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Resilience: Showing strength in the face of adversity #usmsconf17

Here are a few pictures and thoughts shared from the @ussumidwifery ‏ conference ‘Resilience: Showing strength in the face of adversity ‘… Thank you to everyone who came to see the great speakers at this conference. It was a great honour to present my work alongside some of the wonderful researchers listed on this programme…Having spoken at many conferences, I can also say that these student midwives really know how to look after their guests….Thank you  and ..❤🎓😍

Taken from The knitted midwife’s blog: ‘The Royal College of Midwives has highlighted that the UK is still short of 3500 midwives.  This is an update to the published report here.  The update to the report can be seen here. Whilst this is an improvement on the 5000 midwives needed three years ago, this chronic shortage adds to the pressures that midwives are facing every day in their working environment.  Additionally there is a ‘retirement time bomb’ as over a third of the current midwifery workforce is aged 50 or over.’…these knitted midwives represent the midwives missing from the workforce.

All of the speakers at this conference were indeed inspiring, but one message seemed to remain strong throughout…

”BUILD a tribe – don’t wait to find one’ – Prof Mavis Kirkham

Reminds me of the #Findyourflock story last year

We also had  from tell us to “find our tribe”

😊💛

One of the most inspiring parts of the day was seeing student midwife Hannah Cook get a standing ovation at … the future of midwifery is bright…..She will be re presenting her talk at this year’s  awards conference….If you can….get there!

✨

I too feel as if being a midwife is what I am…I also feel that it is written through me like a piece of rock. It is my professional identity. But having resilience as a midwife is not about ‘toughening up’ as  puts it…..

I am not even sure if resilience is the right word for what we are talking about here… Resilience is not a magic pill!

💊💉🌡

The most interesting conversations of the day in my opinion were around the ethics of caring for midwives, and bullying. There is still so much more to do….and I still see uncaring behaviors taking place. Are we an insecure profession?…trying that much harder to prove ourselves?…or are we embittered by another pill too difficult to swallow?…one this is for sure…

Image result for wrong is wrong quotes

This day gave me the chance to meet with and listen to some of my research heroes…Thank you to everyone who engaged in my presentation and to those who continue to engage as my work as it continues…

#usmsconf17

If you would like to follow the progress of my work going forward..

Follow me via @SallyPezaro; The Academic Midwife; This blog

Until next time…Look after yourselves and each other 💚💙💜❤

 

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How do you decide which type of review to use? a guide to beat the literature reviewing blues…

Recently, I have been in search of the perfect methodology for reviewing the literature. So many options…benefits, limitations and choices…I found it really hard to choose the right one.. Which reviewing methodology would Goldilocks choose? which one is just right for you?.. After all of my searching, I thought it my be useful to make a listed guide to what I have found…
So… first of all, what is a literature review?…as always, the academic community will debate around this subject… but feel free to browse my  ‘Guide to Literature Reviewing for Student Midwives & Student Nurses’ here

Perceived strengths.  The literature review method seeks to identify what has been accomplished previously, allowing for consolidation, for building on previous work, for summation, for avoiding duplication and for identifying omissions or gaps.

Perceived weaknesses.  Literature reviews lack an explicit intent to maximise scope or analyse data collected. Any conclusions they may reach are therefore open to bias from the potential to omit, perhaps inadvertently, significant sections of the literature or by not questioning the validity of statements made. Additionally, authors may only select literature that supports their world view, lending undue credence to a preferred hypothesis.

Grant, Maria J., and Andrew Booth. “A typology of reviews: an analysis of 14 review types and associated methodologies.” Health Information & Libraries Journal 26.2 (2009): 91-108.

But there are many types of literature review that can do much more than simply review the literature…so how do you know which one to choose?

discovery

In order to decide which type of review to use, you will need to decide what you are trying to do, find out, or achieve.

Trying to develop a new concept? theory? or model?

Then you may want to explore the use of a critical literature review methodology. This methodology allows you to demonstrate how you have not only extensively researched a topic, but that you can critically evaluate the literature and take new conclusions and interpretations from it. You can then present these new interpretations as a new hypothesis or model… sounds good right?

Search

Not systematic – You are searching to find the most relevant stuff.

Appraisal

No need to evaluate quality -You are looking for literature which is fit for purpose.

Synthesis

Usually narrative, but you can be creative with this.

