Being a midwife in New Zealand

I moved from the UK eleven years ago and became a Kiwi citizen three years later. I have just looked at the last couple of posts I have written for midwives who are interested in moving here, and I have to say that they do sound rather negative. So here are some of the reasons why I love living in Dunedin, New Zealand.

1. Dunedin is the most beautiful place. We have wonderful scenery and wildlife right on our door step. The weather is crap a lot of the time, but on a sunny day there is no better place to live in the world.

2. Its a great place to bring up children. I do not think that there is the commercialization or materialism here as there are in other cities/countries. My kids just do not have the expectations for material things as their peers in the UK - mind you, that could be because we're always broke and they know there's no point in having any sort of expectation!

3. There is not the population and congestion of other cities. Our idea of a traffic queue is a pile up of five cars at the roundabout.

4. Property is affordable....just.

5. We are a long way away from terrorist threats, although we have been feeling some off-shore earth quakes lately.

6. Despite all my moans and groans, the maternity system is brilliant for midwives who want to practice total midwifery care, be self-employed and carry out home birth.

We do have our problems such as high youth suicide, domestic violence and prison incarceration rates. However, as a family we feel very safe here and after a considerable amount of time, we are settled and feel proud to call ourselves Kiwis - except when New Zealand is playing England at any kind of sport and then we are steadfast Poms!

Image: 'Along the Knife Edge' Andrew Baird
www.flickr.com/photos/19538540@N00/1406464741

Emigrating to New Zealand

I emigrated to New Zealand from England 11 years ago. Over the years I have seen families come and go, and recently have met a lot of people who have come to work at the new corrections facility that has opened just down the road from Dunedin. So here are a few words of advice resulting from my own personal experience as well as that of friends and colleagues.

Do your homework
The first big piece of advice is....do your home work before you commit yourself to anything!!

Make sure you know about the region you are going to - is it rural or urban? What facilities and resources does it have? What is the population size? Is a geographically isolated area? There are a lot of geographically isolated rural communities in New Zealand which can come as quite a shock if you are usually a city dweller.

What is the weather like? For some reasons people think New Zealand has a tropical climate - that is not so. The weather varies from region to region and if you live in the Dunedin area, you need to be prepared for weather that is very similar to Scotland. This is all well and good but the houses here do not have the same level of insulation or heating that they do in the UK or Europe. We are hardy folk here - if we're cold, we just put another jumper on!

What is the social make up of the local population? Be mindful that some areas have 'troubled' communities which is why it is difficult to recruit people to work there. We do have problems with gangs in some areas as well as high domestic violence and youth suicide, so think about that when you are looking to settle. However, working in the less privileged areas of New Zealand provides wonderful opportunities for personal and professional growth.

Do not burn your bridges
My other big piece of advice is not to burn all your bridges before you come ie if you have a house in your mother country, do not sell it until you have lived here a while and are confident that you want to settle here. It is very easy and acceptable to rent here, so try renting for a while until you are sure what you want to do in the long run.

Cost of living
Do not automatically assume that the cost of living is a lot cheaper than it is in Europe and the UK. Whilst housing is cheaper, I would say that the cost of living is on par when you take earnings into consideration. Depending on where you live, the cost of food, gas and electricity is climbing as is petrol. Cars are cheap to buy and people make do with extremely old dilapidated cars that would not be deemed to be road worthy in other countries. This is particularly good news for teenage boys buying their first car.

Jobs
Do not expect to get a job that is on par with what you had in your mother country. This rings particularly true for men who come over on their wives' points/qualifications. It can be hard for men to get jobs and that in itself can cause huge pressures for families, especially if the wife does have a job. I have known a number of families who have returned to the UK because the man has not been able to get a 'decent' job. Chaps, you have to be prepared to be flexible and versatile, and may have to take a drop in employment status whilst you look for a job that really suits you.

If you are made a job offer, be extremely clear about the expectations and have it in writing. Again, I have known a number of people who have found that their jobs have not lived up to expectation which has caused undue stress and conflict.

Different culture
Be mindful that we have a different culture here in New Zealand. Whilst we are predominantly 'white', speak English and even drive on the 'proper' side of the road, we think and do things differently from Europeans. I won't go into the differences too much here but I would suggest the main thing to be aware of is that some things are not done to quite the same level as they are in the UK. By that, I mean that the prevailing attitude can be 'it will be alright, mate' but in some cases, they aren't 'alright'. This is especially true with buying a house - there is no where near the same level of checking carried out on a potential purchase that is carried out in the UK. On one hand that makes buying a house a lot easier, but on the other hand it can mean that it is easier to end up with a bad buy.

At the end of the world
Remember that New Zealand is a long way from anywhere (apart from Australia) and it is time consuming and expensive to travel. Whilst it may only take 24 hours to fly to the UK or Europe, it can be difficult and expensive to return especially if you have to make the trip, say, because of a family emergency. Family and friends say they will come out and visit, but often are unable to do so because of the expense. The same goes for return trips back home. So although getting away from the family can be a great appeal for emigration, in the long run it can be very stressful. This is especially true if you have sick, elderly family members at home, or you are bringing a young family here to grow up away from their grandparents, aunts, uncles etc.

Advice for Poms
My last piece of major advice is for those of you who are English. Us Poms are generally not well liked here. When it comes to rugby, cricket or any kind of sport, or anything at all, there's nothing a Kiwi loves more than the Poms being taken down. New Zealanders will even support Australia over us! Now this can be very hurtful but the way to tackle it is to remind Kiwis who got further in the last World Rugby Cup - England or New Zealand!?! This is bound to make you a friend for life.......NOT!

Now this all sounds extremely negative and I know that Kiwis may be thinking that I would be better off back in the UK, but there are some wonderful things about living in New Zealand which I will talk about in my next post.

If you are interested in moving to Australia, have a look at Bill Hampton's web site.

