Saturday, January 8, 2011

Placenta, students and Facebook

There's been a story doing the rounds about a student nurse who posted a picture of herself with a placenta onto Facebook. As a result, she was dismissed from her nursing college just a few months before she was due to graduate as a registered nurse. At face value this appears to be extremely harsh, but I suppose it depends on your beliefs about the placenta.

I have to admit, until I moved to New Zealand I never regarded the placenta as more than an amazing piece of machinery that grows a baby for nine months. In the early 1980s, in the English hospital where I worked as a midwife, we used to collect and freeze all placenta and send them off to be made into make-up. For a while we also collected amnion (one of the membranes) to be used by the hospital's plastic surgeons to put on skin graphs. But when we became knowledgeable about HIV and AIDS, these practices stopped.

Physiological birth
When I moved to New Zealand and became a LMC midwife ( a midwife who carries her own caseload from conception until six weeks following the birth of the baby) I became more aware of birth in holistic terms and supported women to birth their placenta physiologically. The placenta became more than just another piece of birth debris...I recognised it as a vital and integral part of the birth process that midwives and women often ignore or at least, do not give full attention to.

The other thing I learned about the placenta is that it has cultural significance to some peoples. Many of the Maori women I worked with would take their placenta and bury it at a place that had family and/or tribal significance. It took quite a while for me to remember to return the placenta to families and not chuck it straight into the bin.

Lotus birth
I have to admit I have never seen a greater spiritual significance in the birth of the placenta like some people do. For example, some people practice what is known as lotus birth, and keep the placenta attached to the baby until it separates naturally. To me, the birth of the placenta marks (for the most part) the safe health of mother and baby, and is the time when I can relax (like I said...for the most part).

Going back to this case, I agree with Pam Harnden who felt that the nursing college missed an opportunity for education...that rather than sacking the students they should have explained why publishing this photo on Facebook could have been offensive and disrespectful to some peoples and cultures. As a midwife it doesn't matter what I feel about the placenta...what is vital is I respect and support the beliefs of the families I am working with.

Social media policy
It looks like the student nurse will be reinstated following a court ruling. And I would suggest the moral of the story for the school of nursing is to put a clear policy about the use of social media into place.

As for my advice to nursing and midwifery NOT put anything on Facebook or the Internet that is related to the women and families you work with without clear guidance or permission from your lecturers. And remember that your actions and beliefs may be innocuous as far as you are concerned, but may have very different cultural and spiritual significance to others.


Pamela Harnden said...

Much clearer witten than I have done. I agree with everything you have said.

Sarah Stewart said...

But are we being too PC now, Pam? How do I know (or care) if a picture I put on FB offends someone in Outer Mongolia? Does it matter in cases like this?

Christie B. said...

I agree with Sarah's concern here. This student posting a picture of her human face - a female uncovered one at that - is offensive to some before we even include the placenta. Why would Maori views of the placenta matter more here than Wahabbist views on photos of women?

Sarah Stewart said...

But the thing is, Christie...when does cultural sensitivity become political correctness? Eg if I took Wahabbist views into account, I would never publish any photos, which clearly I am not going to do. There is no way we can keep everyone happy when it comes to the Internet, so where do we draw the line?

Sarah Stewart said...

Carolyn said:

I think we need a clear understanding and definition of professional behaviour. Confidentiality is a very basic component of professional behaviour for all health professionals. I believe it is necessary to have the consent of any client, or patient, about any matter I might wish to post, which is directly, or indirectly, related to them. This includes photographs as well as stories. However the temptation is always there to share practice stories which can result in shared learning. I wonder about an electronic consent form stating clients have seen the post and agree to it being made available on the WWW which could be linked to the post. Anyway the safest is not to post about practice at all and not to post images of anything belonging to clients, whether it is toe nail clippings or placentas it is all the same I think. Not suggesting that toe nail clippings have anything like the significance of a placenta but who knows they may for someone and, if they are not my own, they are not mine to post.

Sarah Stewart said...

@Carolyn I was a bit anxious when I said students should rely on what their lecturers advise them. On the one hand, I think this is very good advice. On the other hand, I imagine many lecturers do not understand social networking and connected learning and would advise against any online sharing. But I think they'd be wrong to do this.

What is interesting is that this whole confidently debate continues in health, 2-3 years after we started blogging about the issues. Clearly it is a difficult question to answer.

Carolyn said...

As you are probably the most experienced person I know of in this field Sarah, what guidance can you give about maintaining confidentiality while sharing online?

Sarah Stewart said...

I'd say now what I have always said, Carolyn.

1. If in doubt, don't do it.
2. Talk about clinical issues but in general terms, not about specific clients or practitioners.
3. Only talk about clients with their permission. Actually, I'd even be wary about this as a midwifery student. Whilst clients may not mind you talking about them, the educational institution may.
4. Share and connect with others online because this is a fabulous way to learn. But maintain a professional approach.
5. If you want to do 'heart to heart' debriefing, ranting or such like, join a closed forum such as
But even then, be mindful that others in the forum can copy and paste your words, take them out of context etc

What would you add, Carolyn?

Carolyn said...

I think these are pretty good guidelines Sarah. I can't think of anything I would add here other than to remind everyone that whatever is put into print is essentially there forever. Even if you delete it later the chances are that someone else has already copied it and saved it. So think carefully about the words you use. Perhaps even do a draft and think about it for a few days before you hit tho "submit" button.