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 87 Rakime Elmir on Navigating Emergency Postpartum Hysterectomy, Cultural Advocacy, and Academic Challenges
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Ep 87 (http://ibit.ly/Re5V) Rakime Elmir on Navigating Emergency Postpartum Hysterectomy, Cultural Advocacy, and Academic Challenges
@PhDMidwives #research #midwifery #PIPE-MC @westernsydneyu #birthtrauma #partners
Research link - ibit.ly/n9BUe
Rakime Elmir's journey into the world of nursing and midwifery is nothing short of inspiring. As the first in her family to attend university, Rakime navigated the challenges of a less diverse academic environment with determination, fueled by her passion for women's health and influenced by her mother's childbirth stories. In our latest episode, Rakime shares the milestones of her career, from pioneering research in women's' experiences of having an emergency post partum hysterectomy to designing Australia's first university-branded hijab, supporting Muslim students in midwifery and nursing. Her dedication to improving care for women and promoting cultural inclusivity in healthcare is a testament to her resilience and innovation.
Balancing a PhD with the demands of new marriage and impending motherhood might seem daunting, but Rakime shares her strategies for thriving amid these pressures. She opens up about the meticulous organization and emotional support systems that helped her stay focused, even when academic feedback felt overwhelming. Through her insights, listeners will learn about the importance of discipline, the value of community support, and how to navigate the emotional landscape of academia with grace and determination.
Finally, Rakime delves into the transformative impact of her research on women’s health, highlighting the ethical complexities and the profound privilege of representing women's voices in her studies. From innovative recruitment methods for diverse research participation to advocating for culturally safe care models in midwifery, her story underscores the need for adaptability and persistence in both academic and professional pursuits. Join us as we explore Rakime’s journey of resilience, cultural advocacy, and the continuous pursuit of academic excellence in the face of life's challenges.
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Journey Into Midwifery and Research
Speaker 1Thank you very much for joining me , as per usual . Can you introduce yourself , please ?
Speaker 2Sure . So my name is Rakeem Elmi . I'm an Associate Professor at Western Sydney University School of Nursing and Midwifery . I'm a mother to three beautiful children and a very proud wife as well .
Speaker 1Excellent . How did you get into midwifery ? And we'll start at the beginning , as well , excellent .
Speaker 2How did you get into midwifery ? And we'll start at the beginning . Sure , so I've always had an interest in midwifery , in , you know , a really love for babies , children , women's health , and that all stems from listening to my mother's birth experiences , so she never shied away from sharing her experiences . I'm one of six siblings , um , so I came I come from a quite a big family and she was talked about how wonderful her experiences were , um , the lovely care that she received from midwives she accessed hospital-based care , and so that was lovely to hear and then also the not so good experiences she had as well . So it wasn't all positive , but that just motivated me and fired me to want to pursue this profession , which I sort of knew a little bit about , but I wanted to know more about , and hopefully I was a person that would make a positive difference in a woman's life .
Speaker 1So you went through direct entry at Western Sydney .
Speaker 2No , it wasn't direct entry . So when I did midwifery more than 20 years ago I finished my midwifery program in 2004 there was no direct entry to the midwifery course , so I had to complete my three years of bachelor of nursing and then go into midwifery and at that , at that point , you could go directly straight into midwifery . You didn't have to do the one year postgraduate experience . So , yes , that's , that's the pathway I went down and the really cool having lived in sydney .
Speaker 1The really cool thing I find about sydney , especially western sydney , is it is so culturally diverse that the mix of people you have coming through would have been quite fascinating , with the difference in kind of diversity but also looking at socioeconomic that would have made the midwifery challenging at times .
Speaker 2Studying midwifery is that what you mean ? Yeah , yeah , so yeah , I studied at Western Sydney University . I'm an alumni there . My group wasn't very diverse in terms of who was studying midwifery , so I was probably the only Lebanese student in the cohort at that time . I mean , you know , we're talking about more than 20 years ago , so it wasn't very diverse . So the midwifery workforce wasn't very diverse . But now when we look at the midwifery workforce , it is and it's lovely to see . So I was first in family , so meaning I was the first one going to university in my family , even though I'm the middle child , but my two other sisters older sisters they pursued a different pathway . So , yeah , yeah , it's lovely to see that it's come a long way . Now there's a lot more diversity at Western .
Speaker 1Yeah , to support students within the region and we're going to come back to that because that's your current area of interest and research that you're doing . Where did you go after you completed your undergraduate midwifery ?
Speaker 2Sure . So I didn't do my PhD straight away , but I did a pathway to a PhD . So I started , I commenced my honours program . That wasn't in midwifery , that was in women's health Okay , yep , in breast cancer . Oh , wow , yeah , in the area of breast cancer , looking at women's experiences of breast cancer under the age of 50 who had breast surgery . And the reason why I was so passionate about that was because I have a family history of breast cancer . So my grandmother passed away from breast cancer and I have other close relatives who also passed away from breast cancer , and I had other close relatives who also passed away from breast cancer . So it definitely , yeah , I have a familiar history and .
