Off to Brisbane

Well, this is it. I'm off to Brisbane today for six months...running away from home...having my big OE at the grand old age of 46!

I look forward to continuing our discussions about the Second Life birthing unit project, and also letting you know about my new work with eMentoring.

I don't know when I'll be back online so if you want to get in touch, please either email me or leave a comment.

Solving the sock problem

I have solved my sock problem.

Luckily for me, Dobby the house elf popped by just in time to sort the socks out before I leave for Brisbane.

Socks

Just one more day before I leave the family and move to Brisbane for six months. My husband and daughter are staying in Dunedin. My son is thinking about coming over to Australia for a few months, but he has got to get some money together first.

But the question is....who's going to sort out the socks when I've gone?!

Making a video using ScreenToaster

I have been testing ScreenToaster, which is an online program that allows you to make screencasts; videos of your computer screen. A screen cast is a really great way to teach someone how to use a computer program, or just have fun with personal reflection, story telling and so on.

Advantages
The advantages that ScreenToaster has over programs like Jing is that you do not have to download anything onto your computer. Now I love Jing. It's very easy to use and produces great quality video. But unless you pay for the Pro service, you cannot embed the video you have made into YouTube or your blog. So I use Jing primarily for taking still photos of my computer screen.

Embedding video
In contrast, ScreenToaster produces embed code which then can be uploaded to your blog. And it looks as if you will soon be able to upload video directly to YouTube in the near future.

Problems
It did take a little while to iron out teething problems like the audio. And it is annoying having to go through the whole set up process every time you want to shoot a new video. But I do like being able to access embed code so I can put a video straight into this blog.

Childhood memories
Here is my first attempt at making a video with ScreenToaster. For some reason it stopped recording without me knowing -maybe that was a signal that I was droning on too long. So I am sorry this is a bit rough, but at least you will see the quality ScreenToaster produces. I cannot remember who I got the idea of telling a story in conjunction with Google Maps from, so I apologize for being unable to attribute the idea.

Capture your screen in seconds

http://www.screentoaster.com/watch/stWUJRQUVLRlteRl5UUlJY

Using Doodle to run a poll

I have spoken before about how handy Doodle is as a tool for making times for a meeting with a group of people. What I didn't realize is that you can also use it to run online polls. So if you don't want to go to the bother of making a full survey, this may be a quick and easy alternative. I also like the fact that people can add comments about why/how they voted.

Here is the poll I am currently running - I would like advice as to whether I should buy a domain, and if I do, what I should call it.

ePortfolio Symposium Brisbane 2009

I am very pleased to hear I have just had an abstract accepted for presentation at the Australian ePortfolio Symposium 2009 being held at QUT, Brisbane 9-10th February.

I am really looking forward to it because it will give me my first chance to get out and network with people in Brisbane. My understanding is that there is a lot of good work going on in QUT, including the hosting of Creative Commons Australia. So it's going to be a very exciting few weeks for me.
The symposium will also complement the professional development presentation I am giving to Otago Polytechnic staff via Elluminate in early Feburary.

Here is my abstract:

Developing an open ePortfolio for health care practice, professional development and life-long learning

As a health professional I am required to have a professional portfolio which I must present for review every two years. I have chosen to develop an ePortfolio in an open wiki and blog. This allows me complete freedom to be innovative, as opposed to being restricted to the pre-determined structure of a proprietary ePortfolio platform. Combining blog and wiki not only enables me to store and record artifacts of past work, but also supports ongoing reflection and planning for the future. Developing my ePortfolio in an open online environment allows me to role model portfolio development to colleagues who are unfamiliar with the concept. It allows for continuous peer review, as well as increasing opportunities for further consultation and collaboration. In particular, health consumers have access to my work, which encourages ongoing conversations about health care practice.
The major issue with an ePortfolio in an open online environment is that I have to be very careful about what I write and how I write it. As a health professional I have to think carefully about how I present my clinical practice so I do not compromise my patients' privacy, and do not open myself up to charges of unprofessional disclosure and/or documentation. Thus, it is vital that I reflect in a meaningful manner that does no harm to my patients or my professional reputation. The challenge for health professions is to consider how ePortfolios can be integrated through undergraduate education and then into registered practice in a way that maintains continuity.

What do you think are the advantages and disadvantages of having an ePortfolio in an open online environment?


Image: 'the gritty city' monkeyc.net
www.flickr.com/photos/73584213@N00/95247784

Having a clear out

One of the good things about moving is that you have to have a good old clear out, which often leads to finding things you had forgotten about. This usually leads to much reminiscing and reflection.

I was thrilled to find a couple of old transparencies of me as a young nurse and midwife as I cleared out my desk at Otago Polytechnic yesterday, ready for my move to Brisbane next Tuesday. Sadly I have lost the original photos, and the transparencies are not in very good condition. But I have managed to scan them, and now they are stored on the Internet, where hopefully they will not degrade any further.

Here I am (second on the right) as a nearly qualified staff nurse working on a female medical ward called 'Ethel Woodrow', at the Salisbury Infirmary in Salisbury. My main memory of my five months there was not getting on at all with one of the more senior staff nurses. I never knew why she didn't like me, but she made my life a misery. She was terrible efficient, and I don't think she had much patience with me being a new nurse. Sadly, she died not many years later, and I have always regretted not having the maturity (I was only 21, and she wasn't much older) to talk to her about our problems instead of reacting to her in a very negative way.

