Friday, July 11, 2008

Closing Down Midwifery

It has been interesting and at the same time, worrying to watch the recent trends in attitudes of midwives to the Internet and online behavior. In education there is a growing movement toward openness and learning by social networking. But in midwifery there appears to be a trend toward closing down which is causing me considerable concern, both on a personal and professional level.

Online midwifery
There is no doubt that health professionals have specific concerns and responsibilities with regards to online behavior and communication that are not felt by the general population. And I am the first person to advise midwives to consider how to behave professionally in online forums. However, I have taken the view that midwives should be open about their practice so that colleagues and women can learn from ongoing online discussions.

But with the current environment being what it is, I am wondering if I am living in cloud cuckoo land. It doesn't seem to take much for the media and critics to attack the midwifery profession. And it looks like the focus is currently on students and midwives in online environments. So I am wondering if I am digging a hole for myself by opening up online discussions about my midwifery and teaching practice.

Latest news from the UK
My concerns abut the closing down of midwifery online networks has been highlighted this week by the news that student midwives are being investigated by their universities for their use of blogs. The main concern appears that the universities do not want to be identified in students' blogs.

This was followed up by guidelines published by the moderator of a large online community for student midwives: The guidelines have been in response to the latest Code of Practice issued by the midwifery governing body in the UK. The Code says:
  • Act with integrity - You must demonstrate a personal and professional commitment to equality and diversity
  • You must uphold the reputation of your profession at all times.
The guidelines that have resulted includes advice to be completely non-identifiable ie using anonymous names, avatars and photos.

Missed opportunities
What saddens me is that some educational institutions and midwives appear to have lost sight of the many advantages of online social networking. I am still convinced that the way to manage online activities is to facilitate them, rather than push them underground - to encourage constructive conversation and critique, as opposed to censorship.

Students will always talk about their lecturers and the institutions they are enrolled with. Surely, it will be more beneficial if we all work together to ensure that we use tools such as blogs to support learning; that experienced midwives and educators model good practice in blogging and online communication, and we support students as they explore communities of practice and develop their online identity. I mean, if teachers can manage blogging with their primary students, surely we can do the same with our adult learners!?

Online identity
As much as I understand the rationale for having an anonymous identity online, in some ways I think an open identity is our best protection. However you try to control what is said about you, either as an individual or institution, you will never be able to stop people talking about you.

As an institution, would it not be better to look at what students are saying in their blogs and online spaces and respond proactively to their feedback? By putting out information under your own name or 'brand' you have far more control over what is being said and done then if you ignore what is going on or worse still, try to censor conversations.

By being anonymous and remaining in closed spaces, one is severely restricting the opportunities for communication and collaboration. And the sharing of resources and expertise, such as the current collaboration between Pakistani and New Zealand midwives, will never happen.

Guidelines for using the Internet
I have recently read a post by Tony Karrer about the most common objections to learning by social networking and I think I have heard just about every objection. Tony's post eventually led me to IBM's Social Computing Guidelines which covers media such as blogs, wikis and virtual worlds. Whilst IBM's corporate context differs from that of health, I much prefer their emphasis on open participation compared to the reactionary guidelines I have seen for health professionals.

Do you think midwives and health professionals need guidelines for their online behavior? What do you think should be included in the guidelines?

Disclaimer: These opinions are entirely my own and not necessarily those of my employer or any other midwife.

Image: Me with my cat, Blackie.


Angela said...

Hi Sarah
A very thought provoking post and indicative of the dichotomy of thought that seems to be around at the moment. As a fellow professional (OT) over in the UK who has been blogging now for about a year I wholeheartedly support the value of both the social networking and indeed the sharing of knowledge, thoughts and ideas that occurs on line. As you know our blogging here has resulted in a couple of successful projects with our colleagues from NZ, USA and UK - demonstrating the value I think?
Of course we need to be explicit in the netiquette of an on line presence - but as health professionals this is not really that much different to our code of conduct in our other professional activities.
We have been successful so far in gaining the tentative trust of our University to identify the establishment in our blog.
I guess the more involved in conducting research into the value of social networking to CPD,LLL and the impact on EBP etc the better - oh no - I feel another project coming on...!!!!

Sarah said...