Speaker 2I wanted to know more about women's experiences and whether that impacted on them as a woman and their role in society . So , for many of them , it gave them a second chance at life . They re-evaluated life . They appreciated the things they thought they wouldn't have appreciated . So , yeah , it was lovely , it was really humbling to listen to their experiences and , again , this was pre-covid , so , uh , I had the opportunity to interview them face to face and really immerse myself in their data and , um , yeah , just such a privilege really , how many women did you have a chance to talk to ?
Speaker 2um only four at that stage , uh that's an honest project , so yeah , a small project .
Speaker 2Uh , and again it was women weren't as forthcoming to speak about their experiences . Uh , because again , I think there's a bit of stigma associated with women's health and , um , particularly cancer breast cancer , although it's , you know , it's talked about a lot more now with campaigns pink ribbon and the mcgrath breast foundation like there's a lot more um , there's a lot more support and , you know , peer organizations , which is lovely to see , but at that time , when I didn't start in my honors , it wasn't talked about a lot .
Speaker 1Yes , we did a lot of campaigning and media um , try to reach women through media and even radio , and even after all that I only ended up with four women women that's the good thing about qualitative research is it's not about the numbers , it's the depth and the quality of the amount of information you get out of chatting to someone for 45 minutes to an hour is huge yeah , that's right .
Speaker 2And , like you said , the depth , um , you know , I was chatting with these women for two hours or so and it was just again really humbling , such a privilege and and it makes you reevaluate your life at the same time , that that vicarious type yeah , that you experience , it's quite , yeah , it's beautiful , it really is , yeah .
Speaker 1So where did that take you once you'd completed your honours ?
Speaker 2When I completed my honours I was when I was studying my honours I was actually still working in birthing unit as a midwife and so even while completing my honours , I was thinking about my pathway to PhD at the same time too , and I was really passionate about pursuing an area that there was a massive gap in the literature . So when I completed my honours I thought I you know , there is a lot of literature around breastfeeding , models of care . There may be some gaps in those areas , but what's an area where it's not talked about a lot midwives need to know more information about ? And I thought about the area of um , emergency postpartum hysterectomies . Yeah , and what interested me in that was that through a personal encounter actually at um , at hospital , where a woman had a postpartum hysterectomy and my colleagues just weren't too sure whether that woman should come back to birthing unit or ICU and the management as well , and so , and leading up to the hysterectomy , just the chaotic nature of it , it was real chaos . The woman was , was unprepared .
Speaker 2You know I kept thinking did we inform her enough of what was happening and the events ? Did we include her partner , her support ? People Were they shoved to the side . So I went to the literature and there was nothing out there really . There was no support groups for women , there was no information . Basically , there was no support groups for women . There was no information that basically there was nothing there . The closest thing that came to postpartum hysterectomy was birth trauma and experiences of birth trauma . That's right , and so that's why . Then I thought you know , I need to do something in this area . I knew the incidence was low 0.05% at that time back then , and so that's what interested me and got me into a PhD .
Speaker 1Yeah , Did you approach the university then for that ? How did you kind of like what was the process of getting supervisors ? And starting with that question , Sure .
Speaker 2So it really because it led on from my I'd completed my honours program and so my primary supervisor at that time . We had those preliminary type discussions about , okay , what do you want to do after you finish your honours ? And I said , definitely , you want to go into academia and PhD pathway . And she said , okay , that's great , and where you know , what do you want to study ? And I said something to do with midwifery at that stage and then when I had more of a clearer idea about my proposal and topic and aim and research question , she then directed me to midwives or professors in that area that were well-versed . So it was really as a result of my primary supervisor from my honours , yeah . So then I had conversations with those professors , the professors in midwifery and we put in a proposal or a statement of intent is what you need to put in to apply through the university .
Speaker 1So were you able to do it full-time or part-time .
Balancing PhD Studies and Motherhood
Speaker 2The PhD . I was able to do it in four years .
Speaker 1Okay .
Speaker 2Yeah , I was able to do it in four years and I wanted to do it in four years or a full time . I had enrolled full time , but then I got pregnant in my last year . Yeah , because the time that I started my PhD was the first year I got married as well . So I got married in 2007 and I started my PhD in March 2008 . Yeah , so yes , and we yeah , it was like , okay , all right , let's just yeah , but finding my feet in as a , you know , married woman , as a PhD student , and yeah , and then we agreed to , yeah , I would study full-time because , again , I didn't have any other . Yeah , I had work commitments , but I didn't have any child care commitments . I didn't have any children at that stage . So , yeah , but look , I was working seven days a week , liz , so a lot of sacrifices I had to make . I'd come into we had a HDR room , so a high degree research room at the university , and I knew that , coming into the university , I would be more well disciplined . At least I had space , that area for me . I'd come in really early , you know eight , eight o'clock . I'd leave around four , four days a week and then I'd work at the hospital for three days or three , yeah , yeah , even over the weekend . So it was quite , um , quite intense over those four years .
Speaker 2And then in my final year , like I said , I I feel pregnant and then I submitted my thesis when my eldest , my daughter , was three months old . Yeah , and so you know , you can definitely I was still breastfeeding and completing my thesis . I was , yeah , I was multitasking and doing those sort of um , I had to be really organised , but I was always even with no children . I was doing meal prep . I made sure that I managed my time really well , but I also made sure that I rewarded myself too . So I put certain events in calendars and I'll send it to my husband or my sister or my friends , whoever I was going out with or organising events with .