My second memory is getting engaged, and I was told off by the ward 'sister' for wearing my engagement ring to work. But I didn't care because I wanted to show it off to everyone.

This is a photo of me as a student midwife at Odstock Hospital, Salisbury, UK back in the days when we had to wear those awful paper caps. We thought we were really revolutionary when we voted not to wear them any more.

And here I am as a fairly new midwife, about 24 years old in 1986 or there abouts. That was back in the days when I could wear a tight belt and antique silver nurse's buckle. I tried that belt and buckle on the other day and suffice to say, I didn't have a hope in hell of getting it around my waist. At the time, I saw myself as having a weight problem - I always considered that I was fat. Now I look back at these photos and realise how gorgeous I was. I wish I had realized that at the time, and enjoyed my body for what it was.

Have you ever had a big clear out and found things you had forgotten about or didn't even know was there? What were they, and what was the outcome of finding them?

Virtual birth unit: first scenario

The first stage of the birth unit project is to build the birth unit in Second Life and have a teaching scenario based around a normal birth story devised that the students can run through. This is planned to be completed by the end of May.

Story board
In order for the scenario to be developed and animated, a full story board has to be developed.

Here is the story. Feel free to have a read, and if you think we have missed any details, or have things incorrect please let me know.

Walls going up in virtual birth unit

We had a look at the walls in the virtual birth unit in Second Life. It was an exciting moment because we were able to see something at last.


With Isa Goodman (Aaron Griffths) who is building the birth unit.



Petal (left) with Aastra (Deborah Davis), my partner in crime.



There is a tension between keeping a cosy, intimate feel and making it a space that people can move around, especially newbies. So that is what we will be working on in the next few days.

An ethics question

One of the things I have been planning to do for some time is have a look at a few blogs and Twitter accounts, and run an audit of what health professionals talk about. This is in connection to confidentiality and security, particularly in relation to patient information.

Aim of the project
This project would be in response to all the concern voiced about health professionals blogging etc in an open environment, which has led to a number of blogs and forums being closed or restricted to public access. I have wondered if we over react - that in reality people are very careful about what they say and write. On the other hand, if patient confidentiality is being compromised, maybe health professionals need formal guidelines about online behaviour and computer-mediated communication.

Research plan
What I want to do is look at a number of blogs and Twitter accounts of health professionals and work out the 'risk' to confidentiality to patients, colleagues and themselves. The score is based on a rubric that I have used in previous research.

Ethical issues
What I need to think about are the ethical issues. What do you think I would have to think about in relation to this research method? To help you in your consideration, here are a few points of clarification:

• blogs and Twitter accounts are openly available for all to see
• I would not identify the blog and Twitter accounts in research publications
  
• accounts would be randomly selected via Google search
• I will not be audit an account I personally know, or communicate with.

Do you think I would need to ask permission of the blogger or Tweeter? If I don't ask for permission, should I inform them anyway? If I informed them and they complained, should I continue with including them in the research? Is there anything else I would need to consider?



Image: 'That Way' justinbaeder
www.flickr.com/photos/49503074211@N01/194066146

Using Facebook to network a midwifery conference

I am very excited to see that the Australian College of Midwives is using Facebook to network its next conference, which is being held in Adelaide 22-25th September. I am not a great user of Facebook, but I am very interested to see how this page develops over the next few months, and find out what impact, if any, it has on the feel of the conference.

Planning an abstract on Facebook
I will submit an abstract because I am planning to go to the conference, but am not too sure what to talk about. I want to talk about how midwives can utilise social networking in their practice, but that's about as far as I've got.

So I have made a comment of the 'wall' asking if anyone has any ideas about what they'd like to know about. If I know what midwives are interested in, then I'll be better able to focus the abstract and plan my talk to suit their needs.

I'll let you know how successful this has been as a networking strategy.

Ideas
In the meantime, if you are a midwife planning on going to the conference, please feel free to comment here if you have an idea about what you'd like to hear about in relation to the Internet, online tools or social networking.



Image: 'Mother and child' .robbie
www.flickr.com/photos/14821912@N00/131284220

Getting down to nuts and bolts

Image: '2001-12-02 01-03 Neuseeland 382' Allie_Caulfield
www.flickr.com/photos/28577026@N02/2795931364

Here are Deborah Davis and my thoughts on the details of the virtual birth unit we are designing for Second Life. This is our first brain storm so I am sure we will make a lot of changes as we go along. I would love to hear what you think, keeping in mind the design features I have talked about in previous posts.

Overall look
We want the building to have a New Zealand feel so we are thinking that we would renovate an old colonial building, so it will look a little like Ffythe House at Kaikoura.

• not sure about external colour
• veranda/deck with honeysuckle or similar trailing around it. Here is another view of Ffythe House.
  
• sustainable vegetable garden, growing a few simple vegetables that don;t need much looking after - for staff and families to help themselves to
• flower garden, with water feature and natural New Zealand plants
  
• external lighting - solar
  

Floors
Wooden floors throughout unit. Easy to clean, but can be covered with washable rugs to give more warmth and comfort.

Heating

• solar heating and hot water
  
• under floor heating
• heating in each birthing room can be altered in the room
• ventilation eg air conditioning
  

Birthing rooms

Colour
To create a cosy 'cave' effect.

