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A reflection on #internationaldayofthemidwife (#IDM2017)

International day of the midwife

Happy #internationaldayofthemidwife or () as it is indeed the 5th of May 2017. I wanted to do a quick reflection (and a little dance of happiness) about the fact that the focus of this year’s International Day of the Midwife is…

 “Midwives, Mothers and Families: Partners for Life!”

With messages coming from the International Confederation such as…”It is very important that midwives and mothers both acknowledge the reciprocity of their relationship” – Scarlett

Yes…..we work in PARTNERSHIP with women and their families!…mothers, families and midwives are all equal partners….this means that we can finally break the mold and state openly that we, as midwives can also be prioritised!…Fabulous!

I have often wondered whether terms such as ‘Patient comes first’ is really healthy…as it is terms like this which often infer that midwives come second at best. What do you think?

service and sacrifice

I have also been picking up on some other great messages, pictures and videos this ..such as…..

 

 

I have also been dipping in and out of the Virtual International Day of the Midwife conference sessions a FREE conference that happens online every year….I have presented my work at  () before, and it is such a great opportunity to get people together in one place from all over the world!

This year for  I have recorded a podcast ‘Made by midwives for midwives’. Hosted by London based midwives Anthonissa Moger and Kate Whatmough….  (The Midwifery Podcast: Os closed, go home.)..I will be sharing this in an upcoming blog post…but for now..I am off to enjoy the rest of …there is such positivity in the midwifery world today…Let’s keep the momentum going ❣🎓❣

 

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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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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The 5 stages of academic rejection grief

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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’!

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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 💚💜❤

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Reflecting on the #MaternalDeath report from @mbrrace as a midwife…💜

During the December of 2016, everyone involved in the provision of care for childbearing women (and the women themselves) began to reflect upon the findings of the latest Confidential Enquiry into Maternal Death. As a midwife, I am dedicated to supporting, protecting and caring for other midwives, childbearing women, babies their families. There is no doubt in my mind that these deaths have affected all of these groups profoundly, and society as a whole. But before we begin to reflect, let’s remember that the mortality surrounding childbirth (in the UK) is thankfully rare 

    

 

When we lose mothers…we also tragically effect babies…The Stillbirth and Neonatal Deaths charity (Sands) responds to new MBRRACE maternity report here

There is no doubt that we must learn from all of these  as the president of the explains here. Clearly there is much learning to do and many improvements to make. These key messages should remind us all to ask the question…start the conversation…notice the subtle clinical cues which alert us all to danger, react to risk and remain emotionally intelligent to the needs of childbearing women.

However, what struck me most was the sheer number of women who die from mental health related causes. The MBRRACE report found that “one in seven of the women who died during the period of review died by suicide. Although severe maternal mental illness is uncommon, it can develop very quickly in women after birth; the woman, her family and mainstream mental health services may not recognise this or move fast enough to take action”.

Image result for maternal mental health related deaths mbrrace

You can read the ‘expert’ reaction to MBRRACE-UK report citing mental health as main cause of perinatal death here. Maternal mental health matters – toolkit now available from for those developing a community perinatal mental health service.

Learning to save maternal lives and making change happen will not only improve the lives of mothers, babies and families. It will also improve the lives of midwives, as they will be better equipped to give the care they would like to give as their job satisfaction improves. When the psychological wellbeing of midwives is left uncared for, maternity services may see less safe maternity care. When we care for midwives, the safety and quality of maternity care may also improve. This will in turn contribute to a reduction in maternal mortality rates. So when we are looking to improve maternity care for women, their families and their babies, lets make sure that we also look to support those who are caring for them. It really is two sides of the same coin.

What can we promote?

= That it’s “OK to ask”

How can we support women & midwives? = With trust, compassion & respect

How can we improve safety?

= Evidence based care & excellent communication

 

Preventable maternal morbidity and mortality is associated with the absence of timely access to quality care, defined as too little, too late (TLTL)—ie, inadequate access to services, resources, or evidence-based care—and too much, too soon (TMTS)—ie, over-medicalisation of normal antenatal, intrapartum, and postnatal care.