Analysis

Needs to arrive at a new conceptual theory or hypothesis of some kind.

Cautions

Every conclusion you draw will be subjective – Others may not be able to repeat your process

Looking to identify gaps in research?

Then you may want to conduct a mapping review of the literature. This methodology allows you to map out and categorise the existing literature on a topic. From this you can identify what other kinds of reviews or research need doing, as you identify gaps in the literature.

Search

Can be systematic, but searching is usually bound by time constraints, so this can be determined in line with your scope.

Appraisal

No need to evaluate quality

Synthesis

Use tables and graphics

Analysis

Quantify the research found and outline study types – suggest areas of future research.

Cautions

Can be overly descriptive, try to characterise studies on more than the basis of study design

Want to combine statistical data to provide more precise results?

In this case you may consider doing a the meta-analysis (A type of analysis done within a literature review – so really, this is one component of or add on to a systematic review).

Search

Thorough, comprehensive, systematic – Can use funnel plot

Appraisal

Use quality appraisal to guide inclusion/exclusion and/or sensitivity analyses

Synthesis

Use tables, graphics and narrative

Analysis

Analyses measures of effect numerically

Cautions

Your review can only be as good as the included studies allow..also, there is little value in comparing very diverse study types.

Want to combine quantitative with qualitative?

If you want to explore a complex problem using both qualitative and quantitative literature, then a mixed-methods review is for you…

Search

Your strategy must capture both quantitative and qualitative research

Appraisal

Need to use an appraisal tool appropriate for both qualitative, quantitative and/or mixed-methods research

Synthesis

Use tables, graphics and narrative – Present qualitative and quantitative results separately

Analysis

Look for correlations, gaps in the literature and draw conclusions based on combined findings.

Cautions

Theoretical and methodological challenges in bringing together qualitative and quantitative studies

Need to assess what is already known about a topic?

A rapid review is for you.

Search

Determined by time constraints

Appraisal

Formal quality appraisal required

Synthesis

Use tables and narrative

Analysis

Look for directions of effect, and quality and quantity of the literature

Cautions

Doing things quickly…you always run the risk of bias and mistakes are more easily made

Want to know the size and scope of available research?

A Scoping review is for you..

Search

You may want to perform your search as a research in progress

Appraisal

No formal quality appraisal is required

Synthesis

Use tables and narrative.. you can also use commentary

Analysis

Look for directions for future research – Use this to form new research questions.

Cautions

This is not usually a final output…rather a means to an end

Want to address really current matters?

When you want to offer new perspectives on a current issue or point out a new area for further research, you may consider conducting a state-of-the-art review.

Search

Comprehensive and current

Appraisal

No formal quality appraisal is required

Synthesis

Use tables and narrative

Analysis

Present a current state of knowledge and list priorities for future research

Cautions

Beware of subject experts’ particularly idiosyncratic and personal perspectives on current and future priorities.

Want to systematically search for, appraise and synthesis research evidence?

If you are looking to do more than a just review or systematize the literature, then a systematic literature review is for you.

Search

Comprehensive exhaustive and systematic

Appraisal

Formal quality appraisal is required – This can be used to exclude research of poor quality

Synthesis

Use tables and narrative

Analysis

Present recommendations for future research based on what is known, what remains unknown, and what we are still unsure about…The review should answer a broad research question.

Cautions

Adhere to reporting guidelines for a strong output.

Want to create an accessible and usable document in relation to a broad issue?

If you would like to highlight reviews that address interventions and their results in relation to a broad issue, then an umbrella review is for you.

Search

Only searches for component reviews

Appraisal

Formal quality appraisal  for reviews is required

Synthesis

Use tables, graphics and narrative

Analysis

Present recommendations for future research based on what is known, what remains unknown, and what we are still unsure about…The review should consolidate all that is known about one broad issue.

Cautions

Requires the pre-existence of the narrower component reviews

Want to know what works, for whom, in what circumstances . . . and why?

If you want to unpack the mechanism(s) of how and why complex interventions thrive or fail, in particular setting(s), then the realist review methodology is for you!

Search

Highly detailed and systematic

Appraisal

Justify how judgments were made

Synthesis

Use tables, graphics and narrative – include information on the constructs analysed and describe the analytic process.