Emigrating to New Zealand to work as a midwife

I get a reasonable amount of emails asking me for advice about moving to New Zealand, especially from midwives. So I thought I'd write a couple of posts about this. But please remember a couple of things when you read them:

- this is purely a personal opinion - you will no doubt hear other stories or view points when you speak to different people;
- I moved to New Zealand from England 11 years ago so things may have changed, especially with regards to requirements for emigration;
- my opinion is based on both my personal experience and that of other families who have moved here, in particular midwives and corrections officers;
- my context is moving from England and the British maternity system - you may find things different if you come from a different country and maternity context from England.

This post will deal with issues pertaining to working as a midwife. My next post will deal to more general issues of emigration to New Zealand.

The maternity system is different to that of the UK. So it is really important that you understand the differences and in particular, you understand the midwifery role that you will be taking on when you get here. To get a feel for midwifery issues have a look through my blog and that of Carolyn McIntosh, as well as The New Zealand College of Midwives and The Midwifery Council of New Zealand web sites. The majority of overseas midwives are recruited to be hospital midwives and for many English midwives that role can come as a bit of a shock. Hospital core midwives deal mostly with secondary care patients and with women who have just had their babies. In a lot of hospitals, there are few opportunities to be involved with primary births. So if you are expecting to walk straight into a primary role, you need to check that that is the reality. The other thing to ask yourself is: why can't the hospital manage to get local midwives to do the job?

If financial constraints mean you must have a job, make sure it is secured before you get here. Whilst we have a major midwifery shortage here, you cannot be guaranteed you can get a job that you want the minute you arrive. Having said that, try not to commit yourself to any binding contract just in case the job is not what you want.

Make sure you fully understand the requirements of midwifery registration.

Do not waste your money going through a recruitment agency. It is fairly easy to get a job is your go through the hospitals. Here are a couple of web site that advertise midwifery jobs:

Trademe
NZCOM
Seek

The other option is to go to the web sites of all the various District Health Boards in the region where you wish to settle.

Be mindful that we have a much smaller birthing population than Europe, UK and the USA. The advantages of that is that life is not quite as hectic as it is when working in a big hospital that caters for thousands of births per year. The downside is that you do not get the same extensive experience that you would with larger birthing populations.

One example is the local hospital in Dunedin. It is a tertiary hospital and is one of the two medical schools in New Zealand. But it only has about 1800 births a year - this is the equivalent of a local cottage hospital in England. There are doctors falling over themselves with inevitable high intervention rates. The result for midwives in my view, especially hospital midwives, is a lack of autonomy and decrease in midwifery skills such as cannulation and perineal repair as well as midwifery collaboration ie midwives refer straight to doctors instead of more experienced midwives.

Having said all that, New Zealand offers midwives the opportunity for autonomous practice as lead maternity carer, with an extensive scope of practice that may not be available in other countries.

If you are interested in the experiences of midwives who have emigrated, keep an eye out for the work of Mary Sidebottem who is currently looking at the experiences of midwives moving to Australia.

Refs:

Stewart, S. 2001. Midwifery In New Zealand: a cause for celebration. MIDIRS Midwifery Digest, September, 11 (3): 319-320.

Stewart, S. 2001. What’s it like to work in . . . New Zealand. The Practising Midwife, 4 (10): 34-37.

Stewart, S. 2001. Midwifery education in New Zealand. Midwifery Today, Winter (60): 44-45.

Stewart, S. 1999. Situations vacant: the shortage of midwives in New Zealand. The Practising Midwife, November, 2 (10): 34-36.

Stewart, S. 1999. Midwifery standards review in New Zealand; a personal review. British Journal of Midwifery, August, 7 (8): 511-514.

Image: 'Dunedin from the Peninsula' Barbara Agnew
www.flickr.com/photos/97726668@N00/2948145

Christmas in Dunedin, New Zealand

Despite having moved to New Zealand from England 11 years ago, I still cannot get used to Christmas in the summer. The weather in Dunedin is usually dreadful - cold and wet - which actually makes me feel like I am back in England and feels a lot more Christmasy.

On the plus side, I took the dog for a walk the other day along the sea at Aramoana. For some people this is a place of tragedy and sorrow because a number of years ago a man went on a shooting rampage and killed a number of people.

I always feel a great sense of loss when I go there but at the same time, I also have a great sense of peace and oneness with nature. Whilst I got nearly got blown to kingdom come, it was a lovely afternoon and I was able to watch seals play in the kelp and literally ran into three yellow-eyed penguins. The dog chased a family of feral cats, including three kittens who were nesting amongst the rocks. My husband was disappointed that I had not knocked the cats on their heads with a rock because of the danger they pose to the rare penguins.

I miss my family in England very much at this time of the year but at the same time I feel Christmas is a lot less commercialized for us as a family here than it would be if we were still in England. Because we are on our own, we have had to rely on each and develop our own Christmas traditions. So hopefully, the weather will hold up and we'll get to play our annual game of Christmas cricket.

But Christmas changes as the family grows up. My two teenagers are both working all over the holiday except for Christmas Day in the local supermarket and department store. My husband is working night duty. So I will be home alone with nothing to do except read my historical romances and may be plan some blogs posts!?

Thinking about the aim of this blog

A number of things has led to me thinking about where I want this blog to head next year - what is the aim of this blog? This has come about for a couple of reasons.

The first reason is a result of the conversations about how to cultivate an audience for a blog; how to find an individual brand or niche that will attract an audience. These conversations have resulted from a post by Michele Martin on her blog called "More on Blog Commenting From Bamboo Readers". I know that creating a blog should not be about fame and fortune but rather to provide information and foster learning - from an educational point of view, a blog is not about meeting the author's needs but rather developing a network of autonomous learners. However, in order to do that, one first has to find ways to reach the 'learners'.

The second reason is a post I read by Sue Waters about the 31 day challenge to build a better blog. With my usual impatience, I skipped down the list of daily tasks to number 31 which is carrying out a SWOT analysis including looking at one's mission statement and auditing one's blog.

