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“Midwifery…It’s about the birth of humanity…” #zepherinalecture17

This is just a short post to summarise this year’s  hosted by the . What an inspiring day in midwifery it was.

Zepherina Veitch (1836-1894) was a midwife who put her energies into the cause of midwifery reform. I can identify with this, as my own work focuses largely on supporting the midwifery profession. As we improve….we make reforms. I whole heartedly want midwives to become leaders and agents of change for a better future. I just happen to believe that the midwifery profession will only reach it’s true potential once midwives are adequately supported in the workplace.

Much of the lecture given by the inspiring   was focused upon ‘the woman’s experience’. Whilst we all aspire to deliver the best experiences for the women we care for, I couldn’t help but add on these words to each phrase ‘and midwives too’…

cover image for caring to change reportBut then this document appeared.

Caring to change

How compassionate leadership can stimulate innovation in health care…

Here, we begin to see how compassion in the workplace can stimulate excellence in the healthcare services….If we care to change. Compassionate leadership turns into a compassionate workplace culture…

This lecture also focused on the development of humanised care in favour of medicalised care. A no brainer right?…Perhaps we can ‘humanise’ the workplace for midwives too?

After all….We need more midwives right?

But the pinnacle of this event was seeing the pinnard being handed from today with her final flourish and welcome to  …the new president of the Royal College of Midwives

Also…a huge congratulations go to Onya,   and – new fellows of the . 👏🏽👏🏽😀💜

But at the end of the day…I got to meet some of the most inspirational midwives…one of those being the wonderful  …I can certainly recommend next year’s  ..come along and be inspired!.. Because we all need a little positivity in our lives! You get it with midwifery….”It’s about the birth of humanity…” after all…

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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Debunking Midwifery Myths

New article published here: Oh baby: seven things you probably didn’t know about midwives

…please share it widely!

dad with baby

As I am now coming to the end of my PhD (With lot’s of new and exciting things on the horizon I hope), I have been delving into the depths of the largest global online survey of midwives to date – the voices of over 2470 midwives in 93 countries!

Not only is this really an awesome and very important piece of work… it also holds some quite harrowing findings for our beloved midwifery profession. Yet this report also indicates that – if the voices of midwives are listened to, and if midwives are enabled to overcome gender inequalities and assume positions of leadership – quality of care can be improved for women and newborns globally. Wow….OK…we had better get to work then!

ALSO…

“Professionally, 89% of respondents reported that a clear understanding of what midwifery involves is critical for change to take place. Concerns were also expressed over the perceived devaluing of midwifery combined with the increasing medicalisation of birth.”

 

baby on blue

Professionally, the participants expressed concern about a lack of understanding of what “midwifery” is, the devaluing of the midwifery profession combined with the increasing medicalisation of birth, and the underlying weakness in midwifery education and regulation.

Now, I don’t claim to be able to fix the world in a day..but there was one thing that I thought I may be able to do from behind my PC. I could get an article published in @ConversationUK about the midwifery profession…perhaps I could even debunk some myths and set the record straight!…

I had my article published…please share it widely via the link below:

Oh baby: seven things you probably didn’t know about midwives

Now I was limited in this article. Limited in words and in how many points I was able to make in one article…editors need to keep their publications engaging!..and so yes…I did not manage to publish everything in this article as I would have liked to…and yes there are many many more myths about midwives that need to be debunked. But I am hoping that this will the a start of a new conversation.

Midwifery is defined as “skilled, knowledgeable and compassionate care for childbearing women, newborn infants and families across the continuum from pre-pregnancy, pregnancy, birth, postpartum and the early weeks of life” and it should be celebrated at every opportunity.

Let’s keep the conversation going around the importance of the midwifery profession. Midwives are crucial to the delivery of high quality maternal and newborn care and subsequent reductions in maternal and newborn mortality around the world. Yet they must be celebrated, respected and supported.

The core characteristics of midwifery include “optimising normal biological, psychological, social and cultural processes of reproduction and early life, timely prevention and management of complications, consultation with and referral to other services, respecting women’s individual circumstances and views, and working in partnership with women to strengthen women’s own capabilities to care for themselves and their families” – Can we start to spread the word on this now please?

baby on back

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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Making Birth better: How research shapes practice #bbresearch17

Indulging in my passion for research, I am today reflecting on my time at  …an intimate conference made into a delightful day thanks to  & …More specifically …    &   …

I personally enjoyed this as a more intimate conference, where deeper conversations could get the brain working on what was really needed in maternity services and health research…Another reflection of the day can be seen on Steller here…

As you can see, we had a great line up for the day, and a fish and chip lunch no less!

Highlights for me include:

Stop sexualising breastfeeding!!!! The great presentation by

Learning about associated with at with

Learning so much about at with Prof. Soo Downe

Getting a wave from miles away from  across the miles sending & midwifery love to us all …..❤️

Powerful words from at …. how do we cope as midwives, & ensure excellence in maternity care?

And of course.. # learning all about making sure that blood goes to baby with  with ❤️

Learning about the barriers to identifying poor shared by prof at  with 🎓

Yet there were a couple of overarching themes that came from the day…including….