Speaker 2So I knew that was something for me to work towards and that was a reward for me . They're a really tough month of working really hard on my findings or publishing a paper . I would have those small rewards . So , yes , I was working seven days a week , but I think it was really important for me to also make sure that I rewarded myself , because then that prevented me from burning out , essentially . And , yes , I felt like the whole time PhD was on my shoulders and you know , don't get me wrong there were many times where I had to decline certain social events because I thought , well , no , I can use those , you know , three , four hours to focus on , you know , submitting this paper and then I'd be free up , you know , to do whatever I need to do afterwards . So , yeah , definitely , I think throughout there there are sacrifices , but make sure that you also reward yourself , and that's what I did . Yeah , definitely .
Speaker 1So , when you did come to those really heavy days , and those days where you wondered why you were doing this , did you have them , how did you get through them ? Or didn't you have them because you were managing it in a longer term ?
Speaker 2um , yeah , so I wasn't immune to that to ? Um , to be honest , liz , I , yeah . I remember the feedback that my supervisors would give me , and this is was was on written paper . It's not , it wasn't track changes . Back then , when I did , it was paper and red pen . Yes , use red pen . Um , I know one of them would use red pen and I would be like , okay , I don't know how to write , can I really do this ?
Speaker 2So a lot of self-doubt did creep in and there were times where I would even say to my husband because he was my main source of venting , and I would say I have completed my nursing degree , my midwifery degree , my honours degree . I'm telling you now I will , I can't do this . And he kept saying but you said that for your other degrees and I said , no , like I cannot do this , I trust me . I , this is one degree where I won't be able to finish . So there was a lot of theiefing , no professional therapy that I took .
Speaker 2I didn't have to go down that route only because I did have people I debriefed with , and afterwards there was one supervisor where I would also speak with to say , and she would check on me too , she would go to my meetings and she would say we've just provided you with this feedback . How do you feel about it ? Because at that time , when they give you this paper that's full of red or you know , full of you think , okay , this is a bit of a shock , like you're in shock and because you submit work and you think I've done such a good job , I've spent this much time on it , they're gonna love this . And yeah , it doesn't go as planned . So she would check on me and I found that really valuable but also my other students , other students who I shared a community with and we called it the fish bowl because we were all together and so we would debrief with each other yeah checking with each other and we would know when .
Speaker 2Uh , we'd have our supervision meetings , because they were in the same sort of um area as well , and so I would say all the best today , um , you know , good luck with your supervision meeting , and then debrief with each other and make sure we're all okay . So we'd go for a tea , a coffee , just as a little break , because , again , having those conversations just gives you a bit of a different perspective too , and they were positive conversations
Overcoming Feedback Challenges in Academia
Speaker 2. So I think if they were conversations , for example , going down the route of oh no , no , that's not right . Why are your supervisors giving you that type of feedback ? You know you need to fight back . It wasn't any of those sort of conversations , but conversations around no , this feedback is strengthening your work .
Speaker 2So , looking at a different perspective , so that I didn't take it personally , because it's quite difficult , now I supervise quite a number of students and I say to them this feedback is not meant to be personal , and it's difficult to see that it's not personal when they're saying no , this , you know this is an incorrect use , a different word here , trying to say here further clarity . So I've learnt from that experience , or those experiences , and I try and say it in a in a nice way as well . So further clarity as opposed to this doesn't make sense . Do you know what I mean , liz ?
Speaker 1yeah , and I think it's that that's you learn the importance of time and reflection . So , yeah , once you get that , doesn't matter what color the pen's in all the track changes are in . You just sit there and go oh my god , there's not a paragraph here that doesn't have kind of like a comment on or a change on , and initially it's just kind of like oh , I can't do this . But then if you kind of sleep on it and then you come back to it and go , no , they only want to make it better , and then you go in from a more objective , but that first hour , two hours to sometimes that first 24 hour reaction can be really personal and it is hard to grow into that to kind of go oh damn , oh , look , there's a paragraph with no comments on yes , I'm improving .
Speaker 2Yeah , that that's exactly right , and so that's what the other strategy I would do is that , okay , I've been given this feedback , I haven't coped very well with it , and then I , you know , again I debrief with my peers , I'd call my husband He'd be on speed dial and my sisters and any other friends , and so once I sort of came to terms with it , so again I wouldn't touch , touch it that same day , the following day , like you said , I just sleep on it . I come back to it , okay , fresh eyes . Actually , I can see from their perspective why this needs to change , why I'm not interpreting perhaps a particular quote properly , a narrative , why I've misinterpreted yeah , so , um , yeah , what ? What I would say is just , don't take it personally , and I tried not to , definitely , and so then that that has given me the tools now in my um approach to supervision as well , and I just I always check on my , my students , like my um .
Speaker 1One of my co-supervisors used to check on me , and that's that nice learning circle , because it doesn't no matter what your experience is . You are going to learn from that either something you want to do in the future or something you don't want to do in the future so everything is a learning circle once you get through it . So how did you go about then doing and collecting your data for your PhD ? Because , as you said , it's a very small percentage of women who go through that . So how did you ? I gather you did interviews .