• Room 1 - Rose Madder
  
• Room 2 - DH Drab
• ceilings - white
• skirting boards, windows, door frames - wood
• must not have yellow paint because it makes the babies look like they have jaundice

Lights

• spotlights on the wall that can be dimmed
  
• one portible light

Music soucre
CD player, that can be individually controlled.

Doors and windows

• external door that opens out to garden that looks like this. Here is a photo that shows the entrance to Ffythe House.
  
• windows to match door
• window/door covering - timber venetian blinds
  
• heavy drapes that can be pulled across to create 'cave effect' even in the middle of the day

Living rooms

• colour - Pale Lemon Colour
• surrounds - door, windows etc - white

I would love to hear what you think, and if you have any alternative suggestions.

Midwives and the working environment

I have written several posts about the effect of the physical environment on birthing women: What women want in the place where they give birth and Effect of the environment on labour and birth. But what about the effect of the physical environment on midwives: what do midwives feel about their working environment? These questions are important for us to consider as we design our virtual birth unit in Second Life.

What I want in my working environment
I hate fluorescent lights because they give me a headache. I want to be able to safely lock my possessions away, and have somewhere I can go for a quiet cup of tea and chat. I want to be able to dim lights for labouring women, but I also want good, flexible lighting so I can see clearly when I am doing important tasks like suturing. The most important environmental thing for me is that I can carry out tasks like catch a baby, suturing or support a woman to breastfeed in an ergonomic position in which my back is supported.

What the literature says
Symon et al (2008) found that midwives want their working environment to be clean and secure, with appropriate changing facilities. They also want good lighting, and good ventilation that will reduce cross infection.

Cross (1996) reported that midiwves wanted their working environment to be secure to prevent babies being snatched, and protect themselves against harassment and violent attacks from the general public.

The Robert Wood Johnson Foundation (2008) recommends these environmental features for health professionals:

• convenient placements of sinks, soap dispensers etc to encourage hand-washing (to prevent cross-infection)
• acoustic conditions to minimize noise pollution
• ergonomic work spaces to prevent physical injury
• excellent lighting to areas where there could be a risk of needle-stick injury.

If you are a midwife or health professional, what features do you think are essential for your working environment?



References
Cross, R. (1996). Midwives and Management. Hale: Books for Midwives.

Robert Wood Johnson Foundation. (2008). Environmental Change Recommendations for Ensuring an Optimal Health Care Workplace. Retrieved 13 January, 2009, from http://www.rwjf.org/pr/product.jsp?id=28827

Symon, A., Paul, J., Butchart, M., Carr, V., & Dugard, P. (2008). Maternity unit design study part 4: midwives’ perceptions of staff facilities. British Journal of Midwifery 16, 4, 228- 231.


Image: 'Ward at Alpha Hospital' tahitianlime
www.flickr.com/photos/35319816@N00/912907071

Floor plan for virtual birth unit

Here are the floor plans for the virtual birth unit that we are going to build in Second Life. Have a look at it and tell me what you think, keeping in mind the design features that I have said are really important to incorporate.

Here is the link to the plan that can be downloaded from Internet Archive.

Evidence-Based Medicine (EBM) vs Web 2.0

A few days ago I read an excellent blog post by librarian, Laika (Jacqueline) entitled: The Web 2.0-EBM Medicine split. Introduction into a short series. In the post, Laika talks about how she sees a conflict between EBM and Web 2.0, and that got me thinking about my experiences of finding evidence-based information on the Internet.

Testing the divide between EBM and Web 2.0
This week I have been researching information for a series of posts I have been writing about birth units: what they are, effect of environment on birth, why women want to birth in birth units, design aspects and birth outcomes. As a midwife I have a sense that homely birth units are more likely to support normal birth compared to hospitals, and decrease the rates of medical interventions. So I decided to see if the research evidence supported my beliefs.

Searching for evidence-based information
The reality was that it was very difficult to find evidence-based information that I could have free access to. I used Google, Pubmed and Google Scholar which pointed me to a number of studies about birth, environment, midwifery care and place of birth. But when it came to accessing the full articles, I found many were unavailable unless I subscribed to a database or journal.

Free resources
One of the most useful free resources was Google Books which previewed several books I was able to use in my research. The problem was that the preview only allowed me to see certain pages, and you could bet your bottom dollar that the pages I wanted to see were unavailable. The other problem was that Google Books does not appear to preview newly published books (or at least, not the ones I wanted to read).

The other really useful free resource was the Cochrane Database which publishes reviews of evidence-based information and is highly regarded in medical and health spheres. However, it is still difficult to access the original studies.

Using Web 2.0 to 'research'
As an adjunct to the scientific, published research I decided to use some Web 2.0 tools and ways of doing things to find out information. Using Twitter and this blog, I put out a call for people's views on birth units. The replies were instant, and interestingly they replicated the published research findings.

But because I did not use a recognised research pathway, and my blog is not considered to be a credible, peer-reviewed publication, the responses I have gained and the continuing conversations I am having will not be considered as viable evidence in many quarters.

Barriers to EBM
The reality is that evidence-based information is difficult to source from primary sources. The average person of the street who does not have access to specialist libraries or databases with free full-text articles. Indeed, neither do health practitioners unless they are somehow connected to an educational institution. The cost of subscriptions to databases and journals is prohibitive to the individual practitioner and health consumer.