The third reason has been watching the blog of a colleague of mine, Carolyn McIntosh, and seeing how she has developed her blog. She started her blog a little after I did, but she now gets more readers than I do. So I have been interested to see what she writes about and what attracts her readers and compare that to my blog.

So what has been the quandary for me? It has been about whether I make this a blog about clinical midwifery issues that would appeal to birthing women as well as midwives, or to concentrate on education and professional development, that would be of more interest to educators and researchers. In many ways, this reflection about my blog has mirrored what is going on in my mind about the direction of my career - do I want to stay a midwife or do I want to branch out into education and research that may take me away from midwifery?

If I make this blog about birthing issues, no doubt it will attract bigger numbers because of its appeal to a more general population. If I give it an education focus, especially around e-learning, that may restrict my audience numbers. But the truth is: what I am really passionate about is education and professional development, especially for qualified health professionals. And in particular, I am really interested in how health professionals can support each other and build their own learning from using social networking tools ie Web 2.0. This is because I believe these resources may go a little way to helping to address issues of recruitment and retention in the health services.

Birth issues are very ably dealt with by midwifery bloggers such as Sage Femme, Navelgazing Midwife, MidwifeMuse and, of course Carolyn. I could have two blogs, but I do not have time or energy to maintain two blogs.

So, where to from here? Looking back at my posts I see that the themes are mostly professional development and e-learning, particularly in relation to midwifery. And whilst there for a time, I thought I would concentrate more on clinical midwifery in order to attract more readers, in fact that is not what I really want to do.

So I have slightly changed my mission statement from "Welcome to this blog which aims to discuss matters pertaining to midwifery, midwifery education and research"... to " Welcome to this blog which aims to discuss matters pertaining to education, research, mentoring, professional development, e-learning and Web 2.0, particularly pertaining to midwifery." It is a subtle change but reflects more clearly where this blog is heading ...and where I am heading in my career.

I don't know if this makes any sense and in a way I feel as if I am going round and round in circles, but I hope you will enjoy this blog and find some useful information in it because it is written by a midwife who is working through issues of professional practice as well as an educator and researcher who is working out how to utilite Web 2.0 in her teaching and research practice.

Image: 'Questions' Tim O'Brien www.flickr.com/photos/42788859@N00/318947873

Leaving comments on my blog

One of the main reasons I keep this blog is as a means of talking with people, especially anyone interested in education, eLearning, health care practice, midwifery and childbirth. I hope that this blog passes on interesting information, but the main aim is to generate conversation and discussion.

Whilst I start off the conversation with my own thoughts and ideas, I am really keen that readers feel comfortable to add their own comments. This may be a short 'I agree' or it may be a longer 'I totally disagree and think you talk a load of rubbish!'. I would invite you to say anything you would like, as long as it is not too rude!

Feedback or comments are really important to me as it gives me a feel for what you think about this blog; the way I write as well as the subjects I write about. Leaving feedback allows me to meet the readers' needs more fully as well as providing me with personal motivation. It is also a way to generate ongoing discussion which hopefully will spark off further reflection and questions, and may even encourage future collaboration. So have a go and leave me a comment about a posting.

All you have to do is look up at the top of a post and click onto the small 'comment' label.
A new window will open where you can read other comments as well as leave your own comment.
Write what you want to say in the box.
If you want to stay anonymous, just click where it says 'anonymous' or you can use your own name or nickname.

You do not have to have a 'blogger' account to be able to comment on this blog.
Once you are happy with what you have written, click onto 'publish'.

If you would rather email me compared to comment directly on the blog, click onto the envelope symbol at the end of a post. I respond to all comments and emails.

If you want to be really clever and keep a track of the comments/conversations, you can use a program called cocomment.

A special 'thank you' to Michele Martin who advised me to write this post as a way of encouraging people to interact with this blog.



Image: 'elephant talk'
www.flickr.com/photos/47968145@N00/325235488

The midwife's role in the wider context of sustainability

Carolyn McIntosh has posted a video called "All about stuff" by Annie Leonard. The video challenges us to think about sustainability in terms of the wider global context.

Now I know I am a heretic when I say this, but I was getting a little tinnie bit bored with the whole sustainability 'thing'; another means of controlling my life? I love my car, fast food and heat pump! However, I have been challenged by Leigh Blackall to think about how midwives can contribute to sustainability in a global context.

Supporting breastfeeding and normal birth are two major aspects of a midwife's role that is fundamental to sustainability. Carolyn puts it succinctly in her post in which she talks about the effect of elective cesarean section on resources. As midwives we do not need to burn our bras or go on mass hunger strike, all we have to do is do our jobs! The question is: how well do we do them?

What do you think midwives can do to promote global sustainability?

Image: 'rainforest' Ben Britten www.flickr.com/photos/29205549@N00/14782257

Baby Bump Project

The Baby Bump Project: This is a great blog to follow because it looks at issues regarding body image, celebrity, pregnancy and motherhood. Especially interesting to midwifery students who are thinking about these issues for their studies in midwifery knowledge and sociology.

Image: http://www.pregnancystore.com/zaky.htm

Facebook and Fotowoosh

Have just discovered Fotowoosh, which is an application that turns photos into 3 dimensional images.

http://facebook.fotowoosh.com/public/view/2851262594055137747

The disadvantage is that you have to have a Facebook account to be able to use Fotowoosh.

Midwifery and sustainability

Sustainability appears to be a big theme in all walks of life. For me as a midwife, sustainability is all about how I maintain my practice in a way that provides quality of care to the woman I am responsible for, at the same time as maintaining a personal and family life. Sustainability is about maintaining job satisfaction by providing total midwifery care, yet avoiding stress and burnout. This has been one of the themes of this blog, and clearly it is an issue that is affecting the midwifery profession globally.

