Friday, May 9, 2008

What has web 2.0 got to do with catching babies?

I have just had an interesting reply to a post I wrote a few months ago about my use of web 2.0 tools in my teaching practice. I started to write a very long reply but then I remembered the lessons I have learned so far about commenting and replying to comments in the 31 Day Comment Challenge. I decided to write this post clarifying my reply.

What has web 2.0 got to do with being a quiet, intuitive hands-on midwife?
Anonymous wrote:'s all STUFF, is'nt it? It's decadent, it's wealthy and does it FUNDAMENTALLY help women?
I mean.. 1 women a minute dies in childbirth or as a consequence of pregnancy. Does Web 2.0 help them? Will anything change, or will academics twitter between themselves about something they perceive as new and innovative? I think it needs to be put in perspective. The Midwives I love are the ones that keep quiet, read the women and are perceptive. They may not know the lastest Cochrane review on PROM management or whatever .. they use cellphones for texting their clients and their children and respond to the odd email - but they are not lessor Midwives (not that you are I know in any way suggesting that) because they have limited interest in Web stuff.

One of the aims of this blog to record the details of my personal journey - what I am learning about and how I am applying that learning to my practice as an educator. I am exploring how I can use web 2.0 tools to improve my teaching practice - to educate students to be the quiet, observant, intuitive midwives that women love.

What web 2.0 does for my teaching practice is to introduce me and my students to tools and philosophy that facilitates engagement with the global midwifery community - that can only be a positive thing in my opinion.

International collaboration
I too have questioned my preoccupation with computers and the Internet when there are millions of families in the world without even the most basic of resources. Web 2.0 may not help me personally save lives, but what it does do is give me the opportunity to share resources and enter into collaboration with midwives who work in situations where they are saving lives on a daily basis. One example is the web conferences I have been having with Pakistan midwives. I have been able to put midwives in Pakistan in touch with New Zealand educators and already there is collaboration and sharing that will support these midwives as they develop a midwifery program to suit their context. That would never have happened without web 2.0 tools and philosophical way of thinking.

Stagnating midwives
Anonymous wrote:

Being sucked into it is like being sucked into Evidence Based Healthcare - it becomes somehow institutional and authoritative and 'correct' my mind, quite fascist in it's assumption that all have access (or actually want access) to it, in the same way Cochrane dismisses 98% of literature because it's not an RCT.

I am not saying that midwives who do not use the Internet are lesser midwives. Nevertheless, the Internet increases midwives' access to information and support from a wider midwifery community. Midwives need professional development in order to grow as practitioners and professionals. A midwife will not be an effective and safe practitioner if she does not keep up to date with information and reflect on her practice. She may do all this in a face-to-face context with her colleagues and by reading paper journals. Or she may do it by accessing online journals and entering into discussion with midwives by email or web conferences - in other words, horses for courses.

What web 2.0 does is allow midwives the opportunity to share information and resources as well as communicate and collaborate in a way that traditional communication does not allow. This can be a powerful tool for learning and professional development. A midwife who does not reach out and grasp learning opportunities in whatever form they are offered is a stagnant one, and not a midwife I would want looking after my daughter.

Image: 'West end brook 9waterfall9' orangeacid


Christine Martell said...

Fascinating how the push back comes in a variety of forms in the different disciplines. As I have seen your blog emerge, I immeadiately thought about the benefit of assisting midwifes worldwide and how many more you can reach through the web.

I know you have challenges with licensing and what you can say in a way that I certainly do not, yet you seem to walk with balance and offer real value consistently.

Sarah Stewart said...

Thank you for your comment, Christine. It is always interesting to hear non-midwives' perspectives on my work.

Anonymous said...

responding to anonymous; I think the potential of web2.0 for midwives is that it is a tool for networking and discussing and sharing experiences, knowledge and perspectives. The potential is there for raising awareness, strengthening each other, supporting each other...and ultimately making a positive contribution to womens health - although it depends how we all choose to use it I guess.
The art of being with women - reading them and responding - is a fundamental skill of midwifery I agree - but surely its not the only skill.? I think midwives are far more multi skilled than this. I value and use knowledge and theory in practice and consider it adds depth to my practice. I would suggest it is possible to be intuitive midwives in the moment with women - but also to take responsibility for being well informed so you can engage women in interactive conversations about aspects of care relevant to them. This gives women power and control over decision making. Academic discussion and inquiry is vital to achieving this. If we don't build and construct midwifery theory and knowledge - the midwifery model of care ceases to be an option for women. What remains is the medical model.
Midwives can use these tools to heighten awareness of issues for womens health and well being. It doesn't diminish our role in the one on one situation with the individual woman - it expands our potential.

Anonymous said...

EBP is important because so much of the medical evidence which has directed practice "norms" is flawed. poor quality, not robust - and this has a very real impact on womens lives and well being. A lot of medical practice in the area of birth is not evidence based. It is important that women and midwives know that - without EBP the medicval profession goes largely unchecked. An informed midwifery profession can now say "actually there is not good evidence to support that practice". This is power.

Sarah Stewart said...

At the same time, midwives ignore good evidence that has been around for years and continue with routine practices that have no basis in evidence such as directed pushing in the second stage of labour.

We also have to be mindful of 'evidence' that is flawed such as the breech trial which midwives and doctors hold up as gold standard yet has had detrimental effects on both women's choices and midwifery practice.

Anonymous said...

I guess my point is that this is a good way of heightening awareness or discussing those things

Sarah Stewart said...

Couldn't agree more. I must get off this blog and cook tea!!

Anonymous said...

"The evidence-based enterprise invented by the Cochrane Group has captivated our thinking for too long, creating for itself an enchanting image that reaches out to researchers and scholars. However, in the name of efficiency, effectiveness and convenience, it simplistically supplants all heterogeneous thinking with a singular and totalising ideology.
The all embracing economy of such ideology lends the Cocrane Group disciples a profound sense of entitlement, what they take as a universal right to control the scientific agenda".

What was that you said about power?

Anonymous said...

you seem to feel powerless to the evidence which is a shame I think.
You neglect to acknowledge the midwifes skill in evaluating the evidence both in terms of its quality and its relevance to a particular context, practice / clinical/ social situation or woman. In the NZ maternity system the midwifery workforce seeks to work in partnership with women - bringing knowledge - so each woman can determine the relevance of the evidence for her circumstance.
Evidence only has value when considered in relation to an individual circumstance - at least thats how the midwifery model of care would approach it anyway.
Evidence is something a woman can incorporate into her care - but without a woman it has little value.

Anonymous said...

A further point: in a midwifery model - it is the woman who prioritises the value of the evidence for her. She considers this among her other values. Women are regarded as competent decision makers for their own life, body and family. The midwife facilitates the woman through this process of discovery and learning and prioritising. Deciding when to contribute further and when to let the information sit is similar to the quiet careful art of being the midwife you talk about anonymous - except that you only acknowledge this skill at the moment of labour/birth whereas this is a broader view of it being a more continuous act. Midwifery is about women becoming mothers within this philosophy.