Hi Sarah,
I TOTALLY agree that to drive anything underground is asking for trouble, but what exactly are these midwives doing that is so unacceptable? Is it a case of using a sledgehammer to crack a nut? It seems king of like disciplining a whole class because the behavior of one child was unacceptable.
Rant over!

Sarah Stewart said...

Hi Sarah, to be honest, I do not know all the details, I am talking in a generic way. This post was not meant to be a comment on individual cases & may be there are some causes for concern. But I still think it would be good for us all to work together so that learning is enhanced in a safe, productive way.

Angela: Thanks for your comment. I think I am very lucky to be working in an institution that encourages online communication, blogging and the like. It must be very frustrating to work in a less 'open' environment.

It is tricky, I must admit. I am conscious that I am not blogging on behalf of my employer or the midwifery profession. And there is a good chance that my employer may not wholly agree with what I say. I try to keep my comments generic but my working, professional and personal life, experiences and thoughts are so thoroughly integrated that it is hard to separate them all out. Any tips on how to manage this would be gratefully received.

Merrolee said...

Hi Sarah
A thought provoking approach and I can only follow up from Angela's comment - clearly we need to move quickly from what we are doing and finding and thinking about into undertaking research which will hopefully support what we are all finding individually!

I also wonder if this is the old-age argument about 'who owns the knowledge' therefore who has the right to determine who can do what and say what?

Hmm..... like you Sarah I'm lucky to be in an open environment where our activities are accepted, not driven underground.

Sarah Stewart said...

Your comment, Merrolee, leaves me with a question about the chicken and egg. On one hand we're saying that we need research to show our institutions that blogging etc is a powerful learning tool. Yet, we know from our personal experience (which is a form of research)that it is so. So do we wait for the 'research' before we integrate blogging etc into our teaching or do we do it now because we 'know' how powerful it is?

Sarah Stewart said...

As far as research & projects go, Merrolee & Angela, I'd be really keen for us to combine and look at cross-discipline social networking.

Derekw said...

Thanks for this very thoughtful and comprehensive post, Sarah. The issues you have raised are applicable to many of the contexts I work in - let along midwifery. Must confess I'm torn on the research issue - seems to me that while research is always an important dimension of the work we do, in the case of the adoption of social media the focus should be more on finding effective (and innovative) ways of demonstrating how this media is being and can be used safely and appropriately. It's a bit like the introduction of the motor car - while just a few questioned the need for such a contraption, the majority of effort went into designing safe systems for the increasing numbers of these vehicles to use the roads together (along with pedestrians). Social media we're at a similar stage, needing to define the "rules" and patterns of behaviour we must collectively and individually abide by to ensure the concerns about safety and security etc are mitigated.

Lisa Barrett said...

I am wondering what these institutions have to hide and why they would want to censor blogs. Next thing they will have to chose your underwear.

Sarah Stewart said...

derekw: Please don't get me wrong, I am not suggesting we shouldn't have research, but at the same time I do not think we should be completely closed to social media because I believe there is great work being done with it, even if it is not strictly 'research'.

Lisa: I'll have you know I tell my students they are not allowed to wear g-strings that show - very unprofessional! :)

Frances Bell said...

Great post Sarah.
I don't wear g-strings but I do have daughter called Ellen - something in common then ;-)

Rob said...

I'm sure one day that blogging and participation in online socialmedia will be encouraged but in the UK at least it seems a big question mark hangs over this issue where Midwives / Students are concerned.

On our site, affectionately known to most as people SMNET, we make a recommendation for the protection of our members to remain anonymous - this recommendation is made in light of various NMC rules and cases of midwives and students being told to remove blogs / facebook pages / profiles, or worse being disciplined because of them.

I am sure that once attitudes in the UK progress then this recommendation can be revisited.

The signs of change are there - whilst facebook and blogging may not exactly be encouraged, many universities list SMNET as a recommendation on reading lists - SMNET, whichever way you decide to classify it is still a social network so perhaps times are changing after all.

Great blog Sarah and keep up the great work!

Sarah Stewart said...

Thanks for the comment, Rob. I wrote this post 2 years ago and it has been good re-visiting it and thinking about how or if things have changed over the last 2 years. Certainly, people are advised to be as cautious as they were 2 years ago, but I have seen an marked increase in social networking, especially Facebook.

What do you see are the main traps that you'd advise against, Rob...and others?