The New Zealand College of Midwives has responded to the issue of sustainability in its latest edition of the 'Midwifery News'. Karen Guilliland has written an article entitled ' Supporting and sustaining ourselves' in which she exhorts midwives not to focus on the negative aspects of midwifery practice but rather to continue to fight to guard our autonomy and be steadfast in the knowledge that women want midwives to work with them to achieve normal birth.

Karen is right to remind us that midwives in New Zealand have wonderful opportunities to practice autonomously and we are very privileged compared to a number of countries such as Australia. We have our own statutory/regulatory body - The Midwifery Council of New Zealand - which is quite different from the UK and Australia, where midwifery is overseen by nursing. We have the ability to be self-employed and be totally responsible for the care we provide without being overseen by other health professionals. We have an extensive scope of practice in which we can order medical investigations, refer directly to secondary services and prescribe medication. But this is not enough if the midwife shortage and discontent amongst midwives is anything to go by.

I have to admit that after reviewing some of the posts of this blog, I could be accused of some of the things that Karen talks about - focusing on the negatives such as workload, blaming women for not doing their part to achieve normal birth, losing hope that normal birth is achievable. So I must take responsibility for how I contribute to the sustainability of midwifery, and I see my role as lecturer as a vital part of that. I also see my endeavors to explore alternative means of supporting each other by online communities of practice and e-mentoring as another approach to sustainability.

Every midwife must look at how she can contribute to the sustainability of midwifery so that the profession maintains its autonomy and isn't re-consumed by medicine and nursing. Midwives are hugely responsible for the way the maternity system runs, so you are not happy with it, you must ask yourself how you can work to change it.

Having said all that, I also believe it is vital that we listen to what midwives are saying about the realities of practice in today's world. As Karen said, it is a journey we are on, and we are not in the same place that we were in nearly 20 years ago when midwives in New Zealand first gained their autonomy. It is not enough to blame midwives' discontent on the mis-management of their caseloads.

What is the reality of midwifery practice for you? What do you feel the profession can do to encourage its sustainability?

Guilliland, K. (2007). Supporting and sustaining each other. Midwifery News. No 47, December, 6-7.

Image: 'Sustainability Without Compromise' Richard Eriksson www.flickr.com/photos/35034348378@N01/146872543

What makes a competent midwife?

It appears that there is some disquiet about the ongoing competency requirements for registered midwives in New Zealand (Guilliland, 2007). Apparently, some midwives have complained that the statutory requirements, as laid down by the Midwifery Council of New Zealand are too stringent and onerous.

These requirements include:
an annual declaration to say you are competent in all areas of the midwifery scope of practice and have fulfilled the requirements of the recertification program
an annual standards review - audit and reflection process
maintaining a portfolio
attending annual compulsory maternal and infant resuscitation update
attending compulsory technical skills workshop, once every three years
attending compulsory breastfeeding update every three years
gaining 40 education points and 30 professional development points.

There is no requirement for working a set number of hours or having a specific number of midwifery cases.

Once these requirements have been fulfilled, then one is entitled to an annual practicing certificate.

I can understand why midwives feel this is an added pressure to their already full lives, but in the grand scheme of things, being able to say that you have fulfilled all the requirements for competency to practice is a 'protective' measure if nothing else.

For myself, as a midwifery lecturer who works on clinical papers I am required to have an annual practicing certificate. This is right and proper for a number of reasons, not least that is maintains credibility with students and feeds into the teaching - clinical - research cycle. The issue for me is what amount of clinical work keeps me competent? There are a number of options for clinical work such as working at my local hospital or carrying out locum placements but I am not too keen on doing extra work on top of my lecturing job, study and research, especially if it means doing it in my time off.

So this is what I have to figure out: what clinical work should I do and in what areas, that will help me maintain competency yet do not add an additional stress and workload to my already chaotic life? Or, is the question not so much about what keeps me competent - I consider that I am very competent following many years in a variety of practice contexts and working with students keeps me updated - but more about maintaining confidence?

However one looks at things, there is no doubt that if midwifery teachers, academics and researchers are required to maintain their clinical competency, they must be supported in a way that does not cause additional stress or encourage burnout.

I'd love to hear your views about how you maintain your competence, if you are a midwife. If you are a lecturer, how do you keep current? If you are a student, what are your views about midwifery lecturers carrying out clinical work - should it be a requirement? If you are a non-midwife, how would you gauge if a midwife is competent or not?

Guilliland, K. (2007). Supporting and sustaining each other. Midwifery News. No 47, December, 6-7.

Image: 'Our Midwife' www.flickr.com/photos/32099449@N00/482273120 Stephen Rothlisberger "Kylene, our midwife, is impressively competent and thoroughly professional, and she's the friendliest person I've ever met. It has been our privilege to be in her care."

Blaming the midwife

The recent death of a baby following its early discharge from hospital brings midwives' practice to the fore again. I have no intention of commenting on this particular case but it does have the effect of making one's heart sink because "there but for the grace of God go I".

The lead maternity carer midwife carries a tremendous responsibility and when something goes wrong, she is the one who ultimately carries the can. The midwife in this case will be feeling sick because of the death of the baby and its effect on the family. But the midwife also knows she will be undergoing trial by media in the ensuing weeks as well as facing considerable pressure from the investigation that will now be carried out. This will impact on her personal and professional life; her health, her financial security and the peace of her family.

Now, I am not saying that when midwives make mistakes, they should not be held accountable. Indeed, midwives who perform poorly outside prescribed professional standards and guidelines should be made to account for their decisions and actions. Midwives in New Zealand undergo a rigorous undergraduate three-year midwifery education program in order to be able to deal with the responsibilities they carry. Once midwives are qualified, they are legally required to participate in a program that ensures ongoing competence. They also have a framework(Section 88 Maternity Notice) that clearly spells out the services they must provide.

But there are times when even the most experienced and well-meaning midwife has an error of judgment and makes a mistake. Midwives are no more perfect than doctors or any other health professional. Granted, midwives cannot afford to make the sort of mistakes that put mothers and babies' lives at risk but at the same time, midwives' actions have to be put into context. In this case I have been talking about, the context is a very busy tertiary hospital and we do not know at this stage what else impacted on the midwife's decision to send the family home.

