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 90 Ans Luyben Part 1 on from animal obstetrics to midwifery: A journey of innovation and research
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Ep 90 (http://ibit.ly/Re5V) Ans Luyben Part 1 on from animal obstetrics to midwifery: A journey of innovation and research
@PhDMidwives #research #midwifery #Netherlands #Switzerland #Germany #education @bournemouthuni
https://www.researchgate.net/profile/Ans-Luyben
Ever wondered how a career can pivot from animal obstetrics to midwifery? Our guest is Ans Luyben, an inspiring midwife whose journey began in Holland, not only shares her unique path but also offers her insights into the evolution of midwifery education and practice. From her early days studying animal obstetrics to becoming a pivotal figure in midwifery research, she has navigated a fascinating career across Holland, Switzerland, and Germany. Ans story underscores the diverse entry points into the midwifery profession, influenced by family background and career opportunities, and highlights her role in a midwifery school that closed in 2010, a chapter that left a lasting impact on her professional journey.
Our discussion takes you inside a full-service midwifery clinic in Germany, where the importance of hands-on learning and critical evaluation of information is emphasized. We explore the challenges faced by student midwives today, navigating through information overload and a rapidly shifting political landscape, as witnessed during the COVID-19 pandemic. Ans reflects on the evolution of midwifery education, from the management and pedagogic courses of the 1980s to the current demands, illustrating the resilience and adaptability required in this noble profession.
Dive into the world of midwifery research and uncover the profound impact it has on clinical practices. From groundbreaking thesis work on diagnostic criteria for intrauterine growth retardation to the complexities of cross-cultural studies in antenatal care, our conversation reveals the pivotal role research plays in advancing midwifery. We explore the nuanced perspectives of mothers as an ethnic minority, particularly in Switzerland, and how historical events have shaped their societal roles. Through personal anecdotes and research milestones, Ans emphasizes the power of language and communication in understanding and supporting women's experiences in prenatal care.
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Thank you very much for joining me, as per usual. Can you introduce yourself, please?
Speaker 2:Well, I thought about that the last moment, just shortly, a minute or something before we started this, and I thought what should I tell about myself? I'm usually very short. I was born in Holland. I was trained as a midwife there. I got my. What did I do in Holland? Okay, I got my some course on education, because I worked in a midwifery school and then they started to offer postgraduate education for becoming a lecturer or teaching at school. So I did that in Holland and then I thought that I want to do something more exciting. So I looked abroad and, uh, there were, um, there were uh organizations looking for people to work in Switzerland, and so I talked with them and then I was.
Speaker 2:I had never been in Switzerland and I thought, well, maybe that's an idea to go there. I compared a bit with Germany, but I saw that you had even less competencies in Germany than in Switzerland. And I can remember playing a bit with going to America and I wanted to do an exam and then my papers got stolen so I didn't get there, kind of, but maybe that's okay. I wanted to do an exam and then my papers got stolen, so I didn't get there, but maybe that's okay. So I went to Switzerland and I did some things in Switzerland. I worked in hospitals in Switzerland. I worked in schools in Switzerland. I worked in research in Switzerland. Currently I'm working at a postnatal ward as a midwife, and between 2000, because of your interview, of course between 2001 and 2008,. While I was working at the midwifery school, which closed in 2010,. By the way, I did my PhD in.
Speaker 1:Scotland and we will come back to that. But I want to take you back to the beginning of the journey. What got you into midwifery?
Speaker 2:Well, that's a bit of a laugh. I never knew a bit much about midwifery. I mean, my mother gave birth at home for all of us, I believe in Holland and I had never seen a living midwife. I didn't have a clue what that was. And then there's this counselor on your secondary school and then they provide you with information about different professions and one of them was midwifery. And I can remember also visiting something for a school for pedagogics. So primary, primary, primary primary education teachers, um, which I looked at. Well, and I remember that I have been thinking is this practical, do I have a job afterwards? At that moment it was very difficult to get a job as a teacher. There were a whole lot of teachers there, so that was one of the things that I didn't do. But I was kind of attracted to midwifery because and that's why I say it's a laugh I did in my fifth or second grade of secondary school in Holland it was called Aetaneum, which is kind of the same thing as a gymnasium.
