then just reviewed them without, without naming names, without there being any sense. It's just trying to understand what was going on. So we did that over a period of time and over the six months we, the César and section rate went down to around 22 to 24 percent and stayed there. I mean the important things that it then stayed there and with Robin we wrote that. It's actually my first paper, the first kind of article, which was a commentary, called the courage to be wrong, which he led, which was was fantastic and certainly introduced me to the kind of idea of of multidisciplinary research and coming to it with different ideas.

Speaker 1: 24:17

I think that's that kind of courage to be wrong. There we go. 2003, that came out, yeah, um, oh. And being in quality and safety, um, that is, we're so afraid of kind of what's going to happen if we do admit to making mistakes and we all do make mistakes but as humans, the way we learn is by making a mistake, acknowledging it, learning it. But if you make the same, so if you do it the first time wrong, it's a mistake. If you do it the second time wrong, it's actually a choice, because you chose not to learn from it the first time.

Speaker 2: 24:51

Yeah, yeah, absolutely, absolutely. But and I mean Robin had some, really some of his approach has definitely stuck with me, which is the kind of approaching it all with compassion and kindness. So it's it's that's what you need for the environment to grow and that that's what. So in the UK we talk about patient safety too. I don't know if that comes out. It's part of that whole principle really that if you have a kind of an accusatory or bullying atmosphere, you're never going to get safety and you're never going to improve outcomes. You've got to approach it from a different way.

Speaker 1: 25:29

Yeah, absolutely, it was yeah it was fantastic so how long?

Speaker 2: 25:32

did you spend doing that? So I was there for about um three years and then had my, had another child, um, which was fantastic and it was wonderful to experience New Zealand independent birth. So I'd had my first in the birth centre I worked with in St George's in Sydney and then I had my second at home with a fabulous independent midwife who lived just down the road for me. So so, yeah, that was that was wonderful and um, so Angus was born in 2003. So I stopped working at, I went back to Waittakere for a little bit after that, um, and then I started some work at at AUT, which is so doing some teaching work, yeah, and really, you know, started to get my kind of passion really for working with students, which I still, I still do and I still really love working with, with students and and the you know the amount that they get that they teach oh yeah, teach us is just fantastic. So I was working at AUT and a little bit at middle more and then and beginning to think, um, that I would be interested in doing a PhD at some stage, um, but I had two youngest, you know, at that stage of sort of four, five year old and a two year old and wasn't quite sure how that would come about. So I was beginning to explore the possibilities of doing a PhD when a kind of opportunity fell on my lap, basically um in that um that Leslie McCowan, who's a fabulous obstetrician in New Zealand. She's recently retired um but she and was was looking at um one or wanting to explore um stillbirths in New Zealand because they had there was quite a significantly high stillbirth rate at that stage um and there was an interest in in trying to understand why it was high and what was going on with it and that um she had got some funding to from from one of the local charities um in New Zealand called Cure Kids um to do a few months work beginning to look into a project in that and had put out an expression of interest for someone to work on this project for six months um to see if we could, if they could try and understand what was happening and perhaps design a study that would look at that. So I apply. I basically applied for that position.

Speaker 2: 28:18

That wasn't a PhD but it was something that I had a particular interest in because there's been a lot of um loss within my immediate family. So my grandmother had six um pregnancy losses, two of which were near term, wow, and my mother had four late. So second trimester losses um and I'd had, I'd had two miscarriages before I'd started. So it'd been the kind of recurring, yeah, sort of theme within my family and something that I was interested in. So it completely I mean the mixed, the combination of of working with Leslie um and Ed Mitchell, who is a pediatrician, who did a lot of the work around um, the initial work around SIDS um, so he's a epidemiologist and pediatrician um. So the opportunity of working with them and in an area that I really cared about and it was, uh, not a qual, it was not qual, it ticked all my boxes.

Speaker 2: 29:19

So I jumped at the opportunity and they very kindly took me on to look to do that first sort of um few months work and through that we developed um a case control study, a project um a relatively large project which, um Leslie, I kept trying to pull back going no, no, I'll just, I'll just help you with it, and she's like this could be a PhD. So we then made it into a PhD and got more funding from cure kids to actually do the project which became the Auckland Steelburst study, um, which was what my PhD was. So it was a case control, population based case control study looking at modifiable risks for late steelburst. So it was specifically looking at those things we could try and do something about um and it took a similar approach to the work that that um, ed Mitchell, had done around SIDS. So he did some of the initial work around um infants sleep practices and they came out with sleep position intriguingly, yeah, when when we see what happened with the Auckland Steelburst study and really changed. You know, between him and um I think it's Pete Blair from Bristol in the UK they had both been doing some work around around um SIDS and came up with some some similar findings and really changed the whole picture um for that dramatic reduction in in um SIDS following following their work.

