thru the pinard Podcast
a conversational podcast with @Academic_Liz with midwives & other birth professionals about their studies/ research & how it's changing our practice globally - email thruthepinard@gmail.com
thru the pinard Podcast
Ep 73 Caroline Homer on midwifery continuity of care practice to leadership and research
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Ep 73 (ibit.ly/Re5V) Caroline Homer on midwifery continuity of care practice to leadership and research
@PhDMidwives #MidTwitter @BurnetInstitute @utsSoNM @MonashUni @Deakin @UniMelb @WHOCCCardiff @KingsCollegeLon @MidwivesACM @world_midwives
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When Caroline Homer stepped into the world of midwifery, little did she know she was embarking on a voyage that would not only reshape her own life but also touch countless others along the way. Join us as we delve into Caroline's story, from her initial nursing days in Brisbane, through her transformative jump into midwifery in Sydney, and onto her pivotal role in the Burnett Institute. With a blend of personal reflection and professional insight, Caroline regales us with tales of her apprenticeship experiences and the evolving landscape of nursing and midwifery education. Her journey is a testament to the power of lateral moves in carving out a fulfilling career in healthcare.
Imagine if your curiosity for data collection in research led you down a path of profound professional transformation. That's exactly what happened to Caroline when a role as a research midwife sparked a lifelong passion for inquiry, driving her towards academic achievements and groundbreaking trials. In this episode, we track Caroline's foray into HIV research, her pivotal return to midwifery, and her influential role in establishing the significant midwifery continuity of care trial known as STOMP. She also emphasizes the importance of community and mentorship, shedding light on how the Australia College of Midwives has become an invaluable network for professionals in the field.
Finally, Caroline opens up about the intricate dance of leadership and academia in midwifery, especially in the face of global challenges like the pandemic. She discusses the need for strong leadership, the rarity of clinical chair roles in midwifery compared to other medical fields, and the impact of having a dedicated research code for the discipline. As we examine the nuances of PhD supervision and student-relations, Caroline shares her perspective on the critical role of support and clear expectations for academic success. Her story doesn't just outline a career but illustrates a roadmap for anyone aiming to merge practice with research and leadership in their field, proving that with the right mentorship and community, the journey is as rewarding as the destination.
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Journey to Midwifery Practice
Speaker 1Thank you very much for joining me , as per usual . Can you introduce yourself , please ?
Speaker 2Hello everybody . My name is Caroline Homer . I'm a midwife . My day job is as one of the deputy directors at the Burnett Institute in Melbourne , australia , and my other roles are as Professor of Midwifery at a number of universities . The primary one really , though , is the University of Technology in Sydney , where I am Emeritus Professor .
Speaker 1Yeah , I saw that you have got about four Australian universities , and then you've got Cardiff and King's College as well .
Speaker 2Yeah , that's sort of . The Burnett Institute is an interesting organisation . It's where a medical research institute and a non-government organisation and international NGO . But we're not a university so we don't . We can't administer or award PhDs . So to have PhD students I have connections with all the universities so that's kind of why I have all the Australian ones . But as and most of my students are at the University of Melbourne , monash , deakin or UTS , and then the international ones came from ongoing collaboration . So Cardiff is through the WHO World Health Organization Collaborating Centre with Billy Hunter , who's since retired but a wonderful Professor of Midwifery in the UK , and King's College is mostly through Jane Sandel and other colleagues there .
Speaker 1Now , yeah , Okay , so let's go right back . Let's kind of go take it back . How did you get into Midwifery in the first place ?
Speaker 2I kind of got into Midwifery as an accident , really as many of these things are . I'm a hospital trained nurse , what in those days was a pretty much an apprenticeship model . I worked I was a student at the Royal Brisbane Hospital in Queensland where there were many students . It was a big hospital , 1500 bed hospital and .
Speaker 2I think five cohorts a year of 60 students at a time , so 300 students a year , and it was pretty what can I say ? A little bit brutal in a way . We were very anonymous . I remember saying to the matron in the nurse's home on the first day that they'd got my name wrong on my uniforms and my name was Caroline Homer , not N Homer , and she said N is for nurse and you won't have a Christian name for the next three years . So just kind of get over it , okay . So saying that actually was great training in a way and I don't want to ever go back to the apprenticeship model for nursing or Midwifery , but I do think we had kind of exceptional teachers . We did have a great experience and I learned a lot , but I don't think it was a safe model of care . Yes , now , I was a baby student . I'd got my first stripe on my hat , I was a grand age of 18 and a half and in charge of Guiney ward at night , because that's how the model worked and if you needed help you'd ring up the assistant director of nursing who was on , or the matron down the road or down the corridor and you'd get help . But you know we wouldn't think that was a good thing .