Although many structural factors affect quality care, adherence to evidence-based guidelines could help health-care providers to avoid TLTL and TMTS.

TLTL—historically associated with low-income countries—occurs everywhere there are disparities in socio-demographic variables, including, wealth, age, and migrant status. Often disparities in outcomes are due to inequitable application of timely evidence-based care.

TMTS—historically associated with high-income countries—is rapidly increasing everywhere, particularly as more women use facilities for childbirth. Increasing rates of potentially harmful practices, especially in the private sector, reflect weak regulatory capacity as well as little adherence to evidence-based guidelines.

Caesarean section is a globally recognised maternal health-care indicator, and an example of both TLTL and TMTS—with disparate rates between and within countries, and higher rates in private practice and higher wealth quintiles. Caesarean section rates are highest in middle-income countries and rising in most low-income countries. Although researchers partly attribute the increase and variable rates to a shortage of clear, clinical guidelines and little adherence to existing guidelines, multiple factors—economic, logistical, and cultural—affect caesarean section rates.

Quality clinical practice guidelines need to be developed that reflect consensus among guideline developers, using similar language, similar strengths of recommendation, and agreement on direction of recommendations.

Strategies for enhanced implementation and adherence to guidelines need multisectorial input and rigorous implementation science.

A global approach that supports effective and sustained implementation of respectful, evidence-based care for routine antenatal, intrapartum, and postnatal care is urgently needed.

There is much work to be done. Until next time, take care of yourselves and each other 💜💙💛

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10 Tips for Success & Self-Care for Academics

cozy-dog

Another guilt trip about the importance of self care and being successful? That is why many people will read blog posts like this. We know we should be practising self care and succeeding, but do we really know how to thrive?

(I could not find a concept analysis for either success or self care – please let me know if you do)

We must presume that both success and self-care mean something different to each and every one of us. I am no expert on these topics…. is anyone?…But I think I am pretty good at caring for myself now and working towards success…having learnt the hard way. So I thought I would share some of my hints and tips. Feel free to adapt them, use them, completely ignore them, or ridicule them as ‘poppycock’.

Most people will expect to hear things like:

  • Take a bubble bath
  • Watch your favorite film
  • Curl up with a good book
  • Work hard
  • Network

But I am sure that you know about this kind of stuff already. So let’s look at self care and success for the academic, firstly by identifying the issues that some of us may face.

As an early career researcher, I am frequently told about the stereotyping and inequalities experienced by women in academia. I myself frequently worry about the insecurity of, and problems associated with being an early career researcher, especially a female one.…I worry about where I will find my next job, funding or co-author. I worry about whether I am making any impact at all and whether I will be able to reach my true potential as an academic in the current climate. Academic pressures are in no way restricted to those earlier in their career, many more established researchers are also feeling the strain. These experiences will undoubtedly result in some psychological distress for many academics. So what can we do both proactively and preventatively to improve the lives of ourselves and each other.

Research can seem like a lot of hard work for little reward.

Tip One: Keep your eye on the goal. Visualize yourself being happy, frequently. How would it feel to publish that paper? Get that fellowship? Collaborate on that project? Create your own self-fulfilling prophecy rather than focus on a possible spiral of doom.

How to do this? – Identify what makes you happy, or what will make you happy. Then do more of what makes you happy, or have a real go at getting what will make you happy. I personally love my research work. I know that many other academics feel the same way. Happiness to me is succeeding, making a difference  and making a real impact through my work. The stress I feel is associated with this not happening.

This stress and negative thinking serves no purpose unless it positively drives me towards my goal. Yet who wants to be whipped to the goal posts?  I use visualization as a driver for success. I see myself feeling and being the way I want to be…and I allow myself to believe that this vision will come true. This makes me much happier than thinking about the alternative. So I stick with it.

The practice of meditation may also assist you to work through your thoughts, direct them towards a more positive outlook and allow your goals to become meaningful and achievable.