Speaker 2: 30:49

So we took a sort of similar approach of really going. We don't really know what's going on, but we will look at all the things that we might be able to do something about. So to do with accessing antenatal care, to do with lifestyle, you know, to do with how people eat, levels of stress, how people worked, how people slept. We had hypotheses for each question we asked but it was very broad sweep because we really didn't know and at that stage no one had actually asked women whose babies had died what was going on, because people said that it was they. They shouldn't be involved in research. It was too traumatic, it was scary.

Speaker 2: 31:25

So we spent a lot of time while I spent a lot of time talking to um, to sands, to local um support groups, to say, would you want to be involved in research? You know, this is what we're thinking about. Is this intrusive, is this going to re traumatize, is this going to be a problem? And they universally said no, please come and talk to us, please come and do this research. We need to be involved in research because we need to know what's going on.

Speaker 2: 31:52

Um, and it was thanks to that that we got through ethics. It was a while because a lot of the ethical panel said you can't interview it. When we in well, we, I, I did all the interviews except for about four that uh had a fantastic midwife who helped me near the end. Um, we interviewed women who'd experienced third trimester stillbirth and the earliest was four days after the birth of their baby, up to six weeks after the birth of their baby, because we were asking questions that were to do with what they did during that period of pregnancy. So they it couldn't be too far away because they wouldn't remember um, and there was obviously still issues around around recall. But the closer to the birth, the more important, the more likely it was that they would remember certain things that happened like.

Speaker 1: 32:40

Obviously you'd have the support organizations for the women to kind of work to and the consumer reps that would help through support for them. How did you protect yourself emotionally? Because, having been in that position and then hearing all of these stories, how did you protect yourself?

Speaker 2: 32:59

um, it's really interesting. We had some. I'd set up um a sort of debrief session, partly with my supervisors, um and through one and through sans um the sort of possibility of talking to them. But interestingly I didn't feel I needed it and I think that was for two reasons. So it was a. One is that it was a. It was a quaint study, so we had a questionnaire. It was a. It was a interviewer administered questionnaire, so the question they were there was 20 pages question it normally the the shortest interview for the controls was 40 minutes and the longest took about two and a half hours because we'd often go off on tangents and talk about other things. What you do, um as you do. And one of my biggest regrets is that my supervisors were very, very quaint head and they said don't collect it. You don't need to collect any of that other data. You know you. You won't know what to do with it, don't?

Speaker 1: 33:56

and we didn't have recorded.

Speaker 2: 33:58

None of it was recorded. So I had a questionnaire that I filled in but I didn't record any of those one. I mean it's it stayed with me. But those amazing conversations that we had and and looking through the baby photographs and the kind of feedback around the birth, anyway, it's one of my biggest regrets that I didn't record that learning point. Learning point always, you know, if you've got those opportunities, record if you can. I mean we didn't want to record because we thought that it would be quite intimidating to, yeah, have a recorded there at that time. So there was rationale to that to some extent. But I do regret it and even if I took a, taken really extensive field notes and been able to analyze that, I wish I had.

Speaker 2: 34:43

So one of it was that there was a, a containment to the questions to some extent, and I would say that the second thing was that the women themselves provided that nurturing. Was that really? I could feel that the, the process of asking the questions and exploring what was going on was almost invariably beneficial. Yeah, it felt positive. I felt that we that there was something positive happening, even though we were talking about incredibly sad things. I quite often cry with them.

Speaker 2: 35:21

But when I left it I didn't feel trauma. You know the traumatized. I felt angry and frightened by the, sometimes by the care or by the kind of missed opportunities or by the fact, you know, it feels so unfair that this happens. But I was interested. I thought I would find it more traumatizing but actually I think that the kind of positive nature of that we were perhaps trying to, we were unpicking things and perhaps finding some answers felt that it wasn't so I I mean I also got huge support from my supervisor. Leslie was a mate, was a fantastic support in terms of discussing, you know, the process of what's, of what was happening.