Speaker 2No , so then I finished nursing and I got a bit bored of Brisbane . It just didn't kind of work for me . And I was at a pub with a friend and she said I'm going to go to Sydney for six months . Do you want to come ? And I went oh yeah , why not ?
Speaker 2So we got in our little cars and we drove to Sydney for six months and I worked in Bone Marrow Transplant , actually , and oncology at Prince of Wales Hospital and then at St Vincent's Hospital in Sydney , both jobs which I actually really loved and I applied to do the oncology nursing course through the I don't know if it was called the Australian College of Nursing , then maybe it was the New South Wales College of Nursing and I didn't get in and I was really upset and I kind of , you know , thought that was my pathway . And then again at a pub one of my most of my clever decisions get made at pubs with friends and she said I'm going to do midi at St Margaret's , why don't you apply ? And I went oh yeah , why not ? You know , in those days the sort of double certificate , triple certificate thing was a thing .
Speaker 2Yes , so the world had just started university trained nurses , but they were very new . The first crop had think had just graduated , but it was a very new concept . Yeah , the roof . It was well away from being in universities . So I didn't get into St Margaret's . I can't quite remember why , but I didn't .
Speaker 2So I went to the Royal Hospital for Women Right . We had again an apprenticeship 12 months program where you had school in the classroom down the bottom of the hill and did all the training through the hospital for 12 months , rotating through all the services . So again I had a certificate in nursing and a certificate in midwifery . Yeah , so that's kind of how I got to midwifery . It wasn't a life dream , it wasn't a calling . I didn't love it at the time . But that many of our student experiences are tough and difficult . I think going from being quite an experienced nurse it was probably only five or 60 years out as a nurse but felt pretty experienced to being a student is never easy , although I had some fantastic people who mentored and supported me in that year and made some brilliant friends , many of whom I'm still in contact with . So lots of good things along the way .
Speaker 1And it's changing the mindset from . I'm very similar . I was hospital trained here at the Queen Liz in Adelaide . So changing the mindset from a sick patient to a well woman in midwifery takes a little bit of cognitive kind of like jumble because you're so used to the sick patient and it's like but no , pregnancy is a normal state . There are women who have preexisting conditions but yeah , that can be . Take a little bit of mindset to get through .
Speaker 2I think that's true , liz , but I think at the time that wasn't the concept in the hospital . I and I'm ashamed now that I knew I didn't really know that , right , maybe , maybe . I mean , of course it's true .
Speaker 1But if you're in a hospital , it's still a hospital , yeah it certainly wasn't embedded in my experience .
Speaker 2Maybe it was embedded and I missed it , but it certainly wasn't embedded in my experience . It was a big hospital , lots of technology and a bit of yeah , I didn't get that concept of women are well when they're pregnant and I didn't get the philosophy of midwifery , and I hope we've got better at this . In our training . I did not know a thing called the College of Midwives existed until many years later . It wasn't embedded in our student experience it wasn't . It kind of wasn't a thing that I heard about . I think maybe it was that hospital didn't really have the connections , whereas if I'd gone to some Margaret's or Crown Street it would have been quite different . But so I kind of felt I missed all that . You know , philosophy of midwifery and the things you've just said around . They're not sick and maybe , as you say , it's because it was in a hospital and I didn't come . Yet I did really want to go and work in the birth centre .
Speaker 2So the Royal had one of the first birth centres in New South Wales and it was a little cottage at the front of the hospital where you drove in through the driveway . It was an old child and family health centre that got turned into a birth centre and there was this wonderful place next door called Heraphith House . That was kind of like a motel and so when women had had straightforward births but still stayed in hospital for a few days , in those days everyone stayed in hospital . It was upstairs , downstairs . It now wouldn't pass any kind of accessibility criteria lots of stairs and complicated little corridors but it was a fantastic place and I remember doing postnatal care there and that was probably when I kind of got what midwifery was starting to be for me and I understood . The birth centre was next door , where it was a very different experience than the labour ward . So while we were never allowed to work in the birth centre as students , I kind of thought there was something going on behind that door that probably I wanted to be involved in at some point .
Speaker 1But venue is quite often in the hospital situation . They're designed to produce workers , they're not , and they're sustaining a staff .
Speaker 2So and it was a different time . This is 1980s . It was a very different time . But I left that hospital and went back to nursing . To be honest , the last I went back to nursing for about six months to a children's hospital and then I my partner at the time was going to the country , and so I went to the country with him for six months and still worked as a nurse , but started working in the midwifery service a little bit more , although my job mostly was was on the postnatal ward and I was very good at the milk room . I don't know if you had the milk room , but and I won't name the hospital , but it's a rural hospital where someone a midwife made all the milk bottles for the day . So if you think about that , that says something about the way we fed the kids , but also says something about how we valued midwives , that a trained midwife could be put . That's all they did for the day . Imagine doing that now . What a waste of a resource .