Speaker 2From the little bits of reading that I've done , it looked yeah so I did a purely qualitative study and I used a triangulation of methods , so that just means a few methods to collect my data because we wanted a wider reach of women and this was women across Australia who had experienced an emergency postpartum hysterectomy , because we knew the incidence was really low .
PhD Research Recruitment Challenges and Ethics
Speaker 2And so , for a PhD , I was also mindful of the challenges I might face with recruiting women , because I had experienced those challenges with my honours program and so I didn't want to go through that same process and I wanted it to again to be at the level a PhD needed to be . So I did face-to-face interviews . I went into women's homes and I interviewed them face-to-face .
Speaker 2The other method was telephone because , again , women across Australia , from Victoria , western Australia , new South Wales , so women across Australia , from Victoria , western Australia , new South Wales so allowed women across Australia to participate . And then I also had email interviews as well , so women who preferred to correspond with me or to participate in an interview via email , and what motivated me to go down the email correspondence was at that time I think I had a one of my . One of the other students was doing some work around sexual health and she used text messaging all right yeah , as a data collection method , because of the stigma associated with a sexually transmitted .
Speaker 1Absolutely yes , yeah .
Speaker 2So I thought , why not just broaden my horizons and options here and look at all three methods and , fortunately for me , yeah , many of the women opted to do yeah , you know at least one of the three options , so that was really great plus me .
Speaker 1I ended up doing that with in my master's many years ago , um , because I looked at registered nurses experiences of refusal of blood transfusions , okay , um , and I ended up having almost like an email interview with one of my participants because timing just never worked out and it was really interesting of going , okay , here are my questions , they'd send back their answers . I'd then follow up with some more kind of questions to what they'd answered and I think we ended up doing about five or six backwards and forwards to kind of get it , so that I then didn't have any other questions to what they were giving me . And it was a really interesting because you're relying on the time difference and you didn't want to interrupt them because you knew they had so many emails and it felt disjointed . But the information they still gave was fabulous and it was already transcribed , which made it even nicer .
Speaker 2Yeah , that's right , know I for this ?
Speaker 2For my phd work , I had a lot of interest among women who had a hysterectomy , but not after after birth as well . So , yeah , and when I again I recruited through media , social media and um and media in general and I had women in their 60s , 50s , 60s saying that I've had a hysterectomy , I'd love to speak with you , rakeem , and I then had to say , look , honestly , I validate your concerns , but the purpose for my study really is to recruit women who've had a hysterectomy after birth for emergency reasons . So , and then it was again another , another conversation of you know , but my experience is really important as well . You need to look at my experience . So they're just some of the challenges that I had to navigate through again and then touch base with my supervisors to say , you know , I've had a lot of interest , but these are women who have had this to me in general .
Speaker 2And at one point then I contemplated , after my PhD , perhaps I can look at women who have had , you know , their experiences of hysterectomy . But I didn't go down that pathway . I thought , no , let me just keep my PhD contained , because I also had other interests too after my PhD .
Speaker 1Yeah , I think it shows . I know with working with my honours students , my masters students , that when we have put out surveys for recruitment , that when we go through and clean the data , there's a fair percentage of women who don't fit the inclusion criteria when they kind of go in , but they're passionate , as you said , about talking about their experience , because women's health is still not seen as equal to men's health . We , we know in research , we know in trials , we know in funding , um , and it's all been down , a lot of women's , especially reproductive health , is oh , that's just women's issues . It doesn't need to be taken seriously , or it's a weight issue or something like that . So the fact that we've got so many women wanting to talk about these issues shows you that there is enough interest to do the research .
Speaker 2It's what we do with the results on the other end , to change practice yeah , and and just going back to your point , liz , about women wanting to talk about their experience and also wanting to debrief with someone , perhaps the researcher for many of these women , I was the first one that they have spoken with about their experience , you know , besides either their partner or someone else close to them , and for some of them they hadn't even they didn't have that opportunity to speak , either their partner or someone else close to them , and for some of them they hadn't even they didn't have that opportunity to speak with their partner because they felt as though their partner may not be that understanding .
Speaker 2So , yeah , definitely like a lot of considerations there were under women's health , but for some of the women that I interviewed , they said , yeah , sure , happy to be interviewed , I'm also come . I have my medical records with me too , rakim , so I'm bringing those along . I know you're a midwife too . I'd like you to have a look at those , so I had to then , yeah , I was an insider as a as a midwife , but then I had to say to them again , for the purpose of this interview it'll be just asking you questions around your experience , your support needs , so really clarifying what my role is as a researcher as a student . Yeah , so it was . Yeah , it was quite interesting for many of them . They felt as though there was a bit of mismanagement of the care that they received and they had obtained their records for a number of women . It wasn't just one woman that mentioned that to me , it was a number of women which actually makes me think about when we're looking at ethics applications .
Speaker 1We have to put in psychological safety for researchers , but also for participants . We have to be able to provide resources for them , whether it be lifeline counselling services . And looking at , when you look at the degree , one in third , one in three women are having a level of birth trauma or some kind of distress . Do we actually need to start including in that , because of the boundaries required with being a researcher and the scope that we have ? Should we I mean we do put in if this brings up any distress go and contact this , this and this ? It'd be nice to actually have a more formalised debrief kind of organisation that we could that is run by midwives or counsellors or counsellor midwives and obstetricians . That could actually link people up and if they wanted a formal debrief that they could actually get that Something for the future maybe .