To be honest, I am not totally sure where I am going with this post. I guess what I want to have acknowledged is that the midwife's job is far from an easy one, although there are a number of professional processes in place to support her, and we should not be quick to judge. I also think we need to acknowledge that there is additional stress in the midwife's job knowing that she cannot afford to err in judgment because even the smallest slip can have severe repercussions.

What I question is: do midwives do enough to support each other in this world where even the smallest error can impact hugely on one's professional standing? Is the stress of this which hangs over midwives all of the time acknowledged by the profession, or am I just blowing one incident out of proportion? I would also like to know how much of what I have been talking about is a serious issue for midwives? Anecdotally, I have been told that it is an issue that midwives consider and may have an impact of retention. But as far as I know, there has been no research in New Zealand to really look at this.

What I am suggesting is that it is time for us to carry out national research that looks at midwives' recruitment and retention and seriously take on board what midwives say about the issues of being a midwife. In these days of increasing midwife shortages, we cannot afford to ignore what midwives say as being just the rantings of a few dissatisfied midwives who cannot manage their workload.

I would be very interested to hear from anyone who has an opinion about this post, either as a midwife, parent or by-stander. Please feel free to comment anonymously.

Image: 'I9m not keen to shift the blame' John Goodridge
www.flickr.com/photos/38834306@N00/405633410

A personal summary of ASCILITE 2007

Now that I have been home a couple of days, I have reflected on what the ASCILITE 2007 conference meant for me. For one thing, it was very successful because it was a culmination of nearly a year's work with my mentor in which we wrote and presented a paper about designing an e-mentoring system. The other big stand out is that I caught up with a friend, and I learnt more about what it means to live in Singapore.

As for the conference itself, there was no one presentation that really stands out. The value of the conference for me was more about giving me time to reflect on my own teaching and research practice, and consider ways of incorporating e-learning into my teaching. The main thing that came across was that I should take every opportunity to research and evaluate all e-learning interventions that I use. This will be one way of increasing my research outputs without having to worry about getting involved with huge research programs - a cheap, convenient way of carrying out research. And, obviously it goes without saying that evaluation of teaching techniques is crucial to the success of an education program.

The key word of the conference was 'scaffolding'. This term denotes the resources and supports that are put in place to support students in their learning, and is key to e-learning techniques. The more scaffolding that is put in place, particularly with an e-learning activity, the more successful that activity will be.

A major theme of the conference which goes along with that of scaffolding is getting students to engage with e-learning in a meaningful way. Time and time again presenters said that the only way they could get students to engage with e-learning in a way that produced work of both quality and quality was to attach marks to the work. I find this really depressing - surely students enter higher education to learn, using whatever means is necessary? Having said that, maybe students are telling us that e-learning is not effective as it cannot attract student attention without bribing them? But thinking about face-to-face classroom teaching, do students not say the same - I have heard students say that they will only attend classes if they are connected to assessment. So what does that say about our education programs? Are students really learning anything? How can teachers overcome that attitude? How can we encourage the notion of lifelong learning to people who only see learning as a means to a certificate? Answers please on a postcard and send to......

So this begs two questions about my e-mentoring research: how effective is the scaffolding I have put in place and how can I promote the valuing of this means of professional development and learning when there is no discernible reward in the form of a certificate or qualification?

On a less serious note, I got to go to M&S which for an English ex-pat was a highlight. But my goodness, hasn't the price of knickers gone up (only ex-pats will understand the reference to M&S knickers)?!

My very first YouTube video!

People who know me will attest to the fact that I am the greatest drama queen and my real dream in life is to become famous; one reason for having this blog? Although, if I am waiting to become famous as a result of this blog, I might be waiting a long time yet!!

Anyway, in my pursuit of international fame, I have posted my very first YouTube video. This was shot by a friend who was taking me around China Town in Singapore, having scived off the last day of the ASCILITE 2007 conference -here I am learning to use chopsticks!

http://www.youtube.com/watch?v=VEyVAbAMs30

Flickr and creative commons

I followed Leigh's instructions and left comments on a number of the Fickr images that I have used. This is the reply I received from Phil Hilfiker:

Thank you for letting me know where you posted one of my images under the CC license. I also appreciate the fact that you built a post around the topic how to properly use CC licensed photos from flickr.

To completely adhere to the rules of the CC license attributed to the image you chose to use, there's just one little additional point that I like to see respected and that would be great to actually see as a topic included in your post: the attribution. While one can argue that you did in fact attribute the image in your post by including a link to the original page of the photo on flickr, I always very much appreciate to be given credit for a photo with my actual name 'Phil
HIlfiker' (and I think a lot of photographers out there who decide to make things avaible through a CC license feel the same). - After all, those CC images that might be used somewhere on the web, a lot of times without the photographer even knowing about it, also serve a bit as
advertisement for an individual photographer.

Personally, I chose to specify the attribution details on my flickr profile page (http://flickr.com/people/hi-phi/) which admittedly can easily be overlooked by someone just
using a search engine to find a particular CC image on flickr for example.

I guess I should consider marking the attribution requirement on each photo page where I'm showing a CC licensed image to be more clear.

Image: Phil Hilfiker Lightness of being - episode I' On White.
http://www.flickr.com/photos/hi-phi/299980210/in/set-1596134/

When using Flickr images

Here is some excellent advice from Leigh Blackall about using images from Flickr:

As most of us know, Flickr has a vast repository of images that have been licensed Creative Commons. I must acknowledge a problem with Flickr in that image authors can actually change the license that they use on their images, so what might have been a CC BY image when one of us picked it up, may in fact have been changed since. So I think it might be good if we choose to sample someone's image from Flickr that we leave a message in their comment box below the image that thanks them and lets them know what we are doing with it.