Speaker 1Absolutely .
Speaker 2But anyway , occasionally the bells would ring and we would be , would run to the labour ward to be the second midwife .
Speaker 1Right .
Speaker 2And that was that was a really good thing . And so I started seeing labours and being the second midwife and you know I probably wasn't utilised as best as I could , but I probably wasn't very good . You know , and just come out of my training , I was basically a new graduate with no new year .
Speaker 1And you're tied to that . Do that consolidation .
Speaker 2So where did ?
Speaker 1you go from country ? Did you come back to city ? Did you start travelling then ?
Speaker 2Well then I started travelling and I can't quite remember whether it was straight away or maybe it was a little bit few more months in the or another year . It's a bit hazy , but eventually I went to work in Malawi and Africa in a labour ward and and I've said this before publicly but you know total .
Speaker 2That totally sorted me out and I learned to be a midwife , probably more than I'd learnt before . I was pretty much thrown in and thank God for the excellent Malawi and midwives who taught me stuff , because they must have thought I was completely useless . I couldn't put a drip in , I didn't know how to do a vacuum extraction on my own . I'd never delivered a breach on my own . I've never really what to do with twins , this is all on your own . You're not somebody else , never really assisted at a caesarean . So you know , suddenly all of these things were what you did and I these days I wouldn't recommend anybody do what I do .
Speaker 2I think when we go and work internationally , we go when we've got skills and capacity and we can offer something . We don't go to get things . And I really went to get things and I and I don't think ultimately that's a good model . I mean , at a personal level I'm very grateful that I had the experience , but I'm kind of sometimes embarrassed by my , my , my uselessness and generosity of people . But anyway , that kind of was a fantastic experience A year in Africa working in that labor ward . I came back kind of right . I know what I want to do now . I'm just going to go and do midwifery , and so that that was . You know , those sort of sliding door moments on somewhere else . Something different might have happened , did you ?
Speaker 1find a culture shock when you came back to Australia after a year in Malawi .
Speaker 2Yeah , I mean the things you're allowed to do and not allowed to do in Australia are quite different I think . I think , while you know all the skills are fun to be able to do , more importantly for midwives is the , the trusting women walking alongside women , understanding experiences and diversity . I mean those things I think were more valuable . I'm not sure I would have wanted to do all the things that I had done in Malawi in Australia . That just would have been to to left field , but I think it gave me a renewed confidence in the capacity of women to give birth . I think I'd kind of lost that along the way a bit with interventions .
Speaker 2So in Malawi , you know , women walked a long way , as they do in many parts of Africa and Asia Pacific . Still they walk a long way in labor . They arrive , they give birth . It's often quite straightforward but it's often quite brutal to you're alone . These women were always alone , they were on a bed . But then we started to think well , it might be different ways to do this and so kind of re . Well , for the first time really understanding women's capacity , I think was pretty powerful . Yes , a culture shock , but in a positive way as well , I think .
Linking Midwifery and Research Journeys
Speaker 1So when did you start realising linkage between midwifery and research ?
Speaker 2Well , when I was at , I worked in Lab Ward for a few years , again in the , in the at the hospital , at the hospital , and then I got an opportunity to be a research midwife for one of the obstetricians in the hospital and it was a project that I never . I never got any , I didn't design , I didn't get any publications out of it , I didn't really understand what I was doing . I was really just collecting some data . But I found that really interesting and around that time I started doing a graduate diploma in child health . And in those days , liz , there really weren't any options for midwives . You had to do nursing qualifications . There weren't . It wasn't a masters of midwifery or anything .
Speaker 2So I started doing a graduate diploma because that's what I could get into without having an undergraduate degree . And you know , I started learning how to write , how to use a computer , how to do an assignment , which I haven't really done essays and things before , or literature reviews , and I don't know what that was . And yeah , so that then I , then I at that point actually , I left midwifery for a little while and went into research , into HIV research . I was really interested in HIV .
Speaker 2I've been worked in Africa in the early days of the pandemic and I went and worked at some Vincent's in HIV research and I think you know Africa sorted me out on the midwifery stuff and then that job sorted me out on the research stuff kind of gave me a really good understanding of you know what what trials were , what research was , why it was important , how it could change practice , what it could do . And I guess while it wasn't midwifery , it was continuity of care , people who were having a specific treatment in HIV and I think you know that when I reflect back on it that's the sort of links for me . Even though it wasn't midwifery , it was continuity of care and it was research .