Speaker 2Yeah , no , that's a really important consideration I have . I published a paper on interviewing women on sensitive topics and some of the challenges and the data that I have in that paper . That was a 2011 paper that I published . A lot .
Speaker 2Many of the women talked about how cathartic it was to talk about their experience and then even that alone was just enough for them and they felt they didn't need anything else . But some of the women I did have to pause the interview . I did have to , you know , stop the interview completely and re-interview them or commence the interview at a later time . You know , having those sort of considerations in this for them , as part of , you know , ethical processes as well , makes a difference . But because my head was so into that space of , I know I knew it was a small percentage of women that had emergency postpartum hysterectomies , but it vicariously impacted on me too .
Speaker 2As I mentioned , I fell pregnant in my final year , fourth year , and so , yes , I'm aware that , um , high-risk pregnancy is a very small percentage , but then that also played on my mind a lot and I kept thinking , okay , what if I have a hysterectomy ? What if I bleed ? What if I bleed ? What if I ? You know , I kept saying what , if , what , if ? So , yeah , it was again . I talk a lot with my supervisors at that time , even though that was like a personal experience for me , because it can impact you ?
Speaker 1Oh , absolutely .
Speaker 2Like I was . These were interviews , again , that were lasting more than two hours , and it was something that I was living for three years immersing myself in this data . So it's really important that you , that you take that time out like I did . I didn't again , I didn't take a year out or six months . I don't think there's anything wrong with that either , if you identify that you need that time out . I did take a little bit of time out because I had a baby , because I've found myself at one point too attached to my PhD too . I'm not sure if you come across any students like that , but I was in labor and I was there , you know .
Speaker 2One more sentence , one more sentence . I was like that . I was like that . So I then gave birth or I went to the hospital where I worked at and one of my supervisors was texting me about my PhD and I was texting back about my PhD . I can believe that , yep . And then one of my close colleagues then took my phone , because I think I mentioned oh look , I'm just texting about my PhD , what are you doing ? So I had someone take my phone from me and say no , you need to enjoy your labour . You know , this is your first experience . And so then I sort of snapped out of it and I'm like okay , I am in labor . I don't know . Again , I was in shock that I was in labor too . But , um , sometimes you need that other perspective , because I know that students can become really immersed and burn you out , and you may not realise that you're burning out , but then you'll stop interacting , perhaps with your partner and family , and they're all signs of burnout , that you're taking too much on board .
Speaker 1And that's one of the reasons why one of the questions I ask in the majority of the interviews is about keeping sanity and finding a balance between work and family . And not everyone finds a balance . Some people it is all encompassing , or some people with families . I said I've set the family away for the weekend so I can actually sit and concentrate , or it's a job . While the kids are at school I work out . Then kind of once I go to bed I do a few more hours , so everyone works something in .
Speaker 1But if you don't have that support network , that people kind of checking in on you making sure you're eating especially for those that are international students and who are studying in another country and are living by themselves or are in a room share situation , they've kind of said that the family have made sure that they've ate , or their supervisors or their colleagues have kind of checked on them to kind of make sure they're not just doing nothing but studying , because they've got no other distractions and so they know that they need to get this finished so they can actually go back home again , and especially with COVID , when I knew some international students who couldn't go home so there was no way that they could fly home , but at least technology worked in that , hey , and they could actually talk to family members through kind of like I don't know what apple's version of facetime or whatever it is or even zoom like that .
Speaker 1So that's um , yeah , it's an important thing that you bring up to kind of have that you want to be a functioning person at the end of it .
Speaker 2That's right . You don't want the PhD to or high degree research to really again burn you out and it being like something that you don't want to go back to . Yes , but what interested me and what immersed me even more and more into my topic was that it had to be a topic I was really interested in . And the topic again because everyone's doing it around , whatever a certain topic or area in the media and so on . It's something I was generally interested in and I had my I could um like from a clinical point of view as well as a clinician . So my positionality as a researcher I was able to demonstrate that in my thesis .
Speaker 2And what interested me in um , you know , postpartum hysterectomy , and I say to that much to my students okay , what's interested you in this particular topic ? Yeah , and do you see yourself living this basically um , and doing this for the next few years ? So for many students they're doing it part-time now and because , um , they're not , they don't have a scholarship and so , yeah , they're doing it over six years and for some they'll go over seven , eight years , so we can a really long time . Is this something you can see yourself researching over a long period of time ?
Speaker 1Yeah , absolutely critical , I agree .
Empowering Voices and Cultural Inclusivity
Speaker 1Thinking back to your PhD and thinking back to those interviews , what surprised you .