Analysis

Present the key findings with a specific focus on theory building and testing

Cautions

Ensure that the RAMESES (Realist And MEta-narrative Evidence Syntheses: Evolving Standards) guidelines and standards are adhered to for a strong output.

workings

So…have we made a decision, are we sitting comfortably? are we ready to begin?…Let me know how you get on, and please share any additionally methodologies I may have missed.
Until next times, take care of yourselves…and each other 🌟🎓🌟
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Mindfulness and Self-Care in Midwifery

As my main research interests are firmly rooted within supporting a positive staff experience for healthcare workers, especially midwives in work-related psychological distress, I am always looking for new opportunities to share knowledge with others in this area. …The Global Alliance for Nursing and Midwifery (GANM) is a joint project sponsored by the Pan American Health Organization (PAHO) and the World Health Organization (WHO) Collaborating Center for Nursing Knowledge, Information Management & Sharing at the Johns Hopkins School of Nursing. This blog post provides an overview of a webinar session hosted by GANM entitled “Mindfulness and Self-Care in Midwifery:  Review of Current Evidence and Guided Mindfulness Practice.

For a preliminary introduction to this topic – check out an earlier blog post on this topic entitled “Midwife Burnout: A Brief Summary“.

downtimes

Erin Wright, DNP, CNM, APRN-BC, led the conversation…Participants were diverse, and originated from Canada, Peru, US (Baltimore, Urbana, Birmingham, Atlanta, Buffalo), Ireland, UK (Coventry University and School of Healthcare Sciences Cardiff), Brazil, Montserrat, and Trinidad.

The full webinar can be accessed here.

Much of the research covered, has also been captured within my earlier narrative review: Pezaro, Sally, et al. “‘Midwives Overboard!’Inside their hearts are breaking, their makeup may be flaking but their smile still stays on.” Women and Birth 29.3 (2016): e59-e66.

However, there were some new and interesting comparisons made with more recent research here…

“Four common themes have been identified that traverse the different models of care. The NZ study provides insight into how case load midwifery can be sustainable enabling long term sustainability. The UK study highlights healthy resilient practices that enable practice. What remains uncertain is how models of care enable or disable sustainable long term practice and nurture healthy resilient behaviours within the different models of care”.

comparisons

“The notion of resilience in midwifery as the panacea to resolve current concerns may need rethinking as the notion may be interpreted as expecting midwives ‘to toughen up’ in a working setting that is socially, economically and culturally challenging.”

Sources (Crowther, Susan, et al. “Sustainability and resilience in midwifery: A discussion paper.” Midwifery 40 (2016): 40-48.)

So we are now much enlightened as to how and why midwives are experiencing distress, we also have some insights into how they try to cope (or not)…and where this distress may affect maternity services…but what we are yet to learn, is what may be most effective in supporting midwives in work-related psychological distress…although a few clues are emerging….

Mindfulness is coming forward as a potential tool of support..stress management, education and clinical supervision may also be of benefit to midwives in distress…But how, why and how much is not yet clear.

After exploring the literature in relation to psychological distress in midwifery populations, we were all invited to join in some mindfulness practice..What is mindfulness?

Image result for mindfulness

 

Feeling overwhelmed?…TRY….R.A.I.N

RRecognize What’s Going On

AAllowing: Taking a Life-Giving Pause

I—Investigating with Kindness

NNatural Loving Awareness

Source: Mindful.org

relation-ships

Recommended further reading

Youtube presenters:

  • Jon Kabat Zinn
  • Elisha Goldstein
  • Tara Brach
  • Sharon Salzberg

Websites/Audio Links:

Books: 

  • A Mindfulness Based Stress Reduction Workbook (Goldstein and Stahl)
  • Everyday Catastrophe Living (Jon Kabat Zinn)
  • Wherever you go there you are (Jon Kabat Zinn)
  • Mindfulness for Beginners (Jon Kabat Zinn)
  • Real Happiness (Sharon Salzberg)
  • The Mindful Nurse (Carmel Sheridan)

For more mindfulness exercises, visit the UCLA Mindfulness Awareness Research Center.

book-mark

Thanks for a very insightful and informative session!

Until next time…Look after yourselves & each other 🦄💫🎓

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An exploration of mixed-methods research

What is Mixed-methods research?…. a mixture of methods? …or a multitude of methods in either one study or a succession of research?….Yes….it is a pickle.

What is mixed methods research?