Speaker 1Yeah , and so , vincent , we're doing some amazing stuff in those days as well .
Speaker 2Yeah , it was a really good place to work for a couple of years . And then I saw a job advertised at St George Hospital in Sydney as a research nurse . And interestingly it was advertised as a research nurse working for Professor Leslie Barclay . Oh , yes , and so I went along to that interview and I said I remember saying you know , I really want to work I didn't use the word midwife I really want to work for nurses . I'm I've always done research for doctors and I want to now work for nurses . And I kind of hadn't got the midwifery politics at all . But Leslie was very generous and I mean her title I think at that time was Professor of Family Health . I don't think midwifery was in her title , I think it was Professor of Family Health . So we're all new to the visibility of midwifery .
Speaker 2But then so I did a . I did a job with Jenny Fennick , who now with the UTS , and I met all the all the glitterati . So Pat Brown , hannah Darlin , joanne Gray , nitty Leap , athena Sheehan and we . And we started working together and worked with some fantastic obstetricians and renal physicians Greg Davis , who's still there , michael Chapman , mark Brown and kind of kind of got it and and then started working clinically as well . So I worked in the anti natal clinic with Louise Everett , who's still around doing amazing things , and morphed at some point over those years into doing caseload practice with Louise and Rachel Smith and Lynn Passant , so kind of found my home and found my people . And I think I think that's my advice for people out there is , yes , go and get all your qualifications and all your skills and all the things that you need , but really find your people .
Speaker 2Yeah , for me the College of Midwives was my people and I'm ashamed to say it was only then and I think it was Louise Everett they were all off to ICM in Europe somewhere , norway , I think there was an ICM in Norway at that time and they were all off to Norway and I was , I was astonished , what was this thing called ICM and where are we going and what were they doing ? And they came back with lots of wonderful stories and and kind of I realized , right , I don't know , I'm not a member of this thing called the New South Wales College of Midwives . I must be . Actually it wasn't that . What was it called ? The New South Wales Midwives Association ? Sorry , get it right . And so then I got kind of connected and and that was my people .
Speaker 1Yeah .
Speaker 2So find your people really , really important , and for me it's always been the College of Midwives .
Speaker 1So then , what got you to do the next big step of doing a PhD ? Was that part of the planning ?
Speaker 2Oh God , no , no plan , god , no , no . Remember , I still don't have an undergraduate degree . Along the way I managed to wrangle my graduate diploma in child health with . I never really finished . I finished the sort of you know coursework . Yep , I never really did anything in child health , but I managed to do another four subjects and got a Masters of Nursing .
Speaker 1Okay , yep .
Speaker 2Around that time , which you know was a good thing and a good start . And then I was running a project . I wrote a grant with Pat Brody , we got a grant from the NH and MRC with Leslie Barclay and we started doing a trial on midwifery continuity of care . That is still going . It's called Stomp , which is stands for I can't even remember now , isn't that terrible , but it's midwifery continuity of case and George options for midwifery continuity . It's something like that Project .
Speaker 2Anyway , we started running that trial . It was a randomized trial of over 1000 women and I was the kind of project lead for the trial . And at some point , I think after about a year , leslie said Well , why don't you just do it as a PhD ? And I didn't really know what that was or how one did one and I didn't really think that I actually don't have any of the qualifications to get in . But you know , god love Leslie , she , she made it happen and I never felt I had to fight my way in . I'm sure she did had to fight for me , but kind of it just happened and by the time I enrolled we'd collected almost all the data , were well on the way to collecting it all , maybe not all of it . But you know we had a trial that I designed . It was very clear that it could be used as my PhD because I'd done the work and yeah , so we kept going and I finished that quite quickly .
Speaker 2The PhD maybe in two or three years yeah , two or three years , two and a half years and you know , managed to publish a lot of papers out of that work and you know had had a couple of papers before that . We did a study in the birth center at St George Hospital with Deb Mayther who was the manager of the birth center at the time , and we did a comparative study around birth centers and women who went to the Standard Labor Ward and we did another trial . These days seems ridiculous that you'd have to do a trial about a woman held records trial where we gave some half the women their records to take home and bring back and we kept the other half and we looked at outcomes and so it started doing bits and pieces of research in my role at St George and then , of course , the PhD dropped out of that and and yeah , I've always worked clinically through that time and started teaching at the university as well , started teaching evidence based practice and then started traveling with Leslie . She was a very generous mentor always me and started , I think , my first trip .
Speaker 2I went to Papua New Guinea with her . We had a project supporting nursing at that time nursing research in PNG . And then I think I went to Samoa at one point with Leslie doing some guideline development with Samoa and I'm continuing to work in both those countries , of course , 25 years later , nearly yeah . So no planning , you just take off , take opportunities , liz , and you know , have a go .