Adding a comment to the image serves two purposes:
1. It lets the photographer know what's happening with their image
2. It adds a record to the image page that once upon a time the image had a non restricted license

Here's a video on how to sample images from Flickr's Creative Commons

'Thank you' to Leigh for that excellent advice - I'll start doing that from now on.

Image: Phil Hilfiker 'PICT0001 (1 year-anniversary)'
www.flickr.com/photos/14318462@N00/75853340

More about length of post natal hospital stay

The subject of how long women should stay in hospital after the birth of a baby has arisen again after the sad death of a baby who went straight home after her birth and died shortly after. Carolyn McIntosh has written a very thoughtful post about this and I have nothing to add except my sincere condolences to all involved.

Carolyn has brought up one interesting point for discussion, which is the role of the primary birthing unit. A news piece on our national news suggested that primary birthing units are one answer to the shortage of post natal beds in large tertiary hospitals. I would certainly agree that primary birthing units are key to maternity services in New Zealand and else where; not just as a source of post natal care, but also as a strategy to reduce medical intervention in birth which leads to outcomes such as cesarean section.

We have been lobbying for a primary birthing unit in Dunedin for some years. I understand there is medical support for one that is attached to the hospital, but midwives in Dunedin believe it should be a 'stand alone' facility. This enables midwives to have complete control over the running of the unit and leaves them free to promote normal childbirth without interference.

I am sorry that I do not have time to go into this in any greater depth. I am writing this in Singapore, so I do not have any access to references that back up my claims. However, if you are interested in knowing more about this argument, please let me know and I will be happy to continue the discussion. Meanwhile, keep an eye on Carolyn's blog because I think she is going to look at this issue on greater depth.

Image: RNS Maternity Ward and cots - - RNSH

YouTube and evidence-based practice

I am very proud of myself because I used a YouTube video as a teaching tool in a lecture the other day for the first time. This clip provides a hook to discuss evidence-based practice, be it medicine or midwifery. The students loved it and I thought it was much more useful than me rambling on about why it is so essential to question what one does as a routine in one's practice.

Have a look at this clip. I would love to hear what you think of it as a teaching tool. What are your favorite YouTube clips that you use in your teaching practice?



http://www.youtube.com/watch?v=OeA_OKqqBJ4

Raffles and the Singapore Sling

For those of you who were worried about my health, following the publication of the worst photo of me in the world, I just wanted you to know that I survived my near heart attack. My return to health was greatly helped when I was taken to the Long Bar at Raffles Hotel to have a Singapore Sling by a friend.

What has struck me about Singapore is the way it has thrown itself into Christmas. The decorations rival those in London - they are absolutely beautiful. In a way, that really surprises me because I have this naive view that Asia has resisted western commercialism. That clearly isn't true in Singapore.


Photo: Outside the Raffles Hotel

Learning about virtual role play

Yesterday I attended a workshop at the 2007 ASCILITE conference about virtual role play. The scenario was a university where an academic manager was consulting with various people (staff and students) about a new policy being developed about plagiarism. I was Dr Lily Nguyen, who was the student learning and language adviser. My particular interest was in supporting international students whose first language was not English. I got particularly upset with several people who took the stance that international students were mostly to blame for plagiarism and thought the university treated them as a special case ie did not penalize them adequately. My view was that they required support to overcome language difficulties and also to address cultural attitudes to learning; to think critically and come up with their own views.

The workshop facilitators Ann Davonport and Judi Baron quoted Garrison and Anderson (2003) by saying that there are three elements to a community of inquiry: teaching presence, cognition and social interaction. To get cognitive development, role play requires:
a trigger - news or an intervention
exploration of the topic
integration of learning into the scenario
resolution once the role play is completed.

Clearly, there has to be a lot of planning and preparation to come up with a scenario that will address learning outcomes - good design of the role play is vital. Good teacher presence is vital which doesn't necessarily mean attending the activities but making sure that the participants are well supported and informed. Thorough briefing before the interaction is important, as is debriefing afterward. Debriefing is particularly important if the participant is acting contrary to how they are in the world. Resolution is also important so that the students do not feel left high and dry following the completion of the role play. Role selection can be either pre-decided according to participants' personalities and experience or random, depending on the topic that is being explored.

Assessment must reflect the learning outcomes and take into account that role play is as much about personal insights as the topic of the scenario. Assessment may take the form of reflective pieces recorded in journals or e-portfolios; quizzes and/or peer assessment. A rubric for grading is very helpful and it may be appropriate that learners are encouraged to develop their own rubric for assessment.

From a personal point of view as those who know me will attest, I am a drama queen at the best of times, so I relish any opportunity to get involved with role play. However, I initially questioned how easy it would be to engage with role playing in an asynchronous online environment; how would those creative juices get stimulated in a very artificial environment? But I found it to be a lot easier to get into role than I thought - I was just warming up and the workshop ended, which probably is just as well because I do have a tendency to get carried away at the best of times!

I didn't like BlackBoard as the instrument for the delivery of material and communication - it felt very clunky and it was very time-consuming working my way around to find information. New users of BlackBoard would have found it very off-putting. I would like to know more about other platforms for role play such as blogs, wikis, and even SecondLife.

An unexpected outcome for me was that I started to think about how international students learn and how their cultural identities impact on their learning, especially with regard to plagiarism. Whilst I have little to do with international students, I will be a lot more aware of their learning needs in the future.

For educators who are interested in role play as a teaching tool, the Situational-learning Community of Practice for Educators (SCoPE) project has been created to share ideas and resources about role play in education. This project is affiliated with the EnRoLE project which also aims to support educators working with role play.

Reference: Garrison, D. & Anderson, T. (2003). E-Learning in the 21st century: A framework for research and practice. RoutledgeFalmer.