Speaker 1: 36:12

What's the next thing you might now steal from those conversations?

Speaker 2: 36:16

From the conversations, I think one of the biggest things and this is a real change, Liz that's happened over the last 15 years. So I collected data for three years because we needed three years to get the numbers. It sounds a terrible thing when it's talking about death. So we actually planned it that we would approach all women who had experienced third trimester stillbirth in the Auckland region for three years, and we estimated that it would be between 150 and 200 women, and it was 155. We had a 72% consent rate, which was amazing.

Speaker 1: 36:58

Wow, that's huge. It was huge.

Speaker 2: 37:01

But so this was it in 2006 to 2009. And still at that stage, stillbirth was silent, was taboo, it wasn't talked about, and one of the biggest things from the this is from the conversations, not the quant data collection bit, but the conversations part was the need to be heard, the silencing, the fact that women would say they can't go back to their antinatal classes and talk about their birth because their baby had died. No one asked them, people just disappeared because they didn't know what to say and they knew that it wasn't because people were nasty or had anis in any way, but they felt alone and the silence and they would talk about the. They expected to come home to the noise of their baby and to people and they came home to silence and that it was silent at home and silent out there. People wouldn't look them in the eye, they couldn't talk about things, and I think that. So that felt really important and I do think we've changed in that I don't think it is as silent anymore. There's still problems, there's still issues and there's things I'm interested in talking about is how we talk about the potential of stillbirth in pregnancy.

Speaker 2: 38:25

I think we sometimes go too far in a different direction by using stillbirth as a fear tactic yeah, oh yes Rather than as a way to know that this is part of what can happen, so that it's not such a shock. So for many of the women, they thought they were the only person that it happened to and that somehow they've not protected their baby yeah, guilt, and that that again was helpful during the research going no, you know, I'm talking to someone else next week and next week, you know it's terrible that it is, but you're not alone. Yeah, and I think so. I think we've moved forward, but we've still got things to do because it's so, it's such a tricky topic, but that, so that was one of the most important things that came out of for me from those conversations and was the helpful thing that I certainly learned over the time to really to talk about the birth process. They you know these women, and sometimes their partners, would be there Mostly. I would certainly have. I would have some of the interview only with the women, because there were things that they wanted to tell, that they would tell me that they didn't want their partners to know, and there's one woman who had actually secretly been smoking during the pregnancy some of the time when she didn't want her partner to know and she was, she was sure that that was the reason and we could talk through the fact that that was really you know, she had one cigarette a day, because we, as I said, that was part of that process of feeling. Actually we can, we can unpick some of this self blame. That happens that I can't remember where I'd gone somewhere, but the importance of, yes, talking through the birth process and actually you know their mothers, their parents, and really acknowledging that even though your child has died, you're still a parent, absolutely that felt really, really important and I think that I I probably, as I interviewed, got better at asking the questions around how they, how you know what happened as they went into labor, what happened in their birth that weren't relevant supposedly, to my questions, to my research question, but what's totally relevant to them Because it validated them as parents and of having given birth and of that you know.

Speaker 2: 40:54

That's. That's those, those when, when you've got so few memories, every memory is precious, precious, and if no one will then ask you about them, how do you embed those memories? Because so much of memory is storytelling, that's how they become integrated. So it reminds me always that now you know, and from since then, when anyone asked me what research I did, and I would say that it was still birthed in, a number of people would who would say you know my baby died and would tell me their birth story. And we know that as midwives, don't we? That people want to tell you their birth story, but even more, in a way, with women whose babies have have died, they need someone who they can tell it to, who's not going to be shocked by it or or feel that they feel that they are allowed to tell their story and that that feels really important.

Speaker 1: 41:50

I know that's something that students are really scared of is a of being in that situation and not knowing what to say, or saying something that makes it worse. Yeah, and it's. How do you find that balance when it's not something you want them to experience frequently, but when you do experience it, you are allowed to have your own emotions because there's shit of a thing to happen. It like nobody deserves to have a child die. It is meant to be a happy occasion, yeah, but you have to deal with your own emotions and then still be professional and then still hope that you can be productive at that time.

Speaker 2: 42:29

Yeah, I think. I think you're absolutely right, liz, and it's really. It's actually important to be emotional because then you're connecting. It's the relate we talk about relational care. You're connecting to what's happened, and if you are completely blank, then how do you do that? But the important thing is that it's not about you, so you can I mean, that's what I would say to students you know, you feel, you're feeling you, we know, we know that it's emotional work that we do. Oh yeah, that's that's important.