Speaker 2:I went in my free time I did a course on obstetrics for animals oh cool, basically for cows and sheep. Yep, basically for cows and sheep. And I did that because my late father, who already died when I was two, did a kind of a course At that time. It was an organization that sent you written material. It's the same thing as we would now do an online course. It was written material on such stuff and it kind of the subject interested me. So I did this course and I was the only only person in the room who was not a farmer, but I I mean, I I had a farming background, but I was not a farmer and I can remember taking my exam together with another farmer and luckily he was there, but I mean, basically it was the subject that interested me, so not as much the profession as well as the subject.
Speaker 2:I could have been a doctor, but I mean in holland. At the same time there was a called numerous clauses or something for for um doctors and it's well, and they have a set limit for people to enter in a university program and they had that for doctors in Holland as well, and you didn't know if you would have a job afterwards. That's the same thing as well. I mean, I didn't really consider that and my mother said afterwards well, you didn't want to go to school that long, so maybe that has been a topic at our team at the time as well. So basically then I decided to go to this school and they also I mean they. At that moment they had a number of about 300 people that wanted to become a midwife, so they took a test and then they sorted about 60 out, and those 60 had conversations and then they would sort 20 out of that.
Speaker 1:Oh wow. So that's quite a rigorous selection criteria.
Speaker 2:That was a bit difficult. Yes, it was amazing. I mean, I was one of the 60 afterwards so I went to this test, but the the journey was very difficult. It normally would take two and a half to three hours from our place and uh, or the place where my parents lived, and then the journey was about five hours because all Holland was icy and it was very hard to travel and things like that.
Speaker 2:So then they called me for the second round of conversations and then I had a big discussion with my parents at five in the morning because I said I'm not going to go there, I am not going to go there, I don't want to do it. And my mother said well, you have to. And I said I. I said I cannot, it's far too far, it's much too far away. And then at the end I didn't go and I worked for a year in a resident home and in a bookshop for 11 months or something like that, and during that time I decided again to give it a try and I just came through all the rounds and so I started midwifery education. So that's how I came to midwifery, but it's maybe not the similar thing as other people.
Speaker 1:There's a variety of pathways that people come into midwifery. It's fabulous.
Speaker 2:I really didn't. I knew what a GP was I mean, my mother gave birth with a GP but I really didn't know what a midwife was.
Speaker 1:So even though that the Netherlands have got a very high home birth rate and it was more common practice than hospital, from what we've kind of known, I think it's changed a little bit now. So the home births weren't with the midwife then it was or were you the youngest of the family, therefore didn't get to experience the others?
Speaker 2:No, I mean I lived in a village where the GPs did the home births and in that time it was still common that there were also some GPs who did that. For the village that I lived in, or my parents lived in it about 1400 people. There was no midwife. I mean that that was too little, I think, for a midwife, and I mean at that time there were also not very many automobile mobiles, so there were less. It was more difficult to go somewhere Because I can remember my dad had one of, or my second dad had one of the first automobiles at that time and I can remember about 63 or something like that.
Speaker 1:So where did you then go after your education I still call it training, but I'm trying to change it After your midwifery education, where did you work after that?
Speaker 2:I first comment on the midwifery training part. We had a long discussion at ICM, I think around 2010,. If this was training or education, and people decided then that we should not talk about training anymore, we should talk about education, and I think that has been a good step. The second part of your question was when did you go after you graduated?
Speaker 1:Where did you work?
Speaker 2:I stayed at a midwifery school Okay, there was a clinic next to that, I think. They had a vacancy at that moment and they offered me to stay.
Speaker 1:So a full-service clinic or antenatal, postnatal only.
Speaker 2:No, it's a full-service clinic. In particular I think you see it, there has been such things in Germany as well it has been a special maternity care clinic. They had a special part in it that meant people from that environment, from that city could give birth there for a lower price. For a lower cost, because we work with student midwives. So all the student midwives were trained there as well or educated there as well. They didn't go to other hospitals.