Speaker 2The value of a participant , like the participant voice , um . So I kind of did get that from my honours , but more so with my PhD , because I interviewed more women , so 21 women um , the power , the power of participant voice , and how it's just so raw , what a privilege it really is to enter that field and how well prepared the researcher needs to be as well . And what I mean by that , liz , is that if I knew myself that I had a really tough night the night before , I would make sure that I had the strategies to ensure that I was present in that moment woman to listen to her experience , because , again , it's a privilege . So what sort of stuck with me was how the research needs to ensure that they are equipped with the tools to really be able to listen to women and create impact from those stories , from that data , and do it justice . And so , through my publications because I published five papers from my PhD I wanted to make sure that those voices did come through and I did justice , because for many of them , they wanted to participate in their research to help other women .
Speaker 2Yes , yes , I felt I had a responsibility then to ensure their voices were heard , and so what I then did was we had a follow-up seminar after I completed my PhD about women who had a negative birth experience , and one of the participants I could recall that she wanted to participate in some sort of advocacy or make her story known a bit more beyond research , and so I invited her , as a consumer , to talk to her at this seminar .
Speaker 2So she was yeah , she was happy to do that and I think just engaging and offering participants those sort of opportunities if they're willing , and ethically , if you , if you've nominated that and mentioned that in your ethics application , then I think you know that that's really good work because they're helping .
Speaker 2You know other women as well , so they're the sort of things that really stick with me is you know , how can you ensure those voices are heard , that you do it justice as well ? I wanted to include all the data I had , but I couldn't possibly include everything in my publications and in my thesis , and many students want to do that as well . You can only really yeah , depending on how much data you have , you can't possibly include everything but the main . What are the main things that are coming out , particularly in qualitative research , that you can shine the light on and present it in a way that you can either change practice or encourage other women to come forward as well , and I was doing that through my dissemination of work I presented at quite a few conferences again , because I wanted these women's voices to be heard as well .
Speaker 1So , yeah , so how did you celebrate Once you finished hand it up it's all signed how did you celebrate ?
Speaker 2once you've finished , hand it up , it's all signed . Hey , celebrate , yep . So we um . At that stage , I again , I um .
Speaker 2By the time I graduated , I think my daughter was eight months old , um , and so what I did was I didn't have my , I didn't wear the hijab , um , throughout my ph PhD . But when my daughter was eight months old , I , and after I finished my PhD , I thought you know what I want ? To put the hijab on . I felt like I had this I don't know calling it's difficult to explain , liz , but I feel like this is the right time for me to put the hijab on . So this is really my sign of celebration , because I thought I felt really liberated and empowered . I've just finished my PhD and I want to celebrate . I want to , yeah , empower other women as well to go on this journey , um , and and do wonderful things . Yeah , and we also went on a lovely holiday , yep , which was nice . We went overseas , um , I'd never been to Lebanon before , so that was really lovely . We went there for seven weeks oh , nice time yeah , it was really nice .
Speaker 2Um , before we went overseas , we had a lovely family dinner . Um , yeah , we took a lot of photos . It was . It was nice and and intimate . So , yeah , but I feel like the bit the the biggest thing and the biggest transformation was my hijab , which I find like is my shield and the sign of liberation for me yeah , and we could talk about that in itself in .
Speaker 1We could take hours talking about that , because a lot of people who don't understand where it comes from could see it as a sign of oppression , not a sign of liberation . So we could have a whole different conversation on that . But you've actually got a fame in that you are the first person to design a hijab for a university .
Speaker 2Yes , yeah , that's right In Australia . Yeah well , internationally as well . Oh , wow , yeah well , internationally as well . Oh , wow , yeah . So the interest did come from my interactions with students as an academic and from personal experience as well , and also from , again , students mentioning their lived experience of wearing a hijab and perhaps nursing or midwifery not being compatible with Islamic beliefs and practices , when in fact I knew it was compatible . So it was really demystifying that and clarifying and having those conversations with students to ensure that our students received the support that they needed so that we could retain them and they could complete their course or their program and work in their respective degrees .
Speaker 2Because we had quite a number of students drop out of the high attrition rates and we had quite a few students' concerns and we had students that would complete the program but not work in their programs , but not work in the field , in the profession .
Speaker 2And I knew that , with the increase in diversity , multiculturalism we needed , it was imperative to have cultural diversity across our healthcare system .
Speaker 2So I brought together a working group that involved community leaders , academics , myself and we designed a branded hijab , the first national branded hijab and perhaps internationally , that received a media reach of 10.1 million and it was a sign of the reason why it was so important is because it resembled and symbolised that sense of belonging to Western social cohesion and inclusivity . Yeah , and so we found that there was an increase in students entering our programs who were culturally diverse . Western was known for then introducing this innovative piece of clinical uniform that has now been translated across a , or the guidelines not the hijab , but the guidelines that were accompanied with the hijab have been translated across a number of institutions and , I believe , new South Wales TAFE . And along with those guidelines , we also put in place some resources which have been implemented across LHDs , so local health districts , which is quite promising . Yeah , and look , our women . We know from our women that some of our Muslim women want a Muslim midwife .
Speaker 2Yes absolutely yeah , so they just feel a lot more comfortable .