Speaker 2: 43:02

And actually to be connected to our emotions is partly what makes us a good, makes you a good midwife. I think is having that connection. But it's also knowing that that doesn't take over the experience of the person that you're caring for and and with, and that I would. You know, the most important thing that I felt from from the women is is to be honest. So it's having that. You know. It's being honest about your emotions, but being honest about what's happening. One of the hardest things is when people put you know aren't truthful, so they'll say everything will be okay, or you know time will heal, or those sort of trying to placate things. You're young enough to try again. Yeah, I'm sorry, you know trying again is irrelevant to your child dying.

Speaker 1: 43:53

And even if it happens in one in every three pregnancies, that doesn't help either.

Speaker 2: 43:57

No, yeah, but it's so that for students it's be truthful. And if that truth is you don't know, then say you don't know. So it's like you know, if you can't find the fetal heart, don't go, I'm sure it will be fine. Because it may not be fine, say I can't find the baby's heart rate. Therefore I'm going to do this, this or this to find it, but don't go, I'm sure it'll be fine. Yeah, because if it's not fine, it's really not fine. You know, that's what's hardest.

Speaker 1: 44:28

So I mean you found that those conversations weren't as draining as you were expecting. You had your setting up with your debriefing, with your supervisors and also with sans, but the actual bigger process of doing your PhD over three years, fitting into a life with young children and still having a life and a work and a study balance, how did you work out a routine or what worked for you to kind of keep your sanity through the actual study period?

Speaker 2: 45:00

Yeah, that's a really good question. I mean, the PhD took nearly five years because I had three years of actual data collection. So I had a year building up to it and then a year and a bit afterwards, and I would say the two. So I worked a day a week clinically during the time and actually the common eye Because I got the kind of scholarship through or funding through Cure Kids. I felt completely, you know, I needed to do it for them. I also needed to do it for them as soon as I started interviewing I knew I needed to finish it Because I had a duty to get that information out and do something with it. So that really helped having a kind of strong motivation.

Speaker 2: 45:49

There was no question in my mind once I started that I would finish Because I couldn't just leave those, I couldn't have wasted those people's time and actually from me, having young children really helped keep it boundaries.

Speaker 2: 46:07

I needed to be home for them and so I treated my PhD as a job and I put the boundaries as you would on a job, so I would always make sure that I was home.

Speaker 2: 46:22

I needed to pick them up from school and my husband at the time was studying and was not as involved and so he was able to pick them up twice a week, but the other times I needed to pick them up and so that was a sort of end to my day, or to that bit of my day, and I would do the kind of study work for about an hour every evening after they'd gone to bed, but during the day I kept some boundary and I'd always keep one day at the weekend that I didn't work and that's kind of what kept me sane through it and it's partly was I said, seeing it as a job rather than as a PhD.

Speaker 2: 47:08

Yes, it was a PhD, but it was. I treated it like a research job, I suppose, and tried to keep it contained for that. And I knew when I started that it would be three years and it was by the end of the three years. I was tiring and the hardest bit was was was identifying women and sort of chasing them without trying to get that balance of not feeling like you are pestering people but making sure that you got your recruits. And I think anyone who does research knows you know the the challenge is getting ethics and actually recruiting people to study.

Speaker 1: 47:46

Especially something so safe, the most challenging bit. Yeah, you kind of feel a bit of a grim reaper, kind of trying to. You're around there at that most precious time and heartbreaking time. Again, I'd like to speak to you, please.

Speaker 2: 47:57

Yeah, and for both them and for the control group. So the control group were women who were pregnant at the same time as the, at the same gestational age as the women who'd had a stillbirth but were still pregnant. So. But I then had to talk to them about the fact I was doing a study about stillbirth and then I was asking all these questions and, amazing, we got the same. We got a 72% recruitment rate for the control group as well, and that that was partly due to the nature of midwifery in New Zealand. So the fact that they were independent midwives I, I went through the midwives they were the midwives of the gatekeepers. Yeah, and because I'd worked clinically and I had a relationship with the midwives in Auckland and they had a relationship with the women, they could say, yes, it's safe. Yeah, Thomas, Ian is you know she's not going to say you kind of think you can trust the conversation.