Speaker 1:It's the perfect setup, isn't it I? Always stayed there, that's the perfect setup for students.
Speaker 2:As such for education.
Speaker 2:Yeah, it's good, I think, and I think it's good for basic education to have a model like that, because it gives them a certain, it gives them more certainty, I would say, in what you're learning, because you're still learning the first three years.
Speaker 2:I mean we talked about that for the introduction of new employees in a workplace. You cannot put them one day with someone and the next day with somebody else. They need to have a kind of red line in that so that they know this is what I'm learning, because these are the basics. And once they get the basic stuff, they know kind of the routine, what's going on and how you should do that. Then you can see that they work with other people with other opinions, they expand their knowledge in that way, or their way of working with different kinds of things, how you can do it. But I mean, then they can, um, they can integrate it and if you start that in the earlier stage, they don't know what's true or what's not. I I don't say that truth is one thing, that's something else, but you give him a bit more of a foundation, a bit more of stable ground it takes a while to find your feet sometimes, especially that changing from the student to the graduate.
Speaker 1:You've had that safety net but you still feel like a student and it takes like that. First six months in that graduate program is, I think, the hardest of your careers and it's quite often that time when some can actually go. No, can't do this if they don't have that support and sense of belonging yeah, I think, I think that's a good.
Speaker 2:I basically think that you need one or two years after. I mean, at that time it was three years. I cannot say, I cannot tell much about the four years program if that's better for feeling more secure in what you're going to do, um, but I think, um, it takes, and even then I take it, it takes at least a year because I mean, during your education still, people are offering you this environment to grow and to learn your competencies and there's still somebody else looking with you. So you're not fully responsible. I thought the first two years, the first one year, was fairly hard in terms of responsibility. You're suddenly responsible for everything. So, in comparing with my PhD, it's when you become a mother. Suddenly on the back of your mind are all the things that you have to think of to, because this is such a complex empathy. But you're responsible for this person and that's a big thing, I think.
Speaker 1:So did you do other postgrads before you did your pathway into PhD, or did you go kind of straight into a PhD?
Speaker 2:Well, I talked with Billy Hunter and we had a bit of a commenting in it. We both said well, you know, when I was working as a midwife there was nothing else, this was it. You could do a management course. I did that. At a certain time, the beginning of the 90s, I did a management course and in 85 to 86, I did one of the first courses for pedagogics in the central discipline that was what it was called then Yep At the Vrije University in the Netherlands. I was really, I mean, you're young and you want to grow, but there was not much to it. But I mean, when I got the opportunity I was very interested to do that because you want to grow on. I mean, it takes you maybe those two years to get into your work, to learn to live with that responsibility, but then you also want to expand your, your horizon, which is easier to do now particularly it's easier.
Speaker 2:There are a lot of options. I don't know if it's more, if it's easy for those people who are having all those options. I talked with a friend of mine a couple of years ago who had two daughters and she said I mean at this moment. She said, you know, it's very difficult for them to deal with so much information. And then the title information overload and information burnout was found out and the fact that in problem-based learning people try to reduce the number of sources that students could call on, just to reduce it a bit. I mean, you still have to learn problem-based learning to pick out the things that you need. I mean that the internet is offering you such an amazing amount of information. I mean, I'm I'm not that fussy with it. I would say I cannot trust this, I cannot trust this, and you just go through that and you think, okay, those are my most important sources that I'm going to call on. But I mean, if you do not know and haven't been growing into this, that's hard.
Speaker 1:It goes to extremely overwhelming with what options are and also with, yeah, your sources, because you have to critique them, you have to do quality control of them so you know who you can trust. And then you also have to look at the political um situation that's seen, and I think of the cdc during covid and that government legislation had them remove certain words and references to things, so you've got to sit there and go okay, so that used to be a trusted source. Is there anything else that's actually influencing that now and is there something that can support it? And that's a skill in itself. Especially now with AI, that's going to become an increasingly more important skill.