Authoriative knowledge
But does that not suit us as health professionals? We all know knowledge is power, so if we are the only ones who access to evidence-based information, it gives us power over our patients/clients. And that's quite a convenient place to be in if we want patients to do what we want them to do.

Web 2.0 challenges the authoritative knowledge of medicine and health professionals. Web 2.0 challenges us to be open about what we are doing and thinking; to share and collaborate with each other and patients; to make information freely available so that patients can use it to take an active part in decision-making. But do health professionals really want that?

EBM 2.0?
As a health professional I welcome evidence-based practice. In midwifery, research has seen the end of many routine practices that have at the very least been unpleasant (pubic shave and enemas) and at the worst, darn right harmful (episiotomy). It is vital that my practice is based on the latest up to date information so that the care I provide pregnant women is the best, based on what we currently know.

However, I also feel that it is vital that we integrate the principles of Web 2.0 into our practice so that evidence-based information is freely available to all, health practitioners and consumers. That we work together to share and collaborate, and find alternative ways of communicating and disseminating information to the traditional journals that are locked up, and only available to those who can afford to pay to read them.

How do you think we can use online tools such as blogs and wikis to disseminate evidence based information? What are the problems with utilising information in practice that is not published in conventional medical, peer-reviewed journals? How do we overcome fears about credibility?

As a health consumer, where do you go for health information? Would you trust what a doctor, nurse or midwife said on a blog?

Do you really feel there is conflict between Web 2.0 and EBM? If so, what can we do about it?



References
Jordan, B. (1997). Authoriative knowledge and its construction. In R. Davis-Floyd & C. Sargent (Eds.), Childbirth and Authoritative Knowledge: Cross-Cultural Perspectives (pp 55-79). University of California Press: Princeton.


Image: 'Soudeh under Serum' Hamed Saber
www.flickr.com/photos/44124425616@N01/262522417

Giving birth in Second Life

I have no idea how we are going to animate the virtual birth unit, but here is an idea of what giving birth in Second Life looks like.

I am a bit freaked out thinking that people give birth in Second Life for fun, but it is interesting to watch the video from a technical point of view. My favorite bit of this video is that the midwife is wearing a big glittering diamond ring over her sterile gloves!! I'd never get away with that in real life...but then again, I wish I owned a big glittering diamond ring in real life!


http://www.youtube.com/watch?v=_fKa6gFf9sQ&feature=related

Concepts of birth unit design

Image: http://www.flickr.com/photos/fab34/1396560517/in/photostream/

fab34

The key resource for the design of the virtual birth unit in Second Life is the work of Bianca Lepori who is an Italian architect: Mindbodyspirit architecture: creating birth space (Lepori, Foureur and Hastie, 2008). Bianca believes that the architectural design of a birthing space should take into consideration the spiritual and emotional aspects of birth, as much as the physical ones.

Moving, feeling and dreaming body
I cannot repeat all the features that Bianca talks about in the book chapter, so if you're interested, I strongly recommend you look at the book. Because it is a new book, it cannot be accessed at Google Books, so I'm afraid you'll have to beg, borrow or steal. Or you can get hold of the editors: Kathleen Fahy, Maralyn Foureur and Carolyn Hastie.

Here is a summary of her main points.

The moving body
The woman needs to be able to move around, to have the space and freedom to get into whatever position she wants in order to keep the baby moving through the birth canal.

The feeling body
The woman needs to have access to soft textures and firm, supportive surfaces; to be touched or not, as she wishes; the right temperature; have access to water flowing or still; to feel loved, respected and supported.

The dreaming body
The dreaming body is instinctive and responds to images and colours. So women may need access to dark and quiet environments; needs to remain focused so should not be distracted by harsh noise and bright light; responds to curves, not sharp angles.

Design features
I have already mentioned a number of the design features that Bianca advocates in my previous posts. Here are a few more that I haven't mentioned:

• culturally safe
• images of beauty, mother and earth in forms of artwork
• rounded corners and edges to furniture and walls
• low wall for leaning on
• rope suspended from the ceiling for hanging on
  
• ability to move medical gases, suction and emergency equipment to where the woman is
  
• window to outside world
• pleasant area to walk in, both inside and outside
• door at the side of the room - bed not in line of sight
• toilet and shower room en suite, but big enough to birth in if the need arises
• natural materials such as timber and tiles - avoid metal surfaces
• secure places for woman to lock her things away
• equipment hidden out of view
• natural light - no overhead light
• windows low enough to see view when lying down in bed
• sound proofed rooms so woman cannot hear other labouring women
• CD playing music of woman's choice
• comfortable accommodation for supporters - access to telephone, food and drink, shower and toilet
  
• food and drink available for woman and family - toaster, microwave, iced water, fridge
• telephone in room
• non-slip floor surface.

Colour
Bianca also advocates the careful consideration of colour based on the seven chakras which are associated with the body energy system.

Red - security, sense of survival, trust
Orange - sexuality, relationships with others
Yellow - personal power, self-confidence
Green - love, compassion, forgiveness
Blue - communication, giving and receiving information
Purple - intuition, self-realisation, letting go of negative thoughts, wisdom
Violet - spirituality, connection to "God"


What do you think of Bianca's ideas? What would you suggest? Does this make sense or do you think it's a load of new age baloney? How do you think we can integrate these features into our virtual birth unit?