Speaker 2: 48:45

I think you know something positive was said for us for the recruitment. I mean that was all right.

Speaker 1: 48:53

Because it just unlike I've had this conversation within it and she talks about it all it can take is an eye roll when I said I've mentioned it can just be something really subtle and that will put a woman off and go. Yet not don't want to be involved at all, but if the midwife who is by her side is kind of going, oh yeah, she's, she's a made of mine, yeah, trust her, should have hands with her, then that trust is huge.

Speaker 2: 49:16

Yeah, it is huge, and it's something that I'd say to any researcher make those, those networks, those connections that you make before you start your study are absolutely crucial for the people who might be the gatekeepers or who you're connecting with. Is it's for a while that for the first six months, when I was going around talking to midwives, going to all these different groups where maybe there'd be only one or two there to say this is what the study is, this is why I'm doing it, this, you know I might contact you. Is this okay? And a bit of me was thinking why am I doing this and I'm spending hours and hours and hours with one or two people? It was absolutely worth it. Yeah, it was absolutely worth it.

Speaker 1: 49:56

Yeah, we're going more and more towards co designing with our research. We're going more toward we've having compulsory inclusion of consumer groups, because we are then making sure that it is that balance. There is that kind of the ethical approach to it, but we're also looking at stuff that they're interested in as well, that we don't think of. So and it is. It helps with that recruitment as well. How did you celebrate when you finished this all? You packed it all up, you got your feedback back. It's like whoa, it's over with now. How did you celebrate?

Speaker 2: 50:35

my PhD. Yeah, um, I celebrated by moving back to the UK.

Speaker 1: 50:42

Okay, so I did something. You move. There's a pattern here.

Speaker 2: 50:46

There is a little bit of a pattern. When I had planned to move. There is a intriguing thing that it hadn't kind of when. It sort of had come like that I I'd actually had the opportunity to have three months writing, writing up time, and during that three months I came back to the UK to spend time with my mother, who had been recently diagnosed with Alzheimer's.

Speaker 2: 51:11

So, I spent some time with her and I bought my children back to the UK and to Yorkshire and we all loved it. So it that convinced her. They went back to New Zealand for six months to finish off and to work a bit, but decided at that stage that we would relocate back to the UK. So it was a bit of a wrench. It's not something I recommend. So I did have. I did have a celebration and interesting time because within the university because I got my, I got the PhD in in time and had just kind of grammatical corrections they had a, they had a reward, a financial award which I bought, and I bought my first iPad with. So that was my celebration. It was amazing. It felt like a complete treat. So that was in 2000, the end of 2011, when they so that was very exciting, so I did that and then move back to the UK, but I wouldn't recommend it. So it's something. Quite sorry, I've got a clock ticking in the background.

Speaker 2: 52:17

You might hear me hear it For any other researchers. I would really, I would really recommend staying where you were, if you possibly can to, for that early postdoc period, because it definitely had a had an impact. It was partly because I wanted to go back to practice. I really missed the last year of writing up. I did minimal practice. I worked about once a month, once, a couple of weeks at the most, and I wrote so when I was coming back to the UK. I knew that I wanted to. I didn't, I didn't want to stay in academia at that point. But looking back, it definitely would have been good to have stayed in the same place.

Speaker 2: 53:03

And actually they continued in New Zealand to extend the Auckland stillbirth study to the whole of New Zealand because we had some. So our main, our kind of headline finding was that the position that women settle to sleep in at night had a significant relationship to risk of stillbirth. So the three fold increase associated risk. But if you settle to sleep on your back and that was a novel finding it chimed with what we know as midwives that we don't you know that when women lie flat on their backs, you've got postural high. You've got you've got the impacts of the weight of the uterus on the vena cava and we know that we turn them on the sides to to sort of impact the heart rate. But no one had ever thought about what they did, what people did at home. So we knew it's in hospital. We hadn't thought about it at home, although in these attests had in theatre.

Speaker 2: 54:04

It's logical when you think about it. It's logical when you think about it, but we hadn't asked.

Speaker 1: 54:09

And we hadn't thought about it.

Speaker 2: 54:11

But we obviously needed to replicate it because it was the first. You know, it was the first study that had shown it. So in New Zealand they actually carried on to the to a multi centre study across the whole of New Zealand and replicated the PhD across. That it would have been. It would have been lovely to have been involved in that. But I moved. I moved straight back to the UK and and went into a very busy consultant midwifery job within about four months of being back in the UK.