Speaker 2:No, I'm very interested and in AI as such, I just have to wait until something turns up with an AI course or something like that. Like, I see good things that you can use it, but I also see very many dangerous things that I think we have to be very careful, and I'm not quite sure if if the internet like it is like now, will stay like this well, it's going to be interesting because I don't think any of the ai companies are making money because it's all for free or some minor subscription, yeah, but there's a lot of um because it's all for free or some minor subscription.
Speaker 1:But there's a lot of intellectual property cases now coming up with the sources being used and mined. And it was interesting in the last couple of months that one of the publishing houses Taylor and someone can't remember put a press statement out saying that they're they've made an agreement with an ai company to allow them free access to all of their publications and authors aren't getting a choice to sign on. So it's like, well, we've got your publication, we've got your ip, we're now just going to give it to machine learning for good or evil, depending on your point of view um, and that was they just put that out and I'm sure the others anything in the free, free market is, can and can be used, because it's really hard to chase down your copyright no, but I haven't been thinking about that, that part that you're mentioning now.
Speaker 2:I think that's very interesting. I I sometimes am surprised by things that happen that I don't think it would happen. And then something unexpected come in and I think, okay, well, yeah, there's something that's coming up now that's going to push it back a bit and show you the limits of something that's possible or not.
Speaker 1:And I was reading something briefly before I came on something on the socials that ChatGPT still adds pretend kind of references to your searches and.
Speaker 1:I've caught a couple of students because of that, because I haven't been able to find their citations. But Gemini, which is through Google, and Gemini is their AI platform, that they're advanced, is now actually putting. When you do a search through them, they actually give you credible resources and citations that you can actually find. So some of them are and I think Claude's another one. There's a few different platforms that are coming out that will actually search credible information and, let's face it, google's got LinkedIn to Google Scholar, so it's got the perfect kind of like side road to get into the credible sources. But you still have to see whether it's being cited correctly. There's still that checking that you need to do and is it relevant kind of information that hasn't been debunked by something else? Anyway, we've got off topic there, but it is really interesting to kind of like look at that. Um, okay, so you did your management in the early 90s, so anything else in that decade that got you into research, that got you onto the PhD pathway.
Speaker 2:Yeah, I first thought, okay, how did I get into that PhD stuff? And then I suddenly I looked at my maps, my folders, the written material that I still got, and then I suddenly came to something else. I mean, during the time that I worked at the midwifery school, I think I got into being interested in research. I mean, I've always been, that's what I thought, that's the main part. I've always been a very creative person. I have been. I have periods that I went into drawing things and I really liked it and I did some good stuff and I went into writing poems and I did something for a youth association the magazine of a youth association, which I was an editor of at that moment as well, was an editor of at that moment as well. So I worked at this midwifery school, I did this teaching degree and then I know, before I did my teaching degree, I did my thesis for my midwifery degree on and now you might have a laugh as well on estriol, hpl and CTG in regards to as diagnostic criteria for intrauterine growth retardation. Oh nice, and I was very interested in that because I worked at an antenatal ward and I saw these women sampling urine the whole time, 24 hours and I thought it was exhausting. And then I kind of had an idea Well, nothing was done with it, or HPL and I thought, okay, let's look into that. And I was a gynecologist interested in that. So I did it with two other students.
Speaker 2:Um and um, we looked at several history, uh, histories, of women who had intrauterine growth retardretidation and we sampled that data and we looked at when it was decided to end this pregnancy or to induce this pregnancy I would not say end. It is very hard to induce this pregnancy or try to get this child in the world because it was better outside and inside the womb. And then we also wrote a letter to a chief gynecologist of another hospital what their opinion was, and they didn't do it anymore, I believe. And then we found out that basically the last decision of trying to induce this woman, when it would be time to give birth to this child, was decided based on the CTG registration. And this is all antenatal, of course. This is a risk pregnancy. This is an antenatal decision. This is not during birth, which I think for a CTG is much more difficult. And then we saw that, based on our thesis, they changed their management.
Speaker 1:Oh, fabulous. So you had an impact on practice.