References
Lepori, B. (1994). Freedom of Movement in Birth Places. Children’s Environments, 11, 2, 1-12. Retrieved 8 January, 2009, from http://www.colorado.edu/journals/cye/11_2/11_2article1.pdf

Lepori, B., Foureur, M., & Hastie, C. (2008). Mindbodyspirit architecture: creating birth space. In K. Fahy, M. Foureur & C. Hastie (Eds.), Birth territory and midwifery guardianship (pp 95-112). Edinburgh: Elsevier.

Effect of the environment on labour and birth

Image: 'Baby' gabi_menashe

www.flickr.com/photos/47947583@N00/218574269

Over the next few days I will be talking about the design of the birth unit that Deborah Davis and I are currently working on for the Second Life Education New Zealand project. We are taking especial care to follow birth unit design principles espoused by people such as Bianca Lepori (2008) because we believe that the environment has an impact on how labour unfolds and the outcomes of birth.

Supporting normal birth
In other words, we believe the hypothesis that a cold, unfriendly hospital environment may impede labour, which in turn leads to a higher likelihood of medical intervention. In contrast, a home-like environment is more likely to result in normal birth.

It is particularly important for us to support any measure that encourages normal birth in this day and age of rising interventions such as cesarean section. So we hope that our virtual birth unit will get people thinking and talking about birth, the birth environment, and how the environment can be exploited to keep birth normal.

What does the research say?
I haven't been able to find much research about the impact of environment on birth. Yet, the concept of the desirability of 'home-like' birthing rooms has been around for some time. I remember getting very excited in the mid to late 1980s when we re-decorated our birthing rooms at Salisbury with Laura Ashley (very posh and expensive) wall paper. This is it, we thought, women are going to do so much better now. Ironically, whilst the rooms had state of the art wall paper, they also still had the hospital bed right in the center of the room, CTG machine next to it and so - I'll come back to this later in this post.

Image: 'Lucile Goetter, bienvenue chez nous' Raphael Goetter
www.flickr.com/photos/29174632@N00/1171788641

Cochrane review
The main research article I have found is a Cochrane review: Home-like versus conventional institutional settings for birth (Hodnett et al, 2005). This review concludes that there is a 'modest' decrease in medical interventions and an increase in maternal satisfaction, vaginal birth and breastfeeding. However, the reviewers also noted a slight rise in perinatal mortality resulting in a caution that midwives need to be mindful of complications.

What is difficult to differentiate in the research is what actually affects outcomes: the environment or management of care. As far as midwifery care is concerned, Fourer and Hunter (2006) refuted the claim in the review that birth is unsafe in a birth unit by pointing out faults in the original research - in one study, no account was taken that the 'bad outcomes' had taken place after transfer from birth unit to hospital.

If you wish to know more about the safety of birth units and midwifery care, I suggest you read the latest Cochrane review: Midwife-led care versus other models of care for childbearing women.

Nesting
What writers have suggested over the years is that the hospital environment increases stress and anxiety, which impedes labour and increases the pain felt by women (Robertson, 2003). [For a more detailed review of the cascade of pain and effects of stress, read Foureur and Hunter (2006)].

In contrast, the more homely birth unit is believed to encourage 'nesting', which is a process of making a place safe for the arrival of the baby - where the baby can be protected from harm (Walsh, 2006a).The features that make this nesting possible is a sense of welcoming to the unit; an ambiance of warmth, trust, nurturing and love. It also means protecting the woman from intruders such as unwanted staff. In Walsh's ethnographic study of a birth unit, women and midwives talked about the feeling that the women could relax compared to the hospital. They had an instinctive feeling that the unit was the right place to birth. The women also appreciated that the unit was calm, had an air of being un-busy, and had easy parking (Walsh, 2006b).

The concept of nesting is one that has been taken up by the Royal College of Midwives in the UK as part of their campaign for normal birth.

Mammals try to find warm, secure, dark places to give birth - and human beings are no exception. But it is the feeling of security and confidence that is important to us, rather than the environment itself. And if we can find ways to help women to feel more private and confident, we will greatly improve the likelihood of them having a normal birth.

Learning from home birth
Probably one of the key advocates for looking at the birth environment from an architectural point of view is Bianca Lipori. Bianca interviewed women had home births and found that they birth in empty, protected areas which mirrors the behavior of all mammals. If left to their own devices, women birth somewhere that is inconspicuous (not on a bed in the middle of a room visible from the entrance/door), and surrounded by furniture that allows them to position themselves in a way that makes use of gravity and relax their pelvic floor, be it kneeling, hanging, squatting or standing. She says:

Women who can give birth naturally do not need particular colors, nor beautiful furniture that reminds them of their homes. They need a space in which to express themselves, in which to wait; they need the space-time to let it happen. The only thing they really need is not to be forced into a particular position. Even pain dissolves with movement; pain killers are a consequence of stillness.

In my next post I will look at the design features that Bianca Lipori advocates in a birth unit.



References
Foureur, M. & Hunter, M. (2006). The place of birth. In S. Pairman, J. Pincombe, C. Thorogood & S. Tracy (Eds.). Midwifery. Preparation for practice (pp. 94 -111). Sydney, Australia: Elsevier.