As these tips continue, think about your own goals for happiness…whatever they may be…think about achieving them in relation to these tips and your own experiences.

I behave in the way I want to feel or be… Surely if I continue in this direction. Good things will come…

Tip Two: The problem of job insecurity for early career academics baffles me as Job security for early career researchers is a significant factor in helping research make an impact. Yet this seems to play on my mind recurrently. It is always a worry. However, worry really does nothing to resolve this issue, and only seeks to get in the way of my progress. In order to progress, I will need to ‘work smarter’ and embrace confidence in my own abilities. Worry and negative thinking has no place in this strategy.

Negative thoughts often lie, and so I swipe them away one by one by placing them on a train that is passing the station (Visualization) – I then sit for a little longer, and imagine the way I will feel and be once I reach my goals. My mood and stress instantly lifts once I do this. I am more confident and feel much stronger. I am ready to be happy.

 

Tip 3: Say No and be proactive – We need to look at what successful academics do. From my observations, they often say ‘No’ to anything that doesn’t suit their own focused agenda (they remove the ‘noise’ and toxicity), they ooze positivity, they are confident, they are assertive, they tell people what they need to succeed and they hang around with the most inspiring people. Therefore, the most obvious strategy is for us to do the same. Say ‘No’ to negativity, and to the people and things which do not enrich us as people. Let people know what you need in order to thrive. Embrace those you feel drawn towards as positive people.

Activity: Making the best of me…

1: Ask yourself how others can get the best out of you

2: Offer what you can realistically do

3: Communicate what inhibits your productivity with others

4: Actively describe what you need from others in order to thrive

Getting the best of me

Tip 4: Express gratitude and forgiveness for enhanced wellbeing. Not always easy, but worth investing in. This task not only unburdens your mind, but allows you to see all of the good things currently going on in your life. Regularly write down 5 things that you are grateful for. Also…try to forgive yourself, and others…often.

 

Tip 5: Address your work life balance as a fluid entity. I believe that the idea of a separate home and work life is changing. This is a good thing. It takes the pressure off and allows you to be a whole person, rather than one split in two…See yourself as a whole being, a working, living and family centred being. You cannot slice yourself into pieces.

See this blog -> ‘Work’ is a verb rather than a noun…it is something we do…not always somewhere we go…

Living in the ‘now’ rather than being at either home or work also allows us to enjoy more of ourselves and our lives. Notice where you are, what you are doing…Smell the flowers, look around you as you move, work, play and just allow yourself to ‘be’.

smell-the-flowers

Tip 6: Eat Sleep move, repeat. It really is that simple, but utterly essential for optimum productivity, stress reduction, health and wellbeing. Eat nutritious food regularly, sleep 7-8 hours a night and move…Exercise, walk, swim, run, cycle…Be outdoors as often as possible.

float

Tip 7: Write. Write your thoughts, your feelings, your ‘to do’ lists, your ideas, your goals down regularly. This not only means that they are out of your head, allowing your mind to be quieter, they are also made real…They are good to share..and worth addressing (when you feel able).

Tip 8: Talk about who you are. There is a tendency to talk about work first. What we do, what we are working on and what we are planning to work on. Start new conversations with how you enjoy your hobbies or your favourite music. This lets other people know that you are indeed human, and it also gives you an identity other than your work persona. Be authentic. It is healthy for you, and others to know the real and whole you. You are fab 🙂

Tip 9: Help other people and accept help yourself. Lift one another up, support colleagues, show gratitude, offer support and guidance where you can. Be a mentor. Be a positive role model. Be the change you want to see in the workplace and accept all of this in return. This will not only make you feel good, it will change the culture of your workplace, and bring about reciprocity for everyone’s success.

LiftEachotherUp_libbyvanderploeg

(Image via http://www.libbyvanderploeg.com/#/lifteachotherup/)

Tip 10: Celebrate the successes of yourself and others. Yes. Focus on the great things that you and your colleagues have achieved. However big or small, these feelings of success will snowball into a self fulfilling prophecy, where you feel valued, supported and part of a team that cares. Some people will feel uncomfortable about doing this, and feel icky when they see others wallow in their own brilliance. But what is the alternative? We all talk about how rubbish we all are? How will that make us feel?…

Spend time reflecting on what you have achieved. Write them down…use these achievements to inform your own vision of yourself…This is who you are. You are great.

