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

SLENZ: Formulating plans for the virtual birth unit project

Earlier in December I attended three days of SLENZ workshops that aimed to put substance to the proposal for a virtual birth unit in Second Life that Deborah Davis and I have had accepted. Up to then, I had a vague idea of how the birth unit could be used in midwifery education but didn't really know how it would look and the practicalities of its development.

Working together
The process of working together was very interesting. The SLENZ group is made up of educators, Second Life experts and developers, and of course we all have our own opinions about things. But following much discussion we came to agreement - it was a great example of how people can negotiate a diversity of opinions and professional knowledge.

I especially valued Leigh Blackall's caution about how this project can incorporate students who do not have access to the broadband width or computers that support Second Life. I have also been thinking a lot about a comment John Waugh made to me - he maintains I need to immerse myself in Second Life. I do not agree, especially as Second Life is not my favorite web 2.0 networking tool. I believe I need the skills to be able to mentor students and health professionals in Second Life, but I do not have the time or inclination to spend hours and hours becoming the Second Life guru that John is.

Three stages of birth unit project:

Stage One

1. Development of the birth unit according to specifications of Birth Unit Principles. This will include sign posts that explain the features of the unit and why they were chosen according to research eg links to research about the benefits of water in labour next to birthing pool.
   
2. The unit should be ready for 'testing' by the end of February.
3. Should be appropriate for first year students to look around, with lecturer taking them on the tour and explaining what is going on. This can happen any time during 2009 at a time convenient for both students and lecturers - to be tested with students at home in order to see how students cope away from campus, especially those in rural locations.
4. Comic strip and video that tell the story of the birth unit especially for third year students who do not have access to the Internet - to be developed as alternative media to Internet that can be posted to student.
   
5. Normal birth scenario (from early labour until birth of placenta) developed that student works her way through: two people are required, midwife and woman which can either be lecturer and student, or student and student. This should be ready for second year students to test during 'integration week' at the end of May and tested in a computer laboratory. Can also be tested with third years in computer laboratory in June seminar.
   
6. This scenario will not be automatized - students will have to work with another person. This may be an opportunity for networked learning in Second Life eg the student works through the scenario with another Second Lifer (not necessarily a student).

Stage Two

1. Development of the normal birth scenario so that students have to make decisions about the birth that is not going as normal as expected eg labour is long, or woman becomes dehydrated.
   
2. To be ready end of October for second year 'integration week' and third year seminar in November. To be tested in computer laboratory.
3. Alternative media.

Stage Three

1. Development of scenario into abnormality and emergency outcomes eg neonatal resuscitation and transfer to hospital.
2. To be ready end of October for second year 'integration week' and third year seminar in November. To be tested in computer laboratory.
3. Alternative media.
   

If Stages Two and Three do not eventuate, at least the birth unit will have been developed. Also need to keep in mind the needs of the other schools of midwifery who we will invite to test the unit - their time frames will not be the same as ours at Otago and Christchurch.

User story
I have developed the initial user story based around the decision points in labour that are advocated by the New Zealand College of Midwives.

Decision Point 1: Woman comes to unit with support tells midwife she is in labour

Decision Point 2: When woman wants intermittent support from midwife

Decision Point 3: When woman wants continuous support from midwife

Decision Point 4: Second stage of labour

Decision Point 5: Birth to skin-skin

Decision Point 6: 3rd stage of labour

Things to do

1. Get plans for birth unit to Aaron Griffths so he can start working on development as soon as possible.
2. Deb and I to start writing about the birth unit, coming up with stories about why we have chosen the features we have chosen.
3. Start to plan research outputs.