I am on a learning curve (as always)…and I have been refining my understanding of mixed methods research…so what is mixed-methods research as I understand it now?

Firstly…what is a method?

I like to think of it as a recipe. Everyone knows a recipe for making a Victoria sponge…Eggs, sugar, butter, jam…and cream….But perhaps my method is different from your method..I add vanilla essence….you prefer yours with blackcurrant jam….We are both using a recipe or ‘method’ for making a Victoria sponge…

It’s just that the recipe or ‘method’ has both agreed standards… and modified versions.

Image result for victoria sponge

So…in research terms, I used to think of mixed-methods as literally a mixture of methods used in a single study….perhaps questionnaires and interviews…or a focus group and a literature review…But there are others who have defined it differently. Basically…we are actually looking at a mixture of both qualitative and quantitative research in one study/paper…Here are some other definitions below from leaders in the field..

Pat Bazeley: I tend to distinguish between mixed methods and multimethod, although if I need a generic term, I used mixed methods. Multimethod research is when different approaches or methods are used in parallel or sequence but are not integrated until inferences are being made. Mixed methods research involves the use of more than one approach to or method of design, data collection or data analysis within a single program of study, with integration of the different approaches or methods occurring during the program of study, and not just at its concluding point. Note that I am not limiting this to a combination of qualitative and quantitative research only, but more broadly, combinations of any different approaches/methods/data/analyses.

 

Valerie Caracelli: A mixed method study is one that planfully juxtaposes or combines methods of different types (qualitative and quantitative) to provide a more elaborated understanding of the phenomenon of interest (including its context) and, as well, to gain greater confidence in the conclusions generated by the evaluation study.

 

Huey Chen: Mixed methods research is a systematic integration of quantitative and qualitative methods in a single study for purposes of obtaining a fuller picture and deeper understanding of a phenomenon. Mixed methods can be integrated in such a way that qualitative and quantitative methods retain their original structures and procedures (pure form mixed methods). Alternatively, these two methods can be adapted, altered, or synthesized to fit the research and cost situations of the study (modified form mixed methods).

 

John Creswell: Mixed methods research is a research design (or methodology) in which the researcher collects, analyzes, and mixes (integrates or connects) both quantitative and qualitative data in a single study or a multiphase program of inquiry.

 

Steve Currall: Mixed methods research involves the sequential or simultaneous use of both qualitative and quantitative data collection and/or data analysis techniques.

 

Marvin Formosa: Mixed methods research is the utilitization of two or more different methods to meet the aims of a research project as best as one can. The research project may be conducted from either one or two paradigmatic standpoints (mixed methodology study).

 

Jennifer Greene: Mixed method inquiry is an approach to investigating the social world that ideally involves more than one methodological tradition and thus more than one way of knowing, along with more than one kind of technique for gathering, analyzing, and representing human phenomena, all for the purpose of better understanding.

 

Al Hunter: Mixed methods is a term that is usually used to designate combining qualitative and quantitative research methods in the same research project. I prefer the term multimethod research to indicate that different styles of research may be combined in the same research project. These need not be restricted to quantitative and qualitative; but may include, for example, qualitative participant observation with qualitative in-depth interviewing. Alternatively it could include quantitative survey research with quantitative experimental research. And of course it would include quantitative with qualitative styles.

 

Burke Johnson and Anthony Onwuegbuzie: Mixed methods research is the class of research where the researcher mixes or combines quantitative and qualitative research techniques, methods, approaches, concepts or language into a single study or set of related studies.

 

Udo Kelle: Mixed methods means the combination of different qualitative and quantitative methods of data collection and data analysis in one empirical research project. This combination can serve for two different purposes: it can help to discover and to handle threats for validity arising from the use of qualitative or quantitative research by applying methods from the alternative methodological tradition and can thus ensure good scientific practice by enhancing the validity of methods and research findings. Or it can be used to gain a fuller picture and deeper understanding of the investigated phenomenon by relating complementary findings to each other which result from the use of methods from the different methodological traditions of qualitative and quantitative research.

 

Donna Mertens: Mixed methods research, when undertaken from a transformative stance, is the use of qualitative and quantitative methods that allow for the collection of data about historical and contextual factors, with special emphasis on issues of power that can influence the achievement of social justice and avoidance of oppression.