As long as the feelings of celebration and success are reciprocated and directed towards others as well as yourself….Let the high fives roll.

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I do hope that these tips will resonate with some academics looking for something new to try. In the spirit of sharing, please feel free to add more tips below.

You deserve to be happy – Until next time, look after yourselves and each other ❤💙💜

 

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Mentorship in healthcare and research: Role modelling for excellence

Image result for bad mentor

Mentoring, coaching, role modelling, training…. leading….Whatever you want to call it, I would be nothing without it. That phrase was once hurled at me as an insult…

YOU WOULD BE NOTHING WITHOUT ‘X’ – Well yes..That is true.

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Workplace cultures in healthcare and research are created and shaped by what we do rather than what we say. Simply put, the way we behave is how we end up living. Although we can all be influenced by what we see, hear and experience …YOU can choose how you will and won’t behave. You can equally decide what behaviour you will and will not accept from others. But who will show us the way we want to go?

Image result for behave how you want to live

As I remember training to be a midwife, many people said …”‘take the good bits and leave the bad bits’ out of your own practice, as you develop and grow alongside your mentor”. I did this, and yet it took me a long time to define who I wanted to be as a professional. Some mentors were good, and some mentors less so – personal preference perhaps?… Many tried to direct the way in which they wanted me to go, and it took great courage for me to challenge this directive behaviour. However, as my career progressed, I was able to study Leadership in health and social care at Masters degree level. This really helped me to understand the theories behind good and bad mentorship…

Image result for good mentorship

A good mentor:

  • Has confidence in you
  • Trusts you
  • Empowers you
  • Gives constructive feedback
  • Wants you to succeed
  • Supports your new ventures
  • Listens to your new ideas
  • Identifies your strengths and helps you develop them into constructive outputs
  • Identifies your weaknesses and helps you manage them effectively
  • Shares their wisdom
  • Gives you wings to fly
  • Behaves with integrity, professionalism and dignity
  • Inspires you
  • Is kind to you (and others)!
  • Feeds your passions and thirst for new opportunities
  • Invites you into their network of expertise
  • Grows with you as you as a professional

A bad mentor:

  • Is concerned only with their own success
  • Talks about doing things that never happen ‘All talk’
  • Is always negative about everything and everyone
  • Is never around
  • Cannot commit to your development
  • Bullies you
  • Dictates how you must behave
  • Doesn’t pay attention to the way you would like to develop professionally
  • Never admits when they are wrong
  • Refuses to believe that you may know more than them in certain areas
  • Compares you with others (negatively)
  • Never lets you progress
  • Kills your confidence
  • Makes you feel bad about yourself

Once you find your way, it is important to find the courage to decide which behaviours you are willing to accept, and to role model yourself for the benefit of others. These are important choices to make, as they will contribute to the cultures in which you and your colleagues will be working. Ask yourself the following:

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  • What do you need in order to be productive?
  • What do you need from others in order to thrive professionally?
  • How do you want to behave?
  • What are you willing to accept?

The answers to these questions must be acted upon. Have the courage to communicate these needs…Others will want you to succeed, they will appreciate this information…

…If not…..are you willing to accept that?

My final tip for ultimate success is to find your flock. Gravitate towards those who inspire you… hang around with those who allow you to fly…. learn from those who lift others up and share your thoughts with those who seek out change.

I would be nothing without my ‘Flock’…my wonderful mentors and my inspiring colleagues.

Each and every one of us ‘mentor’ a growing professional every day (whether we realise it or not)! Therefore each and every one of us needs to decide how we want to behave every day..We all create the workplace cultures, leaders and workforce of the future. Lets create something wonderful…

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Thank you to all of you wonderful mentors out there….

Until next time, look after yourselves, and each other 💙💜💚