Hodnett, E., Downe, S., Edwards, N., & Walsh, D. (2005). Home-like versus conventional institutional settings for birth. Cochrane Database of Systematic Reviews, 1. Art. No.: CD000012. DOI: 10.1002/14651858.CD000012.pub2. Retrieved 9 January, 2009, from http://mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD000012/pdf_fs.html

Lepori, B. (1994). Freedom of Movement in Birth Places. Children’s Environments, 11, 2, 1-12. Retrieved 8 January, 2009, from http://www.colorado.edu/journals/cye/11_2/11_2article1.pdf

Lepori, B., Foureur, M., & Hastie, C. (2008). Mindbodyspirit architecture: creating birth space. In K. Fahy, M. Foureur & C. Hastie (Eds.), Birth territory and midwifery guardianship (pp 95-112). Edinburgh: Elsevier.

Robertson, A. 2003. The pain of labour. A feminist issue. Retrieved 9 January, 2009, from http://www.acegraphics.com.au/articles/painlabour.html

Walsh, D. (2006a). Improving Maternity Services: Small Is Beautiful - Lessons from a Birth Centre. Radcliffe: Oxford.

Walsh, D. (2006b). Maternity care: revisioning risk for normal childbirth. In A. Symon (Ed.), Risk and choice in maternity care (pp89-100). Edinburgh: Elsevier.

What women want in the place where they give birth

Before we go ahead and design our virtual birth unit, it is only right and proper that we take a breath and find out more about what women (and their families) want in the place where they give birth.

Twitter Poll
I put out a call on Twitter today asking what people thought was important about the physical space for birthing. Here are the replies from chaps as well as women:

• birthing pool (this was the most requested thing)
  
• large cushions
• birthing pool outside (in garden-type environment [my words])
• pleasant light - day light or light that could be dimmed
• sturdy handles to pull on
• floor space that's padded and clean
• low bed
• flexible lighting
• privacy-ability to lock door
• moderate size - space to roam a little, but possibility of snug, cave feeling

What women want
Whilst this poll was very far from a credible study, the results echo the findings of more robust research. The National Childbirth Trust (UK) 2003 national survey of nearly 2000 women also found that they wanted:

• comfortable facilities for birth companions
• en suite toilet facilities
• control over temperature
  
• somewhere nice to walk
• not being overheard
• a room that was non-clinical, that replicated home
• somewhere they could get food and drinks

The experience of Guy's and St Thomas' Hospital
Before Guy's and St Thomas made changes to their maternity unit in 2003 they consulted with women users. The crux of what the women wanted was:

• that they didn't feel as if they were in hospital
• a comfortable environment
  
• a colorful environment
• a room with a view
• for all the medical equipment to be out of view
• paintings on the wall
• soft lighting

Image: 'LDR Stuff' Alice Chaos
www.flickr.com/photos/36961634@N00/2676082554

Effect of what women have got
In the research recently published by Andrew Symon et al (2008a; 2008b) 559 women who had recently had babies were surveyed about their experiences of maternity units in the UK. The women were more satisfied with their birthing experiences if the maternity unit was spacious and tidy. There were mixed responses about the desirability of a communal area, but women definitely wanted their own space in labour. Noise was a problem for many women, and a number of women were dissatisfied because they could not control lighting or ventilation.

Environment and quality of midwifery care
Two issues cropped up that particularly interested me in this research. The first element is the perception of the environment was tied up with the midwifery care the women received. In other words, it's no good having a nice, large room if the midwife insists on making the woman stay on the bed throughout her labour. The woman receives no benefit from the spaciousness of the birthing room in that situation. Conversely, the room can be small and cramped but if the woman receives excellent care, she is less likely to be dissatisfied with the environment.

Image: '_MG_3981' sean dreilinger

www.flickr.com/photos/43927576@N00/289146281

Who controls the environment?
The other interesting issue was control over the environment. 227 midwives were asked about the environment of the maternity unit (Symon et al, 2008b). Over one quarter of these midwives felt that women should NOT have control over their environmental comfort ie they should not be able to control room temperature or air flow. The justification for this was their concern that the mothers would not be able to control the environment to meet the needs of the new born baby. Yet I bet you these midwives would say that they would want the women to feel 'at home' because of the implication that this helps women to labour well (Lepori, Foureur & Hastie, 2008). But do you not have control over your environment at home?

Midwives and the birthing environment
I would suggest that when designing our virtual birth unit it is just as important to consider attitudes of midwives and the impact midwifery practice has on the environment, as it is to think about what women's needs. How will the virtual birthing unit educate midwives about the birthing environment? How can it be used to encourage midwives to reflect on their own practice?

What is your story?
I would love to hear your story. How did the environment affect your birth or that of your wife/sister/friend? What would be the features of your perfect birthing unit - would environmental things would you want to see included in our Second Life birthing unit? How important is lighting, temperature control, or a nice garden to walk in? What is more important? A nice garden or a nice midwife? If you are or have been a support person, what was important to you with regards to the environment?