Speaker 1That's the most common theme that's kind of coming out is that very few people have actually planned the PhD pathway or know that majority of it's opportunistic , it's serendipity , it's they've already been doing something and someone says your Mars will do it because you're doing the work anyway . So it's interesting how majority of people fall down that pathway .
Speaker 2I think you could change it , though . I think the next generation are different , which is good . I think the younger generation are thinking and they know there's an honest pathway . I think we have to do better at helping people think about the planning .
Speaker 1Sorry I interrupted you . No , no , no , no , no . But I 1000% agree with you . Which is the kind of principle behind this podcast is to help people understand that there is a pathway that they can achieve and doing it and the differences between doing it part-time and full-time . How did you balance , Like , if you're working full-time and you're also clinical , but you're also teaching , you're doing research , you're kind of running a trial and you're doing the PhD , which kind of fits in but how did you balance your life and your sanity during that time ?
Speaker 2I never really thought about it . To be honest , I'm not a big fan of the whole work-life balance thing . I think it makes people anxious about always being out of balance . I've always thought about integrating . I'm much more enthusiastic about a work-life integration Like . For me , my work was stuff I loved doing . I was doing it with people I loved working with . It was all interesting and exciting and we worked hard and we played hard like this , and I never really thought about it as a challenge . I mean , it's no secret that you have to work hard and I didn't have children and for a lot of that time I didn't have partner , so I could just work at night if I wanted to . But I don't remember . I certainly worked harder in more recent years than in those years .
Speaker 2Maybe I was younger and I didn't notice so much . But yeah , there's no doubt you start early , you finish late , but if you're doing stuff you love and you feel like you're making a difference , I think the whole work-life balance stuff . I used to write down my hours of work , mostly just for I don't know why , it was just a habit I would come out of being a midwife forever .
Speaker 2You're used to clocking on and clocking off , so I have old diaries where I've written when I started working , when I ended never did anything with that information . I didn't really care , but it was a habit more than anything .
Speaker 1Looking back , it's been kind of a few years since you've done your PhD . You've been involved in an awful lot of studies , which will come to shortly . What's one thing that still kind of grabs you about your PhD , something that surprised you about your PhD .
Speaker 2Continuity of care . We had mixed risk women . Were they mixed risk or were they low risk ? I can't remember . Isn't that terrible ? It is 24 years ago . But the Caesarean section rate and I do remember this in the intervention group was 11% and in the standard care group who got standard standard care it was 17% , I think . When I think back and I think the prevailing Caesarean section rate at the time was probably 20% . But when we look at what's happening now in Australia Caesarean section rate over 40% in most many places it kind of feels like . That surprises me that it's only been 24 years and we've seen doubling . I mean we'll be a 50% Caesarean section rate country in the next four years , I reckon , and that has such implications for the world .
Leadership and Research in Midwifery
Speaker 2The other thing that surprised me was , I guess the capacity to actually set up new models of care was possible . But it needs leadership and I think we had fantastic Jo Wills was the head of the maternity unit a fantastic , fantastic visionary leader in midwifery and she just kind of made stuff happen . And it's a good message thinking through for the future around what do you need to make innovations happen ? Is you need people to make stuff happen . And when I look back in the last three or four years around COVID we did make stuff happen , we made changes .
Speaker 2It takes good leadership and a bit of courage and I think those things happened back then . Yeah , and I also think the importance of mentoring and support and Leslie was in a clinical chair role so she was paid for by the hospital and the university but based in the hospital and there's not a lot of those roles in midwifery now we need at that time there was , you know it went on to be at least three or four in the area at one point in UTS had Sally Tracy at North Shore , pat Brody at St George , nikki Leap also around there . You know we had we had a number of amazing people doing those roles and that that doesn't really exist anymore . We're lucky now to have Donna Hart's out at Western Sydney doing a clinical chair role and there are others in other states and territories .
Speaker 1Yeah , I was thinking it was always Bradfield in Queens in Western Australia and Annette Briley here in South Australia . They've got clinical chairs .
Speaker 2There are some , but you know how many clinical chairs in medicine are there and nursing yeah , hundreds . So why is it that we've not managed to get that footprint ? And that's , I think clinical research is really important and embedding clinicians as researchers . And that's why I was saying before about the young generation getting them in early but keeping them in the facilities , keeping them in the health system while they do research and after they do research . Yes , we need people in universities , but but we need a better balance than we've currently got .
Speaker 1Absolutely . What do you see is the impact of midwifery having its own research code in Australia , new Zealand , since 2020 , as opposed to being kind of like so very underneath the nursing ?