Speaker 1Which kind of goes back to what we're saying before . Western sydney in particular is known for cultural diversity , but australia we have a representative of every single culture and country in the world we have living here in australia . We don't have , we don't have just one type , we have a whole mix of people and even going back to the first nations , they were a mix of nations as well . So we've always been a multicultural kind of country and you do want to see yourself reflected in the workforce , to have that sense of understanding , because it's not necessarily about language , it's not necessarily about politics , it's not necessarily about nationality , but culture is something that you're a part of and that you grow up with . So there are subtle things , subtle behaviours , subtle actions that , yes , you can live in a country , you can learn some stuff , but there's also an awful lot that is very inherent that you don't know unless you grow up in that kind of environment .
Speaker 2That's right , liz , and last year I was fortunate enough to provide evidence at the New South Wales Birth Trauma Inquiry in Parliament , and that's something that I felt as though I needed to give Muslim women a voice as well , and I did mention that when you're caring for a Muslim woman , you're not just caring for the woman , but you're caring for the family , you're caring for the community , you're caring for an entire village , really . And so when you have a cast of thousands accompany a woman to the birth , it's not because they're being nosy , it's because they genuinely um care about the , the woman . And for many muslim communities , in what ? Many muslim communities ? Because it's not just one community , um , but it's it's women's business , and you know that they will accompany the woman and philistine , they need to nurture her , and in islam we need to honor our , our women , particularly our pregnant women , um , yeah , to ensure they have a good experience so where have you gone afterwards
Enhancing Maternal and Cultural Care
Speaker 2?
Speaker 1I mean , have you seen any change in practice from your phd results ? Any change in ? Are there support groups now for women that can communicate with each other who've had similar experiences ?
Speaker 2So there's not a particular support group for women who have had a postpartum emergency hysterectomy , but what I'm seeing a lot more now are support groups for women who have experienced birth trauma . Right , yeah , and one of the themes from myd was that it was quite traumatic experience for women . Um , you know that again , the whole situation um the event then being given a second chance , almost , um , you know that near-death experience . So that I've seen a lot more of now , particularly in the last two or three years , that the conversation around birth trauma is really becoming a bit more prominent , and so it's encouraging women to come forward and have those conversations and talk about their experiences . So , yes , while I'm not a specific support group for women who have had emergency hysterectomy , they have definitely associated their experiences as traumatic and been involved in those birth trauma conversations and support groups .
Speaker 1So we've got a lot of acknowledgement now . We've got a lot of acknowledgement now . We've got a lot of conversations dealing with it . How do we flip that and stop it from happening ? What can we do antenatally , kind of like intrapartum , early postnatal ? What can we do to stop the birth trauma or decrease it at least ?
Speaker 2I know it's one of the recommendations that I'm going to say um , at least midwifery continuity of care . Yeah , you know it's really important , um , and we need these models funded as well . Um , but with continuity of care , I feel as though there's a still a massive gap , because if you don't know about it , you won't access it . Yep , so our refugee , migrant women are disadvantaged in many ways . So our women who English is their second language , they're disadvantaged as well . They don't know to , as soon as they fall pregnant , to call the MGP midwife or the hospital to book in or you know any other model . So , or a private practicing midwife . They're unaware of those type of recommendations to ensure that they're first in , you know .
Speaker 2So there's definitely a massive um , a gap there and I would advocate for um , diversity , again , among models of care . So models of care that are specifically designed for women who are culturally diverse , who are perhaps paired with a culturally diverse midwife . So those particular models we know will work best for women . And again , that's one of the evidence I also gave , or one of the recommendations from my evidence , because again , they want someone from that same demographic that understands them , that same experience . It's not to say that they have a negative experience . But , um , yeah , some experiences they have are negative actually , and they will experience that . You know racism and discrimination . We know that from the literature . So having a culturally diverse midwife will ensure that the experience is a lot more positive for them .
Speaker 1I was just thinking . It may be that we as a profession we have to do some more outreach going to community centres , going to and this is my ignorance , I don't know whether this is actually doable or not , but I know that here in Adelaide , about once a year , the mosques open the door for people who are interested and come in . So could we as midwives and kind of get together and go to some of these times and actually sit and be there to answer questions and give out information and to chat and that way increase the exposure of the existence of midwives , what we do and how to get in contact with us ? Would that be something that we should be doing more of .
Speaker 2It's a see , that's a really good um strategy , liz , and what I'm seeing more of now is that being asked to going to secondary schools and secondary Muslim schools to talk about my experience and my journey into academia and the profession of midwifery and really trying to attract our prospective students to study midwifery . I attend also open days and just give students a perspective of diversity again across midwifery . One really important comment and striking comment from a high school student that was mentioned to me was that she never thought of entering midwifery but because she's seen me as a hijab woman in academia and knows that I worked as a midwife and I am a midwife , she knows that anything's possible , that her dream can be a reality . So it's really giving them those you know horizons to reach and that anything is possible . And so we actually are part of a research project now where we're looking at reproductive health needs of women , muslim women in particular , and so we're starting at the grassroots .
Speaker 2We're going into mosques , community centres , we're conducting facilitating workshops to really understand what their knowledge is their attitudes , to put in place some learning material and resources to support them , because it's not often talked about childbirth and women's health before you're married , so you're kind of going into it a little bit blind . So I think raising awareness at those grassroot levels is paramount .