Image: 'Ran Yaniv Hartstein The valkyries walk to battle with their god Odin'
www.flickr.com/photos/71052670@N00/270486786

Designing an e-mentoring system

Today I presented my paper about designing an e-mentoring email system at the ASCILITE conference in Singapore. My co-presenter was Associate Professor Catherine McLoughlin, Australian Catholic University. Catherine and I met through the ASCILITE mentoring scheme and she helped me write the full paper that is published in the conferences proceedings.

I think the presentation went well. I didn't go over time like I usually do, so that was an improvement. In the discussion time, we talked about how we can sell professional development programs to health professionals when the programs have no overt benefit ie there are no professional development points or qualifications attached. If educators are having problems getting students to engage with online activities in a formal education program, how am I going to get people to engage with a program that is purely voluntary with no tangible benefit (by this I mean an official piece of paper. Obviously, mentoring has a number of intangible benefits)?

One really interesting suggestion that came from the audience was to use retired health professionals as mentors. I thought this was a fascinating suggestion and would love to explore this further. This ties in with what was said at the recruitment conference I attended a couple of weeks ago-how can we utilize retired health professionals in a way that addresses recruitment and retention issues? The problem I have had in this research isn't so much a shortage of mentors, but rather a lack of people who feel they would benefit from being mentored.

The photo is of Catherine and I. I look like I am about to have a heart attack because...I was about to have a heart attack!! Catherine power-walked me up a great big hill at a million miles an hour, carrying my very heavy lap top in temperatures that are significantly higher than those in Dunedin. I thought I was about to take my last breath!

Off to Singapore

Well, I'm off to Singapore first thing tomorrow morning to go to The Australian Society of Use of Computers in Education (ASCILITE) Conference. I am also going to be catching up with a friend who is a local Singapore person, and she's going to show me around. I cannot wait to see sides of Singapore that I would not see as a tourist.

I'm sure I'll be able to keep up with my blogging and email because there appears to be wireless Internet everywhere in contrast to the recruitment conference I went to a couple of weeks ago. I'm really looking forward to going to this conference; I am hoping to learn a lot more theory and research about e-learning as well as look at the practical applications for the midwifery program I teach in. Will let you know how I get on.

Image: 'Skyline at Night'
www.flickr.com/photos/20697369@N00/13617328

Midwifery in New Zealand

Here is the slide show I presented at my first online meeting about midwifery in New Zealand.

Midwifery research in New Zealand

Tonight I gave a very short presentation about midwifery research in New Zealand at an online midwifery meeting that I organized.

I would say that midwifery research is in its infancy in New Zealand. There have been a number of fabulous small projects going on, many of them as a result of postgraduate education programs at Masters and PhD level. The research at PhD level, to my knowledge, covers fetal monitoring in labour, mentoring, e-mentoring and rural midwifery. I am sure there is more going on, but I am just not aware of it.

The New Zealand College of Midwives developed the Joan Donley Research Collaboration a few years ago. At the moment it facilitates a bi-annual research forum and provides small postgraduate grants, but has the long term aim of being the focus point of midwifery research in New Zealand.

Nevertheless, we have a number of challenges to face, not least that we are a very small profession and funding is very difficult to come by. Major funding from the New Zealand Health Research Council tends to go to medical projects. The majority of midwifery researchers are 'new' researchers and still building a research history.

So I personally see the way forward is through collaboration, not just within New Zealand but overseas. As a new researchers, I think it is prudent for us to become involved in team research so that we can develop research platforms and histories.

I'd love to hear from you if you are a midwifery researcher or researching topics of interest to midwives, whether you are based in New Zealand or overseas. How do you feel about my summary of midwifery research in New Zealand? What do you see as the future for midwifery research globally? How can we strengthen midwifery research? Any personal tips for me as a 'new' researcher?

Here is my slide show on Slideshare.
Here is a recording of my presentation and the short discussion that followed.

Image: 'Midwife taking stock'
www.flickr.com/photos/68319844@N00/446270854

The outcome of the online midwifery research meeting

Tonight I had the second of my ad hoc online meetings for midwives. This meeting had a research focus. As a PhD candidate, I feel quite isolated at times. My research supervisors are both in Australia as are my fellow students who are involved in e-health research. There are a number of midwives in New Zealand who are carrying out PhD research but I do not ever see them as they are in different parts of the country. I co-founded a PhD support group at Otago Polytechnic, but that has virtually folded. So I really miss that sense of fellowship that is generated when a group of students/researchers get together to support each other and exchange information.

I have been particularly envious of midwives who have been able to attend research groups that have been organized in the UK, especially as those midwives are able to 'access' midwifery researchers who are leaders in the profession, not just in the UK but also internationally. So this is the rationale for organizing an online meeting - to increase access to information, support, networking and collaboration that those of us who work in isolation would not normally have.

This is a good idea in theory, and there has been interest expressed in this concept, but sadly only one other person turned up to the meeting. We had a great chat about our research and have plans to collaborate on several projects after Christmas, although we will probably use Skype for our personal communication.

So why have my two online midwifery meetings been relatively unsuccessful?

I think the key reason is that midwives are still relatively unfamiliar with online tools - they lack the confidence to 'give it a go', especially with the level of computer skills required to use Elluminate. Having said that, my colleague who joined me tonight calls herself a technophobe, and she found the session relatively easy to access.

Midwives also have to see the benefit of this form of engagement. Life is extremely busy and stressful at the best of times. So unless there is a clear benefit to the midwife, then it is unlikely she/he is going to take the time out to attend such a meeting. No doubt access to computers can also be problematic. Maybe, the timing is bad being that it is very near to Christmas?

So where to from here? Is this worth pursuing - is it worth me putting energy into organizing regular meetings next year or should I drop it for the time being? Is this something midwives are interested in and have the time to engage with? If I pursue it, what should I make the focus - midwifery in general or midwifery research?

If I pursued this and planned monthly meetings, I think I would use the same format that Leigh Blackall does with his online meetings - 10 minutes presentation and then open discussion. How would you feel abut taking part and giving your time to give a presentation, especially if there was no payment?