Speaker 2Well , we can measure it . I mean , I haven't seen any data on it yet , but I'm sure if I went and trawled through the system I could you know now . Now we will know how much midwifery research is going on and in what areas . I think the classifications include models of care , place of birth . You know important areas that that we want to understand more . So you know what's . What's measured becomes visible .
Speaker 2Yes , you can measure it . Then you can report it , then you can understand it and then you can manipulate how it will work in the future . So if nobody's saying they're doing models of care research , but we know that's needed , then we can do something about that . And I also think it's respectful to midwifery researchers who have punched really well above their numbers , both in Australia and globally . Yes , so it's it's recognizing and respecting that we are a different discipline . Many of us came from nursing . We're respectful and admiring of nursing but , but these days we're not . We're not . I'm not registered as a nurse anymore . I work closely with nursing colleagues , but that's not my professional . So it's good to work together and it means we can . We can understand what nursing research is going on and what midwifery research is going on , and we don't get the muddied or concentrated with each other .
Speaker 1We just need the rest of the world to separate it out as well . What did you do to celebrate your PhD ? Oh , I have no memory of that .
Speaker 2Well , actually celebrating PhDs is a funny thing , because you know you submit and it's all a bit of a let down . Let down , I mean , in those days you would go and print your three copies and bind them and take them to the research office and hand them in , and so at least there was a bit of a ceremony about it . These days you just hit a button , I know . So it's not very , it's not very exciting . And then my examination process took about eight months . One of my examiners got sick and wanted more information . No , the examiner from the UK who didn't understand that we didn't do a Viva , all right . And then , while we were negotiating that that wasn't going to happen , she got sick and was offline for six months .
Speaker 2And I think I was getting to the point where I remember saying to the Associate Dean of Research just let's just get another examiner . I had three examiners and this was the third one . The other two had come through and they were fine and it was . You know , I think it was about the eight month point . I said I'm pulling the plug , we have to do something . But you know you're vulnerable as a student , you don't want to say anything , and anyway . Then finally , I think . Anyway , finally she passed it , and you know , by then I was over it , I'd be gone , I was on something else . So I don't think I ever celebrated . I mean I had a nice graduation . I suppose that's a celebration in its way .
Speaker 1Absolutely yeah .
Speaker 2Yeah .
Speaker 1So what you learned as a student and the fact that you were the magnificent opportunity of having Leslie as a supervisor , what have you taken now that you use as a supervisor yourself ?
Speaker 2So I think
Clear Expectations in Student Supervision
Speaker 2it's . It's kind of important to be clear about expectations as a student and as a supervisor . It's a different relationship to being an undergraduate or an honours student . It has to be student directed and probably less and probably more directional these days than I used to be . These days my students are more likely to be full time . They're often overseas students based in Australia and they're often a bit younger .
Speaker 2I think in the days of the early midwifery PhDs they were often grownups , people my own age who , who you know , had very experienced and knew what they were doing and were onto it and so probably didn't need a lot of kind of chasing or direction . These days probably do a little bit more chasing or direction . I think giving people positive feedback , but quick feedback . Really try , if the student sends me something , that I get something back to them at least within a week , preferably quicker . I prioritise student work over hard work because I know that student is hanging on it and they can't do anything until I give them some feedback . So really try and and Leslie was fantastic at that She'd print things , she'd write all over them , she'd give them back really quickly and that was always hugely beneficial . Other things I do . We have regular student meetings . I must say , as a student I wasn't very good at attending them because I found they sort of got in the way , but I think for many students they're pretty isolated .
Speaker 2I didn't feel isolated as a student , so it probably didn't work as much as it could , but lots of students these days are isolated , and so having shared meetings with other students I think it's important , rather than just a relationship with your supervisors and I think getting brave to just give work away and take feedback , and that's always hard . I've got people I work with now who are very reluctant to give work away because it has to be perfect .
Speaker 2I think criticise is hard , but I think we have to get good at giving it and we have to get good at receiving it .
Speaker 1It is a very vulnerable state to be in , with not only just the student supervisor role , but it's like this is your passion and your writing and it feels like it's you on the paper . And then when you come back and you've got lots of well meaning , well intentioned and very well directed feedback and comments , you just sit there and kind of go oh God , I can't write yes , and that's really to separate that kind of emotion , to go , no , this is to make me better , I can write , this is to help me at the next stage .
Speaker 2It takes a little bit of shifting to get into yeah , and everyone writes differently and their styles are different , and I mean that's always a challenge as a supervisor that you edit someone's work , and I think it's probably more problematic now with track changes . I still do prefer to read students work in hard copy and write on it , because the temptation to rewrite it the way I would is a lot less if I'm not doing track changes . True , I'm not sure what the student does at the other end is just says , except all , except it's not really a learning opportunity . That's me rewriting it for them and I don't love that . And I do try more to put things in boxes that students have to think about and make the change themselves . But I'm not a touch typist . I do it , of course , but I think the old way of printing stuff out and writing on it has a lot of merit as well .