References
Design Council. (2008). Guy’s and St Thomas’ hospital. Designing a welcome sanctuary for mothers to be. Retrieved 8 January, 2009, from http://www.designcouncil.org.uk/en/Case-Studies/All-Case-Studies/Guys--St-Thomas-hospital

Lepori, B., Foureur, M., & Hastie, C. (2008). Mindbodyspirit architecture: creating birth space. In K. Fahy, M. Foureur & C. Hastie (Eds.), Birth territory and midwifery guardianship (pp 95-112). Edinburgh: Elsevier.

Newburn, M. & Singh, D. (2003). Creating a Better Birth Environment: Women’s views about the design and facilities in maternity units: a national survey. London: NCT. Retrieved 8 January, 2009, from http://www.nct.org.uk/about-us/what-we-do/campaigning/better-birth-environment

Symon, A., Paul, J., Butchart, M., Carr, V., & Dugard, P. (2008a). Maternity unit design study part 2: perceptions of space and layout. British Journal of Midwifery, 16, 2, 110-114.

Symon, A., Paul, J., Butchart, M., Carr, V., & Dugard, P. (2008b). Maternity unit design study part 3:environmental comfort and control. British Journal of Midwifery,16, 3, 167-171.

Designing a birth unit in Second Life

After a rather slothful Christmas, I had my first meeting with Aaron Griffths and Deborah Davis yesterday to discuss the design of the virtual birth unit in Second Life, as part of the SLENZ project.

Back to basics
The very first thing Deborah and I need to do is provide Aaron with a detailed architect's plan with dimensions etc. I just wanted to get straight to the juicy stuff like what curtains or style toilet to have, but we have to do the 'boring' stuff first.

Originally we thought we had access to plans, but unfortunately that access has fallen through. Whilst this is not a story I want to get into, I am finding that it is really interesting that whilst in some professional and academic areas open, free access and collaboration is being encouraged, in other areas there is still a very protective attitude to resources and intellectual property. I wonder if and how that will ever change.

Floor plan


So to get this things going so that Aaron knows what he has got to do, Deborah and I have to provide:

• a full set of plans to scale for the birthing unit, remembering that that we need to have room for the avatars to move around;
• ideas about colours, features, textures etc.

Reality
I have to admit to feeling slightly overwhelmed now that crunch time has arrived. I have spent a lot of time thinking about the unit, but now the time has arrived to make it 'real' I have a sense of not knowing where to start. At the same time, it's good to get things off the ground.

I think the key to this project is to take one step at a time. But I tell you what, you invited to the opening party once the birth unit is up and running.

How useful is LinkedIn?

Now that I know I am going to be looking for a new job in a couple of months, my thoughts have turned to what online tools I can use to market myself and increase my chances of getting a job. A number of people have recommended LinkedIn to me, and I have had a profile there for some time. But in view of my new circumstances, I thought it was time to look at LinkedIn more closely.

LinkedIn
LinkedIn is a social networking site very similar to sites like Facebook, Bebo and MySpace. The difference is that it is supposed to be a site for professionals, used for linking people together in the work context. It works on a '6 degrees of separation' principle ie someone will know someone who will know someone who can help you, or give you a job.

Making the most of LinkedIn
The idea of LinkedIn is that you're more likely to get a job through the power of the connections you have. According to Guy Kawasaki in his post How to change the world: 10 ways to use LinkedIn, if you have more than 20 connections, you are 34 times more likely to get a job or make a valuable business deal than if you have less than five connections. Guy goes on to give ten tips for using LinkedIn which include:

• making your LinkedIn profile public which will improve your Google ratings, and make you more 'visible' on the Internet;
• make your profile as comprehensively full of information as possible, which then improves chances of making connections;
• where ever possible, publicize the link to your profile.

How does LinkedIn compare with blogging or an ePortfolio?
There are the skeptics such as Mark Levison who has never found any value in LinkedIn. But I would think it's like anything - you get what you put into it. I haven't spent much time on my account and consequently no one ever contacts me via LinkedIn. All my time investment goes into this blog, Twitter and my ePortfolio. How successful these tools will be in my future job hunting efforts remain to be seen.

LinkedIn and health professionals
Like Alan Stevens, I wonder if LinkedIn is overly hyped, and in actuality it is another Facebook, cleverly marketed to suck in us job hunters. And I wonder how much LinkedIn is used by health professionals and the employers of health professionals? Do employers of health professionals check them out on the Internet? Have we got to that stage yet in health, or is that yet another urban myth?

LinkedIn versus Facebook
I have certainly noticed a marked increase in people connecting with me in Facebook, much to my disgust because I really don't want anything to do with it. So I am wondering if I should put my limited time into building more of a Facebook presence as opposed to spending a lot of time on LinkedIn.

But in the meantime, to hedge my bets, I have completed a little more of my LinkedIn profile and have invited a few people to connect with me.

Do you use LinkedIn? Have you ever managed to get a job because of LinkedIn contacts? Have you every managed to get a job though any social networking tool such as a blog or Facebook. If you are an employer, do you check out future employees in places like Facebook or LinkedIn? Do we in health use social networking for seeking and providing employment? I'd love to hear your thoughts and experiences.


Image: 'LinkedIn smurfs' 99zeros
www.flickr.com/photos/58896623@N00/474752493

Making life easier with Firefox add-ons

Internet browsers are the door to the Internet, and the quality of the browser will affect your experience of the Internet. I use Firefox instead of Internet Explorer because I find it quicker and easier to manage than IE. It is also the browser that I find most recommended by 'computer geeks'.