 

Steven Miller: Mixed methods is a form of evolving methodological inquiry, primarily directed to the human sciences, which attempts to combine in some logical order the differing techniques and procedures of quantitative, qualitative and historical approaches. At present mixed methods must devote itself to resolving a set of issues, both epistemological and ontological. The first must devote itself to what Miller and Gatta (2006) call the “epistemological link,” that is the rules and rationales which “permit” one to proceed mixed methodologically. The second must adhere to some form of “minimal realist” ontology, where either social reality is “One” but can be accessed by different methods separately or working in conjunction, or social reality is multiple in nature and can ONLY be accessed through mixed methods. Present day attempts to couch mixed methods within some broad notion of pragmatism are not satisfactory.

 

Janice Morse: A mixed method design is a plan for a scientifically rigorous research process comprised of a qualitative or quantitative core component that directs the theoretical drive, with qualitative or quantitative supplementary component(s). These components of the research fit together to enhance description, understanding and can either be conducted simultaneously or sequentially.

 

Isadore Newman: Mixed methods research is a set of procedures that should be used when integrating qualitative and quantitative procedures reflects the research question(s) better than each can independently. The combining of quantitative and qualitative methods should better inform the researcher and the effectiveness of mixed methods should be evaluated based upon how the approach enables the investigator to answer the research question(s) embedded in the purpose(s) (why the study is being conducted or is needed; the justification) of the study. (See Newman, Ridenour, Newman & DeMarco, 2003.)

 

Michael Q. Patton: I consider mixed methods to be inquiring into a question using different data sources and design elements in such a way as to bring different perspectives to bear in the inquiry and therefore support triangulation of the findings. In this regard, using different methods to examine different questions in the same overall study is not mixed methods.

 

Hallie Preskill: Mixed methods research refers to the use of data collection methods that collect both quantitative and qualitative data. Mixed methods research acknowledges that all methods have inherent biases and weaknesses; that using a mixed method approach increases the likelihood that the sum of the data collected will be richer, more meaningful, and ultimately more useful in answering the research questions.

 

Margarete Sandelowski: First, I think of this in terms of either a single primary research study or as a program of research. Then, I see mixed methods as something of a misnomer as mixing implies blending together. Mixed methods research, though, is more the use of different methodological approaches TOGETHER in a single study or single program of research. One cannot blend methods in the sense of assimilating one into the other. I use methods here to refer to larger inquiry approaches (e.g., experiments and grounded theory) which are themselves based in distinctive theoretical perspectives. Yet this sets up a problem too, as grounded theory, for example, can be “positivist” (a la Strauss & Corbin), “constructivist” (a la Charmaz), or “postmodern” (a la Clarke) in sensibility or influence. So, if a researcher is doing grounded theory (positivist style) and an experiment (positivist influence), are any methods actually being mixed? In other words, mixed methods research can be defined at the technique level as the combination of, e.g., purposeful & probability sampling, open-ended and closed-ended data collection techniques, and narrative and mutivariable analyses—i.e., in which anything can be used together (linked or assimilated into each other)—or it can be defined at a larger theoretical/paradigmatic level as using divergent approaches to inquiry together. I would not define mixed methods research as constituting ANY combination of 2 or more things, as any research involves the use of 2 or more of something and the use of experiment and survey is 2 things, but they are informed by one mind (typically positivist/objectivist/realist). We get tangled in words, do we not?

 

Lyn Shulha: By collaborative mixed method research, we will mean the purposeful application of a multiple person, multiple perspective approach to questions of research and evaluation. Decisions about how methods are combined and how analyses are conducted are grounded in the needs and emerging complexity of each project rather than in preordinate methodological conventions. . . . Within this context, methods can be “mixed” in a variety of ways. Sometimes, one method serves another in validating and explicating findings that emerge from a dominant approach. On other occasions, different methods are used for different parts of the issues being investigated, and in an independent way. In more complex cases, the methods and perspectives are deliberately mixed from the beginning of the process. The resulting interaction of problem, method, and results produce a more comprehensive, internally consistent, and ultimately, more valid general approach. What sets the most complex forms of collaborative mixed method research apart from other forms of inquiry is that findings depend as much on the researchers’ capacities to learn through joint effort and to construct joint meaning as on their expertise in conventional data collection and analysis techniques.

 

Abbas Tashakkori and Charles Teddlie: Mixed methods research is a type of research design in which QUAL and QUAN approaches are used in type of questions, research methods, data collection and analysis procedures, or in inferences.