Speaker 1And I think you read it differently if it's in hard copy than it's on a computer , and I don't know if it's because we're so used to the computer screen , but yeah , I find I read it a lot more in depth if it's actually printed out than on the computer . It's easy to skim through things and miss important kind of like intentions in it . So where has your PhD taken you ? So what journey have you been on the last 24 years that your PhD has helped in ?
Speaker 2I mean , you know you can't have an academic life these days without a PhD . So you know , as standard , I would never have got a university job . I certainly wouldn't become a professor . So you know , I think it's . It is standard training for academia and I encourage everyone , if they want to do I could go into academia to get your PhD done as fast as you can , because it's just basic training . But more broadly than that , it's given me a focus of something to be an expert in . And you know we've gone on to do a number more trials the mango trial . You know other trials have been involved in .
Speaker 2Focus on continuity of care , I've written a book that's been published a couple of times with Nikki Leighton , pat Brody and Jane Sandel on continuity of care . It's what I'm asked to talk about a lot . Sometimes not everybody appreciates the continuity of care conversation , but that's OK . I've got broad shoulders and when I applied for my NH and MRC investigator grant it was one of the key areas that I put . I made in impact and in those grants you have to say what your research has led to . So I think that was an opportunity to show that continuity of care the research that I led in the early days has led to more research and then now policy and practice , and continuity of care is pretty standard in every policy .
Speaker 2That's not to say that we're good at doing it yet , but certainly we're a long way than we used to , across the country and across the world around knowing that midwives want to provide continuity of care but , most importantly , knowing that that's what women want . And I mean my most recent kind of joy around it is working in low to middle income countries , which has done a big study on midwife led birth centers , which is not quite continuity of care but pretty much , because there's small groups of midwives in Uganda , south Africa , pakistan and Bangladesh . And so seeing those principles of something that I was involved in 24 years ago at St George Hospital played out at a broader stage is a pretty exciting thing and a very rewarding thing that even now the World Health Organization is just about to publish something on midwife continuity of care . We've got it in guidelines and you know I'm part of the community that made that happen , certainly not the only one , but yeah , but that's a good thing . We have to keep . We have to keep pushing it .
Speaker 1Well you , there has to be some kind of leisure out of it , because when you think of the flip side , we're still arguing for it , even though we've had the evidence for kind of several decades to show that it is an ideal model practice . It's got better returns of investment , women are much more satisfied , there's lower intervention , but the frustration is we're still arguing for it now .
Speaker 2Yeah , and we need to make sure we make it doable for midwives to provide the service , for health facilities to enable the services to happen . I think it's sometimes we've made midwifery continuity care look too complicated and too hard and health facilities have gone on . Oh no , no , it's too expensive , that's too tricky , that's too complicated . Midwives have gone on . I don't want to work like that . So I think we have to take some steps back and really think about , you know , what's the first principles that we're trying to do and what are the ways that we can do it that will work for everybody .
Speaker 2It may not be perfect but you know , surely every woman in Australia should know her anti-natal midwife . Yes , that's just a start . That's not into labor and birth and of course that's what we really want as well . But kind of can't be that hard that every woman going through a public or private service going through a private service , they have continuity care because they know they're obstetrician . But surely for a public service , every woman and a private service who choose private midwives of course have the private continuity of care and that's fantastic . So the private models are kind of somewhere okay , although we know there's a whole lot of challenges for privately practicing midwives it also needs to be fixed . But in public services , surely it should be okay that every woman should have a phone number and a name of her midwife .
Speaker 1Yeah , so what's next ? What's the next big plans or next big areas that you're exploring ?
Speaker 2So at the moment I'm working with colleagues in the region , the Asia Pacific region , on really strengthening midwifery . We know there's huge challenges across . There's 22 low and middle income countries in Asia and about 14 in the Pacific . Lots of interest and enthusiasm . We've just set up , with Sarah Baziv , who's a midwifery researcher here with me , midwifery research network for the .
Speaker 2Burmese across the region and that's really exciting . We're just about to start a Centre for Research Excellence , which is about supporting maternal and newborn health in the region with a strong focus on midwifery , strengthening midwifery Fabulous Particularly around education and faculty development , and working with a brilliant team here at the Burnett wanting to really extend what midwives can do within scope of practice and really understand how we can ensure that every woman in the world does get access to a midwife . And in Australia there's still a lot to be done . So at the moment I'm leading the Midwifery Futures Project , which is funded through the Nursing Midwifery Board of Australia , and we're just about to embark on symposium . We're collecting a whole lot of data at the moment , Trying to think well , what's the next 20 years of midwifery in Australia look like ? What are the new solutions to often old problems ? So that's an exciting project that we're well finished by September this year .