Speaker 2:So this was a very good experience and I think this is very important to do. That I think what was also good. I'm not a great fan of letting bachelor students do experiments with women or whatever. I think they should they rather do a review or whatever what's current at the time. But I mean, we had a lot of data and it was never used, except for the statistics of the hospital, because at that time, uh well, the doctors did that so now and then, but they have other kinds of studies, but these were data which were always there and nobody did something with it and the doctors were interested in it. So we did it. And then I can remember some small things that I did. I had a big laugh.
Speaker 2:We were at the time, I think one or two years later, left. We were at the time, I think, one of two years later. Two years later we were fed up with the comments of one of the gynecologists who was saying he worked much harder than his colleague and he was always there at night. So we sampled data of all the birds over nine months in the time, in the free time that we had, because I mean, I was working in the birding rooms and we had some free time in between. So we were looking through all these birding books and we found some data and I made a fun paper about this and actually part of it was was true, because we found out that his colleague was most often there at the end of the evening and the beginning of the morning and he was most often there between 2 and 3 in the night. Oh how cool. So that was very interesting to look how they worked and how that affected them. And then I kind of made a things as a kind of a score for their mood the next day and then, before I moved to Switzerland, I started sampling data.
Speaker 2:But that was a discussion. I think it came out of a discussion with one of the gynecologists and we just had an incident of a child which died after a breech delivery or breech birth, and then we were very interesting and I mean, that's what you did at those times. It was very much reflective research. They wanted to know is there something research they wanted to know? Is there something that we did not see or how could we have dealt with this better? How are we going to guide breech bird? And that was basically the first article that I published in 1991 um about, uh, the breech birds that took place in that clinic and that was very interesting. I mean, basically I would say this was the first bigger research study when I moved to Switzerland. There was a couple of times that I went back there to work on that research and that was a good thing as well. It's still, I think, one of the major studies with a very large portion of normal breech birds.
Speaker 2:We were thinking about if we could make some kind of a score with it, but that was very difficult. I would say. If we talk about ai, maybe it would have been possible now because you you put it into ai, you might they, it might give you some idea of where you can go, but it was a bit too complex to find out score. And then I went to slitzel and then I went to Switzerland and then I can remember it came from the breezebird study because I said to this gynecologist I want to present that in Vancouver on the ICM congress. So I did and that was very interesting and that was of course a next step step. At that time you're developing yourself and it's kind of a big step every time. I mean it's a good feeling you do something extra. It's a good feeling you do something with what you know and next to that you're working.
Speaker 2:So I went to Switzerland and I worked in a couple of hospitals and I did this presentation in Vancouver in 1993. And I was already in Switzerland and then from this came a publication in the midwifery paper in Switzerland. I went to a research workshop in Germany. I got to know a German midwifery researcher at that time. I got to know a German midwifery researcher at that time and I did a presentation in a hospital that I worked in and I started.
Speaker 2:Then we came to the idea in 1994 to start a research group of midwives in Switzerland, still with the idea that we had some kind of a guardian next to that group. Because I mean, basically you're growing, but you know you're still very dependent on the gynecologists. But I mean, as far as they are friendly and most of them that I worked with were, they give you a space to grow, yeah, and it serves their interest, because they are interested in being seen or published or whatever. Most often it goes both ways. It serves their interest, it serves your interest. Yes, so we started in this research group. I think the frustration, because I can remember this is a good story calling my mother in 96, because I felt nothing moved and I was very depressed. I believe it was February 96. And I called my mother and my mother said to me well, child, did somebody die? And then I said no. And then she said, did you lose a lot of money? And then I said no, and then she said, well, child, then it cannot be that bad.
Speaker 1:Perspective.