Add-ons
Add-ons are extra features that embed into the Firefox browser which makes life easier when using the Internet. Here are a couple of my favorite add-ons at the moment.

• Twitterfox: This allows me to monitor Twitter in real-time as opposed to through the web.
  
• Delicious Bookmarks. Makes it very easy to bookmark web sites and save them into my Delicious account.
  
• LOOP. Allows me to turn documents and files in pdf format. This has been especially useful when working on my ePortfolio.
• Firebug. I was introduced to this tool by Kate Foy and I am finding it to be a great tool to learn more about html and CSS, which is the technical stuff you need to know about to be able to build or change web sites.

What are your favorite add-ons or features of Firefox, or other Internet browsers?


Image: 'Firefox Logo' *keng
www.flickr.com/photos/43553042@N00/262875283

My previous life

This photo was sent to me today and is a lovely reminder of my previous life as a midwife. The little chap was born at home three years ago.

Turning over a new leaf

As you can see, I have given my blog a new template. It has been a bit of a struggle to say the least because the template is not one of the established Blogger templates. So to achieve what I wanted, I have had to learn a little about html code.

Aim for my 'look'
What I wanted to achieve was a clean, uncluttered look with tabs which gives an 'about' and 'contact' page as recommended by Beth Kanter. The snag is that whilst Wordpress automatically provides this feature, Blogger does not. But rather than starting a new blog on a different blogging platform, I have chosen to go for template that has been developed by someone independent of Blogger.

Making changes to html
To personalise the template to suit my context, I have had to alter the html, essentially to change the tabs, and allow me to insert my own photo into the header. I am very grateful to Kate Foy, who is a very generous member of my personal learning network, for supporting me during this process. Kate answered my pleas for help on Twitter, and gave me advice as I hit various problems. It took a lot of experimenting, perseverance and patience, but I think I'm almost there.

The photos I have used are from different areas around Dunedin where I live, and can be found on my Flickr page.

Some tips for changing blog templates
If you are thinking of making similar changes to your 'Blogger' blog, here are a couple of tips:

1. Make a blog that you can use to experiment on, rather than your proper blog. That way, if you make mistakes, you will not lose any important data.
2. Don't be afraid to 'play' and experiment. It can frustrating if you have little knowledge of html, but it is only by having a go that you learn.
3. Seek out a mentor who can advise and guide you along the way. You don't necessarily need to be told what to do, but rather supported as you find out for yourself.
   
4. Save all your widgets because there is a good chance that you will lose them in the change.
5. Make contact with the people who developed the original template for advice and support.
   

What do you think?
I am not 100% sure I like this new template but I will stick with it for the time being. And there are still a few things I need to do such as put up my blog roll and a 'best of posts' list, as well as sort out my 'about' and 'contact' pages. But for the time being, what do you think of my new look?

How do you find it as a reader? How easy is it to navigate and leave comments? What do you think about the look? What do you like, and what do you think could do with improving? How do you find the font size - is it too small? In view of the changes I am making to my life and work, how professional (or not) do you feel this blog looks?


Image: Yellow-eyed penguins, Dunedin, New Zealand http://www.flickr.com/photos/92632631@N00/2976093508/in/set-72157608393254012/

7 More Things You Don't Need to Know About Me

I was just thinking about my first blog post of 2009 and I was tagged by Michele Martin to do the 7 More Things You Don't Need to Know About Me meme that's currently going around. I don't often respond to tagging because I haven't got time. But it's 6am on New Year's Day - I am sitting in bed with nothing much to do - hubby's off to work and kids are sleeping off the night before - so here goes.

1. My first 'real' job as a 14 year old was working in a car parts company in Bristol, UK, sorting out windscreen wipers.

2. My first boyfriend was called Dave and he gave me my first kiss when I was 14. We went out for 10 weeks and our dates were mostly made up of meetings at church. One day I couldn't find him at church, which was a little strange. After the service, my dad told me that he had been told that Dave had broken up with me. Dave never said a word to me after that. It took about four years for my broken heart to heal.

3. I stole a pencil sharpener from my teacher when I was 5 (you really, really didn't need to know that!).

4. I think David Beckham is really, really hot!

5. I have spoken to Cliff Richard. He was about to perform at a christian rally. I asked him for his autograph but he refused as he felt it was inappriate for the occaision. I was gutted.

6. I won second prize in a knitting competition when I was about 7. The truth is that the scarf I knitted was rubbish. But all the other entries were crocheted and were expelled from the competition because it was for knitted things. That left just me and another entry, which is why I got the prize for being second out of two. I am still very proud of that achievement.

7. I have a huge, ugly mole on my back. It makes my kids sick when they see it. Have you ever heard of babies born with extra body parts attached to them...you know... like an extra arm or something. Well, my mole is a bit like that ...and it keeps growing. In fact, I'd say it is a bit like Kuato in the film 'Total Recall'. But I am too broke to have it removed. I was quoted $160 by my GP but I am far too mean to spend the money. I can't see it so I'm not worried.

What are the seven things we don't need to know about you?

Here are the seven people I have tagged:

Pam Harnden

Ellen Stewart

Tania Rangi-Thompson

Phil Ker

Anne Cunningham

Leigh Blackall

Carolyn McIntosh