Speaker 1So that was advertised and closed only recently . So you're looking at feedback from midwives , midwife educators and also students as well .
Speaker 2Yeah , we got about 3,000 midwives to fill in the survey . I think there's about 300 students and about 70 midwifery educators . So we're really , really happy with that . We're currently analyzing all that data and we've also just published a review of what women want in Australia . Rather than surveying women , we decided I did feel that women have been over surveyed . Just keep telling us the same things and we just deliver it .
Speaker 2So we've just published a paper on what women want and fundamentally they want continuity of care , especially midwifery continuity of care . So hopefully that work will get picked up and again going back to well , what is it that women want and need and how can we deliver that within the constraints of all the things that we've got ? And how can we support midwives to work to their full scope of practice and to flourish in their work , to not get burnt out , to not want to leave , to want to , you know , progress through their careers , whether it's into education or research or through clinical practice , through inter-private practice , public practice . You know we need a diversity of options for midwives in Australia as well .
Speaker 1So we haven't got at the moment a formal clinical research role or a research clinicians role within midwifery . Have we ?
Speaker 2No , and that is something that needs to happen . At the moment there's , you know , in industrial awards , there's a midwifery consultant role . In many jurisdictions , in many places that role includes a research component . So I think the extension to that is the next role is to think about . In the US they call them clinician scientists I don't know about the word scientist , but maybe I like it but we need , you know , a midwife researcher role , but a clinical one .
Speaker 2A clinician scientist or clinician researcher or something , Both for nursing and midwifery . To be honest , I think if we , if we , if our nursing sisters also had those roles , I think that would make a really big difference in facilities if you had both those roles in hospitals working together . Yeah , that's another avenue that we need to explore because once it gets into industrial awards , then people can recruit .
Speaker 2Yeah they can get , they can advocate for the funding and they can recruit . While it's not a thing in an industrial award , it's very hard to make happen because you don't know what they are or what to pay them or where they fit in the system . And so I think our advocacy is around . You know , clinician scientists , midwife researchers , whatever we want to call them , but they have to be , have to have . The clinician bit is the important bit . Not not in , not with links to universities or medical research institutes , of course , but based in the hospitals or the health facilities .
Speaker 1And we will get there . In America , obviously , they've got the DNP , so the Doctor of Nursing Practice , but they've actually there is starting a DNP so midwifery practice , a Doctor of Midwifery Practice as well . So even they're starting to separate out the nursing and midwifery as well , for which is good , and I think it's Tennessee maybe I might have that wrong , but I'm trying to explore and talk to somebody about that but that's only something that's very new and I think they might have only had their recent graduates . So that could be something that is another option and pathway as well that we could look at .
Speaker 2Yeah , look , we did have a similar program called a professional doctorate in midwifery and in nursing , to separate qualifications . And you know we've had some fantastic graduates Sally Tracy , pat Brody , nikki Leap , sally Pearman all went through that program . We didn't quite work it out , how to do it , I think , and we ended up making those graduates almost do double PhDs . They do professional practice PhD and then a conventional PhD . So these days I think the sort of standard in inverted commas PhD can be made into those sorts of things . I don't think , you know , I think with creativity you can do PhD on anything . We don't need a separate program , but we need , we need roles for them to go into once they're finished .
Speaker 2Because you finish your PhD , however , you do it , and then there's nothing in the hospital for you to do . You still go , you're still a , and not that this is a bad thing , but you have to have a career pathway . Absolutely as a research midwife in a hospital forevermore . You won't , because you'll want a progression . You'll want to go to be the research fellow in the hospital and then the research lead and then the professor of midwifery research in the hospital . So that's the bit we haven't got the career pathway from being the like me started as the data collector . Where's ? Where's the progression that we need to have ?
Speaker 1And that's it . I'm midwife that I've spoken to , have gone . There's no point being a teacher doing a PhD because I don't want to go into academia and there's they can't see another pathway for it . So I think that's one of our biggest challenges for the future .
Valuing Time and Support in Journey
Speaker 1Thank you so much for your time . I know your time is extremely precious .
Speaker 2Thank you for the opportunity and , I guess , to your listeners . You know there's there's a million ways to do this , there's a lots of ways to get there and you know , find mentors , find support , find your people , join the College of Midwives if you're in Australia , and you know , find like minded people to help you , because there's lots of ways to make this journey happen Absolutely and there's just one . And lots of people have different ideas and suggestions and you know that's all good .