Speaker 2:So we had a good laugh about that. But anyway, afterwards I did this midwifery research in Germany together. We decided to run I think in 98 or 99, a survey through the Midwifery Association because they started to get interested in midwifery research. To support they paid our stamps. We sent out a survey on two things Midwifery's opinion, the opinion of midwives about research, and that was I think it was a survey from the UK that we've seen and we copied it kind of and they said we could use that. And the other one was the opinions of midwives about CTGs. Because I had the person that made me free researcher in Germany had asked me, and that was in 95. There was a new hype around CTGs and the main thing at that moment was the kind of some kind ofologists were convinced that it didn't help them to improve obstetric management. They were ahead of their time. No, I mean I got an article that the person was called Beller, professor Beller, and he wrote an article I cannot remember because at the time I believe he was in the States and he was a friend of a gynecologist in Bern and of course this was a German speaking area. And then they said well, hans, can you try to do something about it. So I tried to collect all these articles and these studies and look at them and I wrote a booklet about it in German and I presented that at a research workshop in German in 96 and from this came the survey about midwives, opinions about CTGs, and we published that in 2001, I believe. So I was already into research and somebody who works at a nursing school in Switzerland said to me I think I went there for there was a postgraduate course for midwives and they asked me to present my findings, to present my findings, and I went there to do that and she got in touch with me and said I know a person from Scotland and I guess at that moment she was in Germany, a professor in Scotland, and it would be nice for you to get to know her. Good, so I was working at the midwifery school. I went from Goer to Bern to visit a person in the evening and to talk with her and then we just let it be.
Speaker 2:But then came at the end of the 1990s, came the Bologna Declaration in Europe. This was a contract with all the countries I would say was signed by all the countries, and it said we would move into tertiary education, so we would move in a model with bachelors, master and doctorates, and to be able to teach at the school, you had to do your master. I looked at those things and then I found something that I thought that was doable for me and it was called something like the european university or something in surrey and they're still there and they offered a master in midwifery, okay, and I taught because they had a kind of a schedule you had to be there a couple of day of weeks or something like that, and then you could stay at home. And because I had to stay working, I mean I had to earn my own money and then I applied there and I guess I talked about that with this midwifery professor I cannot remember how that went anymore. Um, her name is Valerie Fleming. I think I can tell that to everybody because she published me afterwards. And then she said, well, come and visit us, because you can do an MPhil, a Master of Philosophy, with us. She didn't talk about a PhD, as far as I know.
Speaker 2:And then I was kind of I remember calling people and said, okay, what should I do? I don't know the difference, because a Master also of science and a master of philosophy. I don't have a clue, what should I do? And then I went there and I looked at that and basically I got my information. It was nice, I mean, and I don't even think that we talked about the phd, but I think she provided me the options and at that moment my focus was very much on doing a master. The surrey, surrey people canceled that program for that year, so then I didn't have to think about it anymore. So there are a lot of such things happening in my life. I didn't think about it anymore and I thought, okay, then I go there. So I went there and I think Phil was so smart to offer me the option to say, okay, let's do an MPhil with the possibility to transfer to a PhD. So I did that.
Speaker 1:Did you move to Scotland for that or did you do that from Switzerland?
Speaker 2:No, no, it was a very good program. I mean the advantage of MPhil. Of course you can do a project in your free time, in your own time or your own timing, and I had to be there six weeks a year, so that was very doable. So we looked at what, what my progress was and what I could do, and I went there two or three times a year for two weeks or something like that, which made good blocks for me, and at that moment I had a head of the school, uh, which wanted me to do that, and I could reduce from 100 to 60 percent. Uh, 20 percent was my own time. I had to pay that and I bought 20 percent from the school.
Speaker 1:I think that was a nice deal, sweetheart Deal compared to doing these days. Did you do the same topic for your Masters and PhD and expand it, or were they completely different topics?
Speaker 2:No, it was the same topic. I started with the idea and I think that's nice as well to do it, that idea. I'm still very much a fan of embedding doctoral students in a larger study. This was a start. I sent a letter to about 70 people that I knew gynecologists, midwives and so on and then I had a top three and the top one of that was the effectiveness of the content of um antenatal care. I mean, we're very much at that moment still in the effectiveness era. You looked at that and I mean we talked about that in um, in the at the glasgow caledonian university as well.