 

Thank you to everyone who came to see these wonderful presentations (including those who came to see my own presentation of course – you gave me lots to think about!)!…and thank you all for such an intimate and heartwarming day discussing my favorite topic…Research in Midwifery 😍…

 

And a last word from the Head of Midwifery at Hinchingbrooke  Hospital….(Heather Gallagher)…..

bbresearch

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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‘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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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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Why we should welcome feedback and listen to those who raise concerns in both healthcare and research

Criticism and feedback can feel uncomfortable to both give and receive. It can be an awkward exchange, where both parties may be reluctant to let their guard down, concede to oversights, reveal any flaws and relinquish any feelings of responsibility. It can also be incredibly frustrating on both sides.

Image result for writing frustration

But lets look at both sides of the coin rationally. Firstly, Why would someone offer feedback?

  • They want to make something better
  • They see an opportunity to improve something
  • They want to help you
  • They want something corrected
  • You, or someone else have asked them for feedback
  • They want to offer you their unique outsider/fresh eyes view of something that you may not be privy to.

These are all gifts, learning opportunities and avenues toward creating our best outputs. Here, we theorise that everyone who offers feedback has good intentions, which some may argue is unrealistic and naive. However, I am personally unwilling to lose out on the potentially invaluable gold dust of feedback for the sake of those who wish to meddle in mischief. The vast majority of those who enter both the healthcare and academic professions do so in order to contribute positively.

In order to feel valued and perform to the best of their abilities, healthcare staff must feel heard. This is the same for those in research. As such, whether we agree with the feedback we are given, it must be heard, examined, considered and then either acted upon or rebutted respectfully.

If you are doing your best, feel passionately about what you are trying to achieve and have worked hard to achieve something amazing, it can be hard to hear that there may be cracks in your work, despite all of your well intended efforts. You are also in the job to give your best and contribute positively. But you cannot know everything…so keep listening to those who have the ‘fresh eyes’ to see what you may not.

Image result for ICEBERG OF IGNORANCE

Denial only denies you an opportunity to do better.

Lets look outside the box:

What is going on here?

Restaurant owner:

  • Wants her food to be good
  • Believes she has done her best
  • Defensive and protective about her achievements

Customer & Gordon Ramsey:

  • Wants good food
  • Wants mistakes corrected
  • Wants things to be better
  • Wants to be helpful and constructive
  • Has a new ‘Fresh eyes’ perspective from outside the organisation

The negative response to this feedback could mean:

  • The customer probably won’t return to the restaurant
  • The customer will avoid offering any further feedback
  • A missed opportunity to make things better
  • The expert will at some point back away from offering further assistance
  • The restaurant may fail to reach its full potential

FYI – These restaurant owners always achieve great things for their restaurants once they listen and act upon feedback

Reflection: Can we apply these roles to some of the roles active healthcare and research? (Including our own)!

Don’t despair!… If you get everything right, all of the time, you miss new opportunities to learn

Image result for take a chance

Some of my early academic papers were really very terrible. Some of the work I do now is muddled at first. I make mistakes, everyone does. I am in no way perfect, nor do I alone have all of the skills to change the world. I need help. I welcome help and input from those who can fill in for the skills I do not have and the knowledge I cannot yet see. This is why I welcome feedback and listen to those who raise concerns. In fact I grab every opportunity to do so.

In exchange for this, my work improves, I see new opportunities to thrive, new ideas are generated and collective collaborations make our outputs much stronger. Success.

If I had been steadfast in feeling that because I was so passionate about the work I was doing, nothing could possibly be wrong with it, then I would have missed the chance to create something better. Yes, it used to be frustrating to hear criticism. But this frustration can be turned around.

Once you see that a criticism is not a personal attack, it becomes a welcome guest.

Image result for welcome

More recently, I had a paper accepted ‘No revisions required’. I was worried. I wanted feedback, I wanted changes made, I wanted other people to weigh in on my work and check for anything I may have missed. This is because I knew it would be a stronger paper having been ripped apart and then put back together again….made better.

Everything I have ever done has always been made better when others have offered their ‘fresh eyed’ feedback. Here are my top tips for making the most out of feedback.

  • Welcome and invite it
  • Listen to it, consider it and evaluate it
  • Let down your defenses (It is not an attack – people want to help)
  • Feedback on your feedback – Tell them how it was used
  • Actively search for those who can offer a ‘fresh eyed’ perspective on your project
  • Never attack those who offer you valuable feedback (They will avoid doing it again!)
  • Know that it is OK not to be perfect, you cannot do everything all of the time
  • Avoid blinkered approaches like ‘I know what is best’ & ‘Nothing can be wrong because I worked so hard for it not to be’.
  • Offer your own feedback to others – It will not only help them, but it will make you feel good and contribute toward the collective goal!

We all want to be the best we can be. We need to role-model and make things better for everyone. We need to lift each other up with support and praise.

Let go of your defenses and welcome new opportunities for success.

Free stock photo of typography, school, training, board

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