So there a few questions and issues to mull over. I would really welcome any thoughts, comments or volunteers to be a speaker next year!

Reference: Stewart, S. 2006. Delivering the goods: Midwives use of the Internet. In M. Murero & R. Rice (Eds.) The Internet and Healthcare. Mahwah, Jersey: Lawrence Erlbaum Associates.

Image: 'meeting adjourned'
www.flickr.com/photos/75231603@N00/56701910

Midwife shortage in Wellington, New Zealand

Apparently, there is such a midwife shortage in Wellington that women are being 'bribed' to go home straight after birth.

In some ways, that's not such a bad idea. Post natal wards are notorious for providing conflicting advice to new mothers, especially about breastfeeding. And there's the risk of infection, lack of privacy and inconvenience of being away from home and family, which is accentuated if home is some distance away from the birthing facility.

In New Zealand, we have a post natal follow up system of at least five midwifery home visits, up to six weeks post partum - this is set out in the Section 88 Maternity Notice 2007 which is the document that prescribes what services lead maternity carers/midwives must provide . Many midwives carry out far more than five visits.

As a practicing midwife, I am very keen to get women home as soon as possible because I believe it is easier for them to bond with their babies at home. This can require a significant commitment from me, especially if the woman is having breastfeeding problems and needs me to provide frequent home visits to support her feeding.

But in the end the choice must be the woman's. If she has little or no back up at home, or if she has had a difficult birth, she may be better off staying in hospital for a few days. A $100 food voucher is a poor exchange for a woman who is unable to breastfeed due to lack of midwifery support. What do you think - should there be a minimum stay in hospital following the birth of a baby?

Suffice to say, the underpinning problem of the shortage of midwives is concerning. I am convinced that one way to go is to offer free undergraduate education to women to encourage them to become midwives. What would encourage you to become a midwife? If you are a midwife, what do you see as the problems that threaten retention?

Reference: Chapter 45. Mother and Baby: A guide to effective in pregnancy and childbirth. 2000. Murray Enkin, Marc J.N.C. Keirse, James Neilson, Caroline Crowther, Lelia Duley, Ellen Hodnett and Justus Hofmeyr. Oxford University Press.

Image: 'Wie ben jij?'
www.flickr.com/photos/36521982494@N01/8519847

My online identity: progress!

I have been working on developing an online identity for a couple of months now. I have material on FlickR, Slideshare and Facebook as well as this blog. When I started out I had an online identity score of 0. Now it is a grand total of 3! I'm coming up in the world!

Image: 'Miss Marple'
www.flickr.com/photos/95648671@N00/5419830

Does your control freak need liberating?

I really love this slide show because I think it epitomizes where I want to go with regards to my presentation style - lots of fabulous images backed up with minimal but relevant text. The show is called 'How to liberate your control freaks' authored by Stephens Collins.

| View | Upload your own

Reminder: Online Midwifery Research Meeting

This is a reminder that the next online midwifery meeting is being held tomorrow - Thursday 29th November at 10pm New Zealand time (London Thursday 29th 9am UCT/GMT). Check here to see the time where you live - Time Zone.

http://elluminate.tekotago.ac.nz:80/join_meeting.html?meetingId=1193474325250

This meeting is going to be focused on research and is open to anyone interested in midwifery research, especially postgraduate students and their supervisors. This is an opportunity for researchers, especially students to network and share information about their research. This is particularly aimed at midwives who are studying/researching in an isolated context. The meeting will also be of interest to anyone who wants to get experience of using online meeting software, in particular Elluminate.

The meeting will start with a very brief overview of midwifery research in New Zealand and then will be open to general discussion about whatever interests and benefits participants.

Check here for more detailed instructions. I will be online a couple of hours before hand so if you have any queries please contact me by email: sarahstewart07(at)gmail.com

or Skype:
sarah.m.stewart or sarahstewart07(at)gmail.com

Be there or be square!

Image: 'Cat volume computation'
www.flickr.com/photos/17425845@N00/760054533

Virtual role play in midwifery education

As I have mentioned before, I am off to the ASCILITE conference in Singapore on Saturday. One of the workshops I have registered for is about using role play in education. People who know me will attest to the fact that I am a real drama queen so this form of learning/teaching really appeals to me.

I have used it in class for getting ideas across for example, asking students to act out a scenario about a midwife giving information to a woman in a way that facilitates informed choice. I have always found it to be a fun class activity, although I know it does not appeal to all students. But virtual role play is something very new to me.

The first thing of note is that the workshop facilitators are using BlackBoard as a platform for this. I am finding this quite a challenge because there is heaps of information and it has taken me some time to work out where it all is and where it fits. I would love to try out SecondLife for this sort of activity - I bet it works really well.

The second thing that has struck me is how much preparation and thought has to be carried out by the facilitators behind the scenes. I would imagine that if you do not put enough thought and preparation into an activity like this, it will be a real disaster. Yet at the same time, if you overload students they will not engage with it.

Anyway, the scenario I am involved in is one about plagiarism and the development of a policy in a university. There is concern that it is on the rise, especially amongst foreign students. I am the rep for foreign students and I have to defend their position and make sure the new plagiarism policy does not discriminate against them. I am just getting my head around this so will let you know how I get on.

I would love to hear from anyone who uses role play, virtual or otherwise in their teaching. What have you found to be the advantages and/or disadvantages? Do you have tips about it from the facilitators point of view? How have you used SecondLife for role play? How have you incorporated assessment in role play? If you are a student, what have your experiences been?

Using key words to increase visits to your blog

According to Google Keyword Analysis, 'midwife' and 'mentoring' are the top most searched terms compared to terms like midwifery, midwifery education, mentor, mentoring programs, peer mentoring. From now on I am going to have to think about how I can incorporate those terms into my post titles so that people have a greater chance of finding me.

Umm... that's going to test my ability for lateral thinking! Any suggestions will be gratefully received.

Image: 'Rusty Old Key'
www.flickr.com/photos/41894180985@N01/293036243