 

Note: QUAL = qualitative research; QUAN = quantitative research

Source for quotes = Toward a Definition of Mixed Methods Research R. Burke Johnson University of South Alabama, Mobile Anthony J. Onwuegbuzie University of South Florida, Tampa Lisa A. Turner University of South Alabama, Mobile

Image result for mixed methods studies

There are also now reporting guidelines emerging for Mixed Methods studies (O’Cathain, Alicia, Elizabeth Murphy, and Jon Nicholl. “The quality of mixed methods studies in health services research.” Journal of Health Services Research & Policy 13.2 (2008): 92-98.)

Good Reporting of A Mixed Methods Study (GRAMMS)…Guidelines as follows…

(1) Describe the justification for using a mixed methods approach to the research question

(2) Describe the design in terms of the purpose, priority and sequence of methods

(3) Describe each method in terms of sampling, data collection and analysis

(4) Describe where integration has occurred, how it has occurred and who has participated in it

(5) Describe any limitation of one method associated with the present of the other method

(6) Describe any insights gained from mixing or integrating methods

Mixed methods research is more specific in that it includes the mixing of qualitative and quantitative data, methods, methodologies, and/or paradigms in a research study or set of related studies. One could argue that mixed methods research is a special case of multimethod research.

 

Image result for mixing bowl research

So until next time… look after yourselves & each other…then …in the words of Bob Marley…go ahead and stir it up….🎓💜🌟

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‘Making & Breaking the Maternity Experience’#Uclhmw2016 – A midwifery conference

Attending and presenting work on midwife wellbeing at , I was thrilled to see so much of one conference dedicated to supporting the midwife, as well as the mother. I was also keen to hear  Jacqui Dunkley-Bent update us all on the new plans for maternity services in 2017! – Bring it on!

-Improvement in Perinatal mental health in maternity services was highest on the agenda as we can see here – midwives were really responsive to making these a commitments a reality.

Yet we can see that NHS England is also looking to transform the workforce as part of this plan. There are so many ideas buzzing around my head at the moment that I am feeling dizzy… “so much to do and so little time” – As Willy Wonka would say.

We also saw how mothers are experiencing poor support in decision making…

Both  and  really must be heard by all midwives, everywhere, more often! Read more about these experiences here. …and here.

Women are roaring for change!

Christine Armstrong

There are so many great resources available from dignity in childbirth … We really need to challenge the way that women experience respect in maternity care.

And the #CaringForYou campaign?

Sadly, bullying still a real issue in midwifery, as  confirmed … punity, public shaming & undermining must stop.. We must be kinder to one another…remember why we became midwives in the first place and love each other for the critical safety of mothers and their babies.

…..more ❤️ is needed!

We must ‘Create a positive culture’ –   says at 

What can we do?

There is indeed much to be done. I wanted to personally thank , and @MaureenMcCabe15 (and their teams) for looking after me so well as a speaker at this conference myself. I have never been so well looked after at a conference 😘😍

And thank you to all of those who appreciated my presentation and engaged in this very important work. I love this particular image that people have been sending me (see below)…I believe it was created at the#BirthTrauma2016 conference & shares a powerful message 💜💙💚

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There really is so much to do and so little time!

Image result for so much to do and so little time willy wonka

As a last thought introduced to us by Sheena Byrom ‘Midwives are humming birds never too small to make a difference’

Until next time – Take care of yourselves & each other ❤💚💙💛

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The 5 stages of academic rejection grief

Image result for temper

An academic career has been described as a journey filled with brutal, unrelenting rejection. I frequently find myself having to pick myself up from rejection. It is hard.

In academia..your peers will be some of the most intelligent, creative and driven people in the world. – I have found this to be very true. I am in awe of them all.

Additionally, from the inside, all you ever see is tweets and Facebook posts about how everyone else is winning awards, being featured by the press, or getting cited a thousand times.….Yes. I am constantly celebrating the achievements of my peers…. this is wonderful!…but yes… this does make my own rejections even harder.

Whether it is a paper in a journal, a grant application, your viva or an idea that you have lovingly nurtured and come to love and cherish, there are 5 stages of rejection grief that are more or less inevitable (for me anyway).

Having your work rejected can feel like you have just spent a lifetime nurturing and rearing a beloved child, only to find out that it has grown into an evil and murderous human being in need of ‘Major revisions’!