Speaker 2:A lot of us, when we as midwives, as we started, we wanted to do an RCT. That was our idea of being the best thing that you could do. All of us changed our opinion. I would say most of us stayed. All of us that's a bit much, but let's say most of us, far as I know, changed our opinion about doing rct as the best thing possible. Yeah, and I well, this was the the main thing, and so we played with this thing, I think. The second thing I cannot remember anymore and the third thing I believe was decision making. Yeah, but I got this back and I had the idea because at that time one of the topics was elective cesarean section and I figured out if I had to spend six years with elective cesarean section. The topic was over.
Speaker 2:Yeah, so I wanted to do something else.
Speaker 1:It has to be a passion. You've got to keep it going because you live with it for so long.
Speaker 2:I think maybe Phil came up with the idea to do this from a business point of view. I can remember presenting my ideas at a student's meeting so we could discuss it. So it worked out and the ultimate title has been effective content of routine care in pregnancy from women's point of views in three European countries. And at that moment when I looked at that, there was also a thesis from a person, a gynecologist in Holland, and most of the thesis from these gynecologists. You can offer that to the university so we can read it. I think that's a very good thing. So there are very nice booklets and I asked him about that. We looked at content to look if it was effective. Him about that. Who looked at content to look if it was effective? And he very much looked at it from a numeric point of view. So if the people stick to the things that we decided was important in antenatal care, did this really change the outcome? Did it work?
Speaker 2:And he came to the things that he had three lines. One of them is we measure. One of the things is that we do not measure what we should measure. There are three lines from that that what we measure is not important, things like that, the lines. I think I used that in my thesis again and the lines are very interesting and it is true. I would say that we not usually we don't measure what we should measure and we do not measure what is important to women, and that's it.
Speaker 1:It's the importance important to women. That's it. It's the importance to the women. It's not necessarily the importance to us and I.
Speaker 2:I saw a line of um, what's it called mark case again and he said um, he used to say that effectiveness in and in in care, in pregnancy and childhood should be what is important to women. I mean there's a public health, there's, of course, a public health perspective and I think that's important as well, because I mean it's always important for women that children do not die and I think it's important that children are not handicapped or things like that. So perinatal mortality and morbidity are important things. But I think there has been little fuse in. I did this qualitatively, in a qualitative way I would say bottom up I hear that term a lot of times from Biden, or how he used to organise his economy. I think there's little knowledge bottom up.
Speaker 1:And that's reflected when you look at the research and the literature around birth trauma and the experience of the woman is key that, if you, especially when things aren't going the way they expect, the communication with them, the talking with them, giving them that sense of control and having an understanding of what they're experiencing is critical.
Speaker 2:I do agree with you and I think what is a bit hindering us at looking at that is I. I realize that doing a good quality study in either phenomenology or crown theory or something like that is a lot of work. My friend gynecologist said that's really work of a monk, so it's much easier to do a survey. But we should realise that when we ask questions in a survey they are our questions, not their questions. It's our language, it's not their language.
Speaker 1:That's a very good point to make. So, thinking back on both what you did for your Masters and for your PhD and the extension of that, what is something that still resonates with you now, that surprised you at the time?
Speaker 2:I think there's a lot of surprises If you work with women. I really really like the field work. I really really like the fieldwork. I can remember where I switched. That has been very profound. So I did the study and I think that still has been the master level. I had some.
Speaker 2:I did Crown the Theory and I combined it at that time with meta principles of meta-ethnography, because I did it in three different languages, which is huge Dutch, German. Well, I don't speak very much Swiss German, but German and English. So I worked out and I went a bit too fast. When my super fan fell who is it? I think she will have a big laugh. So I thought in an organizing way OK, I'm going to Holland, I'm going to Switzerland, I'm going to Holland, I'm going to Switzerland, I'm going to England and I'm organizing five interviews in every country, because I cannot do that all at the time, I cannot do it back then and that's a bit much for grounded theory to start with. So you might as well start with one or two interviews.
Speaker 2:And Bell had the idea that you mix it at a very early stage and maybe it worked out better this way. But I had a hard time, as she as well. Um, but I I mean actually, when I then I analyzed all these, these meaning units, because you have to do that, basically I looked back afterwards you have to do that in in one language before you're going to mix them or compare them. That's no good, because you first have to have meaning before you are going to mix it, Otherwise you're going to mix at a code level that doesn't work.