Speaker 1: 54:37

When did you move from there into education?

Speaker 2: 54:40

So I spent about three years as a consultant midwife and started to miss research and miss education. So I again was lucky to get I got a met a fabulous researcher called Mel Cooper who was working in Bradford which is close to where I was working as consultant midwife and managed to secure a succumbent with her to Bradford for a day a week to do some research and to help develop research capacity within their group, and have continued to work with Mel ever since. Actually we still do do work. She does a lot of work around migrant health and that kind of reminded me that I really did miss research and that the consultant midwifery job was becoming more managerial, it was a very busy unit and that I was spending time as head of midwifery and and needing to take on line management role, which is not where I wanted to go.

Speaker 2: 55:37

I'd always known that I enjoyed education for when I worked at AUT and really missed research. So a job then came up at Leeds University which took me back into academia. But I keep flitting Liz into. I would love to. You know, in my dream world I would. I would work clinically one or two days a week and and do education and research the rest of the time, but actually the week's not quite long enough to do all three, and that's the real problem. So I keep mixing. At the moment I'm, my role is sort of 5050 research and education, which is fantastic, but I miss the clinical. Yeah, my role just before that was 55 clinical size, working within a trust, doing sort of guideline development and strategic work, and then research, but no education, and there's nothing's perfect except if the, if the weeks were longer would be.

Speaker 1: 56:41

So, from having your experience with your supervisors, having gone through your masters and PhD, then going into education and being a supervisor yourself, what if you taken out as good and bad? So what kind of things do you now do or don't do because of what you've experienced your scene?

Speaker 2: 57:05

Oh, okay, that's a hard question. That's a really hard question, I hope. I hope that I do some of the good things that I had, which is about supporting someone to fly. So that's what I feel, that you know, we're all doing our own things and one of the nature of research. We have our own ideas on it, but it's so even within a project that was initially. You know, the initial kernel of the idea came from my supervisor, so it wasn't that I came with the project, but we certainly developed it together and it's and it became my project and kind of became my, my baby. It felt like in in the end and I think that Leslie really helped with that and helped, gave me the confidence to to do that, and it's something that I find that I'll be.

Speaker 2: 57:58

I'm interested in whether other people who've talked to have it you know the kind of constant imposter syndrome issue in particularly in research where you go, do I know enough? Because each time I open something I go, oh, there's even more I don't know here. So all the time I feel like and I feel that as a supervisor I consciously or continuously anxious that I'm not providing them with enough wisdom and insights, because the each year. That goes on. I find that there's more I don't know and and that therefore I think we know I'm suggesting this, but there's all those other things that they might do. So it's trying to work with the student to to nudge them and to introduce ideas to them, but to let them fly. Yeah, and that that's hard when you've got different you know, and I have a range of PhD students and people come with with a different level of expertise and they also come with a different levels of motivation. Oh yes, and that that's those things I find tricky. So I find it really tricky when I feel I have to push and be like no, you need to do that a bit more, because that doesn't. I find that harder than the ones where you just plant a seed and then they just go with it and that's wonderful to see, it's really exciting to see. So it's that level of support of enough, but not too much, where you feel like you're over. You're kind of dampening their excitement for what they're doing, but making sure that they've got the tools.

Speaker 2: 59:47

One of the things that has been much better in the organisations that I've been a supervisor in is the amount of educational opportunities and learning that's available. I had fabulous supervisors, but I was the first PhD student that Leslie had had and I think that within that university so within Auckland University at the time, there wasn't a sort of structure of education for PhD students, so I actually did no other courses during my PhD. I taught myself how to, so I use SAS as a data analysis. I taught myself through Google and SAS for Stupid People book, so I self taught. I didn't actually go on any other courses.

Speaker 2: 1:00:40

My masters have been really useful. So I did clinical epidemiology and statistics during my masters and I got fantastic supervision from Leslie and from Ed and from John, who was the statistician. But no, I would encourage students to take advantage of the courses that are available within the university and also to mix with other PhD students. So, again, because I was so busy with my life, I wasn't sort of part of the postgraduate culture and I didn't talk to many. There was a couple in the room that I spoke to occasionally, but I felt very much that I was doing it kind of on my own and I now see the benefit of being part of that community and learning from each other as well as from your supervisors.