Speaker 1And Islam covers a wide variety of countries in different regions as well . So we're not just talking about , in your case , lebanese , we're talking about Middle Eastern . We're talking about Middle Eastern , we're talking about African countries . There's a lot of different groups that are affected and it's not just in this case , in Islam . It's also all the other groups as well , where English is second language , where cultural differences are . That , yeah , we need . It's very isolating and if you can't see , it can't be it . You know we've got that whole thing of . We want to have that inclusion , but also that cultural safety that you're very much a part of and are published on , because if women and families don't feel safe approaching health care , then they're going to put themselves at risks , not just now , but intergenerational .
Speaker 2That's right , and my perspective really comes from a family-centred approach to maternity and that's why my interest is also in partners and fathers , and so we can't possibly address women's health and reproductive health needs and maternity . Yes , it's women-centred , but we can't also ignore the other part of the equation , which is men . So we know from the literature and from also the research I've done with fathers is that if they're not well-informed and they're not included in decisions and they're not part of those conversations , then I'm not able to support women , their partner . So for women to have optimal care with good outcomes , they need a well-informed , educated and prepared partner . So that's where I'm doing that work with fathers as well .
Speaker 1And you're also expanding on that kind of mental health and psychosocial health because you're involved in the Pipe MC .
Speaker 2Yes , that's right , I'm involved in the Pipe MC project and we're doing so . That's a trauma-informed education model for maternity clinicians . It's an interprofessional model that's looking at training for maternity clinicians across Australia . We've done a number of workshops led by my PhD student , one of my PhD students , louise Everett . She's a project officer and it's informed a part of her project , part of her PhD . So I'm coming really from a trauma informed lens and we found that it's been such an important learning journey for many clinicians .
Speaker 2Many maternity clinicians don't have the time for training and education and , as we know , the patients , or , sorry , the women that are coming through maternity doors . There's been an increase in psychosocial issues , having women where there's intimate partner violence . We're having women who have come from that refugee , migrant background and that history of trauma , child and sexual abuse . So it's important for clinicians to approach women and ensure that they're referred to the appropriate services where needed in a more of a trauma-informed approach . Yeah , creating that safe space for women . We don't create that safe , safe , safe space for women . They won't open up , they won't trust us . Um , yeah , they're lonely . We only know the information they give us .
Speaker 1So , um , yeah , I definitely wouldn't open up to someone if I don't feel comfortable with them exactly absolutely , and it is the way that we feel , affects our behavior , affects our bonding and attachment , affects our parenting styles . And then that , therefore , we know that that intergenerational trauma also gets passed down as well . Even though they may not understand the cause of it , our reactions to it become hardwired from a very early age . What's next ? What fun things have you got , or what interesting things are you excited about for the future ?
Speaker 2Yeah , so I still want to continue with my research around parents' transition to parenthood and I want to really . I've been doing some workshops around cultural safety , culturally respectful maternity care and so education for clinicians around cultural safety , cultural humility , really tapping into midwives' vulnerability and sharing their experiences because , again , if they're not comfortable talking about what they need more education in , we can't possibly then , you know , assist , we know . Again , we're having more women come through who are culturally diverse and we can only ensure they have a better experience when we better support our midwives and ensure they have the training and education . So I'm starting to do more workshops across Sydney and perhaps I can start doing some online workshops across Australia . Yeah , so definitely down in that direction . I'm going down for now .
Speaker 1So if you've got what advice ? We've already talked about a little bit of advice that you give to your current students , but if you've got a student coming to you interested in maybe doing some further studies , phd studies , apart from having some passion about the topic , what other advice would you give them ?
Speaker 2There perhaps is never a real right time to study there perhaps is never a real right time to study , but if they feel as though this may be a good time for them to study , because I would say to them that they need the time , commitment , organisational skills , prepare to be organised and be able to make some sacrifices as well . And I'd also ask them to suggest any supervisors that they perhaps want to have as directing or facilitate their research journey , because I do believe that your supervisors are a big deal in the whole . Yes , so they have to feel comfortable with them , they have to get along with them . Uh and um , yeah . That that's the piece of advice I would definitely give them um , yeah , and to take time out if they need
Embracing Adaptability in PhD Research
Speaker 2to . That it's okay to change directions . That's one thing I perhaps should mention as well . Initially , for my PhD , yes , the topic was around postpartum hemorrhage and emergency hysterectomy , but I also wanted to include photographs and drawings as part of data collection , but it was just getting a bit big . So I think you know directions will definitely change . But , yeah , definitely that those pointers for those who want to start out a PhD , and don't put too much pressure on yourself either .
Speaker 2Things will evolve . I mean , my research question evolved . My objectives evolved as well , my methodology . I started with phenomenology and then it changed to naturalistic inquiry . So , yeah , you don't have to have all the answers from the get-go . Things will change and evolve . But have a conversation with someone , take the leap . Definitely , um , that's something I uh , that's the advice I give anyone who wants to go for a promotion as well . Just , you know , take the leap , um , and yeah , you won't . You won't regret it definitely . Yeah , things may seem quite difficult , but , um , don't give up yes , stubbornness and persistence , I think , are very important skills to have for phd as well absolutely .
Speaker 2Yeah , and as long as they have good family support , I feel as though that's really important too . That's another good predictor to success .
Speaker 1Yeah , absolutely thank you very much for your time .
Speaker 2No worries my pleasure .