Speaker 2:And then I put them on the wall because I basically did it by hand and I cut everything out. And I put them on the wall because I mean I basically did it by hand and I cut everything out and I put it on the wall, all the sentences. So my whole room was filled with. I still have pictures of that in my PhD and I looked around and I looked around and I thought I cannot see it. I cannot see it. What should I do? And everywhere I saw blood pressure, urine, all those things. Because you're thinking in affective content of antenatal care, you're thinking very medical, Because this is the way you've been trained or educated.
Speaker 1:I was training back then.
Speaker 2:yeah, I mean, I was educated in Holland, which is supposed to be very progressive, I would say, in midwifery terms, but we're still very medical in our education. But anyway, I looked around and I saw that every day and I thought I have to talk with elder people. So I called somebody that I, I I called my mother and asked her about her experience. And it was much easier to be pregnant then, I would say, than now, because you don't have so much information. And so it, that was easy. And I talked with somebody else I had worked with. She used to be aian, but she has been in human genetics, a very interesting person. And then I called her as well and we talked about it.
Speaker 2:And then at a certain point I walked along my data again and I thought this is it. And then I flipped. I flipped because I saw then the woman's point of view. I saw that what they meant by blood pressure or by urine is. It gave them security, it gave them confidence to say, yes, my pregnancy is going well, yes, my child is okay. And they saw afterwards I said to somebody you have to realize our blood pressure instruments. They see that as a mean that we use to give them that information? It's not important to them.
Speaker 2:I would say the same thing about CDGs, but I should talk with Kirsten Small about that but I would say probably the same thing about CDGs, and I think most interesting was the discussion about prenatal or antenatal screening, what this means for them and how they live with the risk, um, which is basically not answering their questions at a certain moment the second or third pregnancy people said, well, you know they are doing this and I don't care shit because it's not going to tell me what is wrong with my baby or not. They're just saying now you have a risk for one or 200. What should I do with it? And in the data you also saw that they kind of postponed their taking up the relationship, the bonding with their child. I mean basically what I saw in an ultrasound. That was interesting as well. Well, the ultrasound as such is not useful for them, but a good explanation from the ultrasound is should never happen without somebody there who can provide a good explanation what it means to that woman. The information that they got if things were okay or not gave them a good. Gave them a good. But I mean basically the technology. That was not their thing. Their thing was what does it mean for me? What does it say about my child? Which is fair enough, I think. What was also interesting to see that the people who did antenatal screening wanted to prepare themselves for a child with a handicap. They did not enter in at the same time. They did not enter to say I want to have an abortion right away. They wanted to be prepared and they wanted to be able to say, okay, I can live with this or I cannot live with this. What can I do to make a better life for my child afterwards? And what was interesting for me as well is I learned to use the words they were using. Yes, basically it's.
Speaker 2:I think we forget that in our, in our society at the moment. This is an sometimes in some societies, and it's certainly true for Switzerland. This is an ethnic minority, the people who we, our own people, who are becoming mothers. They are symbolically an ethnic minority of a society. I didn't feel that much in Holland because I would say it's still.
Speaker 2:I don't say it's not happening, but I don't think the distance is that far and I think that's because women in Holland played Even if I can now see things that I think I thought at that moment it was better, and there are still those political games which are the same things as in other countries, but I think women had a bigger role to play in Holland in shaping the society. At least I can see that in the 70s and the 80s they were very active and they had an important role or they got an important role in also shaping the society. And from a historical point of view, probably it has to do with the second world war, because I I heard this from some people looking at women's history in switzerland that they saw that this might be a point in the development of that they didn't participate in, they were neutral in in the second world war, female emanciations took huge steps because of the men fighting in World War II in those countries.
Speaker 2:Yeah, yeah, so that might have been. I mean, that is an idea. I don't say that's true, but this is the idea. If you talk with other people.
Speaker 1:It would be a nice interesting rabbit hole to go down for one day if you're kind of looking at something to do.