Speaker 1: 1:01:35

I think that if you're doing two jobs at the one time especially if you're in education and you're doing your PhD on the ward and you're a senior staff member and doing it it's hard to wear both those hats at the same time. But you'll find other people outside who you'll gravitate towards, who will be doing happy to have a chat with you because they're nerdy and they like to kind of ask you questions, or they'll be kind of where are you?

Speaker 1: 1:01:59

up to Just calling where are you up to this week? What kind of changes have you had? So, yeah, I agree that sounding board and they don't have to be in the same area, because sometimes having other people ask you those questions but why is that important? Actually makes you stop and think and articulate what you're thinking and what your rationales are, and they go, but that doesn't make sense, and so it forces you to then change the way that you look at things.

Speaker 2: 1:02:26

Yeah, yeah, yeah, absolutely.

Speaker 1: 1:02:28

So what's next? What are you doing now? That's kind of like keeping you excited and what's keeping me excited your motivation going.

Speaker 2: 1:02:38

So I've got a project about to start in the new year which is looking at supporting women who smoke in pregnancy. So they're all. A lot of the work I do is related to prenatal outcomes, but in lots of different ways. So smoking is obviously a key one and, as I said, I've moved to embrace quantitative research, even though I feel like I'm a novice and I have to keep ringing my wonderful experience friends and check that I'm doing it right. So I did some work a couple of years ago around that interviewed women who continued to smoke during pregnancy to find out what was important to them and kind of why they continued and what might help them stop if or think that it's important, because it is for most of them, they knew that it was not of benefit to their baby, but it was too hard to Anyway, from that we've developed an idea, really from the women themselves, that what they needed was support. They felt lonely and isolated and judged for smoking, and yet smoking was one of the kind of their only pleasures in life. There's an amazing quote that always will stick with me from a woman who said it sounds stupid, but my six are the only thing that hasn't let me down in life. That's deep but it feels very profound, that of how crap people's lives can be and how lonely it is. So from that we're looking at setting up peer support groups, really for women who are continuing to smoke, with a moderator who's had an experience of stopping smoking, where the focus is on the support, not on the smoking cessation, but that there is some information about how you might stop or slow or reduce the smoking, because for a lot of the women they felt that if they got that support then they might be able to stop smoking. But the support's the one that needs to come first. So we're doing a feasibility study looking at whether this online peer support makes any difference to engagement with smoking cessation services and any engagement and any effect on smoking cessation during pregnancy, but also on their levels of support and connectedness and sense of social support during pregnancy. So that'll be nice to start in February.

Speaker 2: 1:05:27

Yes, I'm part of an ongoing, so from the PhD there's been ongoing work internationally since then. So we did a study in the UK that replicated the PhD called the Miner, the Midlands and North England Stillbirth Study, looking at third trimester stillbirth. So exactly the same population-based case control study, which found exactly the same. Basically we had the same findings as the initial study around sleep position but also around elements to do with fetal movements and to do with other parts. So it was broad range.

Speaker 2: 1:06:06

And we're now we've just started recruiting about three months ago to a similar study looking at stillbirths that occur between 20 and 28 weeks, because certainly in the UK the third trimester stillbirths have reduced quite significantly over the last five or six years because there's been quite a lot of focus on that, partly from some of the findings that we originally came out with but the earlier stillbirths haven't. So we're looking to see whether some of the same factors around fetal movements, around sleep position, around kind of caffeine consumption, things like that, whether they are relevant to the earlier stillbirth. So that recruitment started. Alex Heasel in Manchester's leading that study, but I'm part of that, so that's interesting.

Speaker 1: 1:06:52

Now there's a feel when you know that research that you produced as part of your PhD has said such a profound effect and is still being used and worked with and worked on, kind of like so many years later.

Speaker 2: 1:07:14

It's amazing. I can't quite. I don't quite believe it really. To be honest, I really don't quite believe it. I had a really odd experience in the summer. I went to a conference a star legacy conference in the US, and somebody came up to me from Canada and said you're, thomasina, your papers changed my life. So they basically he'd read the papers from 2012 around sleep position, started to do some research and it has now done a PhD looking at related factors to do with sleep position in Canada. That's now become his career and at the conference there were three papers, three talks that all fed back to some of that original work that we'd done and I had no idea that it was being done in Canada and America and other parts of the States. I knew that it's part of Australia's bundle maternal sleep position. It's part of the guidance in NHS, which is fantastic and I can remember.