Image result for chucky

1. Denial and isolation

This is wrong. It cannot be. I was so certain that my work was beautiful!…I don’t want to talk about it 😦

2. Anger

How dare the reviewer pull apart my work in this way…do they know nothing???!!

3. Bargaining

OK, I will take a look at the revisions. I will accept comment 4 and 5, but I’m not doing what reviewer 3 wants!

4. Depression

Gah!….these revisions are so laborious and depressing.

5. Acceptance

Oh…OK…phew… it is done. I am happy with it. I am at peace and ready to resubmit!

Image result for who said everything will be alright in the end and if

Feedback is golden…but it can be challenging to accept…it feels like rejection….but we are all actually moving forward ..all of the time. See here about the importance of feedback. I don’t believe that managers, reviewers or examiners are out to get us (not all of them anyway)….and so we must remember that none of this is personal. It is not a rejection of you as an entity, it is a very subjective point of view which may actually improve the work you do.

Try to portray humility and gratitude…Rather than any knee jerk feelings…

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“I’m sorry… you’ve got major revisions to do”

Work that needs major revisions? How will people judge that? How will I be judged? is everything I thought I knew a lie?..what would another reviewer have said? (Most of the time the reviewers all want different things in any case)!

Self doubt, career doubt, black and white thinking and a feeling of doom sets in. ‘I am not good enough’…I begin to catastrophise. But then I reflect…what is really behind success?

Image result for iceberg of success

I think that my approach to revisions needs major revisions. I continue to work on these revisions daily….

Every piece of work that I have ever revised following feedback or rejection has improved. Yet every time…I have to put all of my toys back into my pram before I begin the process of making any changes. I go back and forward around the 5 stages of academic grief..round and around…but it always ends up fine in the end….mostly it ends up better.

I live in constant fear of rejection, failure and disappointing those who I respect most… But we must try to get over our fear of failure and rejection, or we loose the opportunities we have to learn and grow.

Remember…things always feel better in the morning…you will not always feel this way. The cure for academic rejection grief is not always instant success…it is compassion for both yourself and others.

Until next time, take care of yourselves and eachother ⭐🎓⭐

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💚💜❤Preventing Birth Trauma at #artofbirth16💚💜❤

Recently, I was asked by Dr. Gloria Esegbona from the @art_of_birth to share some of my thoughts on birth trauma at the latest  summit at Kings College London. My first thought, as always was…. do you mean physical? or psychological?… I was assured that her latest event would be addressing both. Time to learn & grow 💚💜❤

art-of-birth-event-with-sally-pezaro-2016

And so how can we as midwives prevent physical birth trauma?

“we can reduce ventouse to and with left lateral & slow head delivery

“Preventable physical to & caused by poor positions and outdated pushing practices

Quiz – Which methods of pushing during vaginal delivery and pelvic floor relate to which perineal outcomes?

(No peeking at the link to get the answers first!)

#Discuss #GetYourGeekOn

Methods:
-open-glottis technique?
-Valsalva pushing?
———————-
Outcomes:
-incidence of instrumental and cesarean delivery?
-incidence of postpartum hemorrhage?
-urinary incontinence
-Episiotomy rates?
-maternal satisfaction?
-fetal heart rate (FHR) abnormalities?
-Apgar score?

No peeking at the answers link before you comment/answer below!

(We are still awaiting more evidence in any case)!

The Art of Birth is promoting art in the science of to prevent #birthtrauma 

And so what about the psychological trauma and the 2nd victim…the midwife?

Can we begin to understand women’s experiences in relation to psychological birth trauma? How do we revisit the language we use during birth? Can we all be more compassionate in our practice?

I was quoted on this day when talking about “superhero midwives” – healthy, well-supported lead to healthy, well-supported mums. …It is true…so many people wanting to do good….some burning out. Some traumatised.

I thank you all for hearing about my work on the wellbeing of midwives in the workplace.

I had some really great panel questions too…What I loved most about this conference was that I managed to receive lots of  and create  with so many inspiring midwives, doulas, students and others wanting to support each other, share and learn  💚💜❤.. I can’t wait to see some of you in the near future and learn more about how you have turned these lessons into practice. 💚💜❤

Until next time – look after yourselves and each other #GetYourGeekOn 💚💜❤