Speaker 2: 1:08:23

I can remember us sitting down and formulating that question in the questionnaire and we initially, the initial hypothesis was around sleep disorder.

Speaker 2: 1:08:36

Breathing actually was one of the key elements of it because supine sleep increases that and we thought that that might reduce blood flow. We didn't realise the degree to which actually the impact of the uterus, the weight of the uterus has that impact on maternal return, and that there's been some really interesting MRI studies since in Auckland on that. So it does feel amazing and I was talking to a colleague of mine, an epidemiologist, and I keep saying I kind of haven't quite found the next study and they said it's because you got it in your PhD. It's unusual to do an epidemiological study where you actually get a significant finding which is then confirmed in later studies and appears to make a difference, actually genuinely makes a difference to, and that certainly in New Zealand they've done ongoing studies and that fewer and fewer women settle to sleep on their backs, there is a reduction in stillbirth. We have no, we. I can't say that it's related, but we know that makes a difference.

Speaker 1: 1:09:41

It's makes a difference, seems to make a difference, and there's a physiological explanation for why it happens which is why we put a bolster underneath the left hip, the right hip, when we're actually doing CPR and anything like that. So if you want to put a bolster underneath your hip, move that way, yeah. And it's simple, simple intervention which brings me to two things. A I don't think you can call yourself an imposter anymore, because that's just proving you're not, that you can't be, I still have, but also I think so much I don't know.

Speaker 1: 1:10:14

I mean, that's part of it because, as when you know that you don't know. But that's also the good part, because there's so much to still learn. But I think it also highlights the fact that we live in such a technological connected world that if you are working in an area, reach out to the people who've done the studies before. Reach out, send them a social media message, send them an email. I'm researching in this area. I really like this paper. I would love to kind of get your ideas or something like that, because I think that's we're too afraid that imposter syndrome. I'm only a PhD student, I'm only a student and you're a professor. It's like I think anyone would love to get a genuine email, not a harassment kind of one of these emails that come and talk to our conference type thing, but having a genuine person show an interest and say I've read this paper. I really like this kind of what did you mean here, or could we kind of look at that? I think that needs to be encouraged more.

Speaker 2: 1:11:11

Absolutely Make those connections and we I love it. I don't care who it is. Who would you know someone doing? I've had people you know doing a masters go I see that you've written on this and when it happens it's wonderful. I love it because someone's interested in what you're doing, because otherwise you, you know, you wonder whether you're just kind of talking into a vacuum and never worry. I mean, I would definitely the message out there never worry about what you know number of letters off their name or where they, where they work or whatever it is Make that contact, reach out. The worst is that they don't respond to you and often they mostly so. For me, if I don't respond, it's because I'm really busy. So send me another one is what I would say. Just send me another email, because I might notice it that time.

Speaker 1: 1:11:55

I think I've seen a couple of memes about academics answering their emails, that they like to answer their email in three seconds or in three years.

Speaker 2: 1:12:05

Yeah, and it's like I'm just going through my I'm just replying.

Speaker 1: 1:12:08

Do you still need this?

Speaker 2: 1:12:10

Yeah. So exactly what happens, you know? Because if it pops up while you've got your emails open and you're in the I'm answering emails mode, I'll answer straight away, Yep, and and. If not, it just falls down the bottom and I say that to my students. I say, if I will, I will respond to you within 24 hours. So it's necessary to for the other academics. If you don't get a response within 24 hours, send me another email. Yep, I won't be cross, it won't be pestering, but just send me another one, because it will come to the top of my email pile again.

Speaker 2: 1:12:40

And then I will. I will respond to you, so, so yeah, I encourage people to do it, so said that the worst thing is that they don't respond Exactly.

Speaker 1: 1:12:52

And you don't kind of, you don't lose anything. Thank you very much for your time.

Speaker 2: 1:12:57

Well, it's pleasure. It feels very strange talking about it, but it's so simple.

Speaker 1: 1:13:04

It's a scenario of your passion. It's what you've done. Yeah, yeah.

Speaker 2: 1:13:07

Yeah, no, it's wonderful and, and you know, research is is a fantastic thing and, as a midwife, as long as we stay connected to why we're doing what we're doing, and that's about. It's about making a difference and it's about understanding the world, yep, and you know what can be bad about that?

Speaker 1: 1:13:28

And we just do that one question at a time.

Speaker 2: 1:13:30

Yeah, yeah.