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Description

In 2016, I entered as a joint Paper Coordinator for a third-year physiotherapy undergraduate module (Managing Complexity in the Community Environment). We inherited a paper that was very didactic in delivery and required the students to incorporate their collective knowledge on the module into one Summative Assessment as a written assignment. While the assignment had to be submitted to Turnitin for a review of plagiarism; students were also required to submit the same assignment to Blackboard for the purposes of marking. This seemed non-intuitive and open for error. Student reviews for the paper in 2015 were “average” to say the least, and as incumbent Coordinators, we agreed that we would utilise creative liberty to refresh the delivery and mode of assessment.

Reflection

We gathered up the teaching team to discuss a new approach to the assessment. The teaching had been delivered by four lecturers- all with their own specialty. The purpose of the paper was to demonstrate complexity in common physiotherapy conditions. With the teaching being delivered by four key lecturers- all with their own specialty- it was proposed that we adopt a problem-based learning approach, which used complex case scenarios from the four key areas as a mode to assist complex clinical reasoning and consideration of interprofessionals. These cases were delivered in small group teaching to enable discussion and exploration of the scenarios- some of which included blended learning through a virtual environment (myself) to incorporate resources they would readily utilise when on clinical and graduation, as well as to promote “investigation” of the scene- rather than providing all clinical features for the students.. .

We also wanted to emphasise the importance of good clinical documentation- in particular- referral letters to interprofessionals. Our first summative assessment, therefore, included submission of a 1 1/2 page referral letter (with 1/2 page of endnotes) that was submitted to Turnitin. By keeping the assessment relevant to the case scenarios presented in the small groups; the assessment clinically relevant; and also some creative licence (i.e. students came up with their own letterheads; business name; digital signature: and logo)- it made it all manageable for students. By submitting once to Turnitin and utilising the available marking tools (including cut and paste; user strings, etc) it made for easy turn over of feedback to students which was then utilised for the second summative assessment (clinical reasoning regarding the content of the letter).

So- this is where “To Turnitin” worked for us last year (2017):

  • Reflection on clinical problem-based learning
  • Rather than an “assignment”- assessment was relevant to a clinically useful skill that was not otherwise introduced (or assessed) in the programme (i.e. development of concise referral letters)
  • Develop consistent feedback strategies
    • Use of a Rubric for learning outcomes
    • Link comments in Turnitin directly to the learning outcomes
    • Use “QuickMarks” “Commonly Used in Turnitin
    • No information in the “User’s Comments” Section- feedback was to be provided “within” the assignment

This approach has been found to be successful by the teaching team, with the students quickly seeing the clinical relevance- rather than “just another assignment”.

Future use of Turnitin for this year (2018) may include the use of the audio feedback feature, or to consider the use of video feedback. This is something that has been used successfully in discussion with a colleague in the paramedicine department (LS). Turnitin_MCCE_Assignment

XXX_MCCE_ConcussionCase_2017

Feedback_Studio

 

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I have been using Evernote for a number of years now, though have not been conscious of how I use it. Here’s my reflection on what has worked for me:

  1. Get Premium. While the free account gets you going, I enjoy the fact that I can access the notes from a variety of devices- including offline and has a more powerful search facility (including searching pdfs and handwritten notes)
  2. Organise folders the same as email. I have used the GTD strategy of organising folders in my email. By replicating this in Evernote, I automatically organise appropriate documents into the right folder. Always problematic when you think that a key phase is best at the time, though makes no sense later on- better have the two systems using same “key words”
  3. Tag- if it works for you. Certainly helps for grouping. Personally, I find tagging more labour intensive as the built-in search tool and use of the folders above does me fine.  Others I know who use Evernote swear by the tagging…
  4. Know your Evernote email. This can be found by looking in your Account Info
  5. Know some shortcuts. When sending emails, know that:
    1. The beginning of the subject line will be the title of your note
    2. To pop your email straight into a known notebook, include “@” immediately followed by the appropriate notebook in the Subject field.
    3. Into tagging? Add “#” immediately followed by an existing tag in the Subject field
    4. Need a reminder? Include an exclamation point- e.g. Email Subject: Portfolio Meeting !2017/04/12
    5. Need all of the above? Then the order is Email Subject: [Title of Note] ![Reminder Date] @[Folder] #[Tag]
  6. Want to quickly present your info? The presentation tool is a quick and easy way to present what is in an Evernote note. Once in presentation mode, look to the far right where you can change the “Presentation Settings”, adding horizontal lines to your note to create the likes of slides…
  7. Install browser add-ins. Most browsers have add-ins that you can download to make clipping notes to Evernote a piece of cake!
  8. iOS IFTTT applets. The “if [this occurs] then do this” applets for iPhone and iPad are also handy. This might include converting your Reminders to a note, saving Instagram photos or Tweets to Evernote, quickly appending to a to-do (or shopping) note, or copying new Evernote to Onenote

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Describe

Our third year, semester one physiotherapy programme aims to integrate knowledge gained from the previous two years as well as “step up” from a NCEA level six to level seven paper (Table 1). This includes a shift from a more teacher-directed approach to that being mainly student-directed learning (SDL). This in itself required an integration of knowledge from multiple papers (fields), problem-solving unfamiliar (and at times complex) scenarios and learning through leading others in the development of problem solutions.  In student feedback of papers in semester one, year three, students identified as being (somewhat understandably) anxious of the workload; felt unclear as to where to start; and that “bringing it together” was overwhelming. These concerns, therefore, reflected on a paper that I coordinate (PHTY710) in that semester.

Table 1: NZQF Level Descriptors (adapted from Table 2, The New Zealand Qualifications Framework p30)

Dimension

Level 5 Level 6 Level 7 Level 8 Level 9 Level 10
Knowledge Broad operational or technical and theoretical knowledge within a specific field of work or study Specialised technical or theoretical knowledge with depth in a field of work or study Specialised technical or theoretical knowledge with depth in one or more fields of work or study Advanced technical and/or theoretical knowledge in a discipline or practice, involving a critical understanding of the underpinning key principles Highly specialised knowledge, some of which is at the forefront of knowledge, and a critical awareness of issues in a field of study or practice Knowledge at the most advanced frontier of a field of study or professional practice
Skills Select and apply a range of solutions to familiar and sometimes unfamiliar problems Analyse and generate solutions to familiar and unfamiliar problems Analyse, generate solutions to unfamiliar and sometimes complex problems Analyse, generate solutions to complex and sometimes unpredictable problems Develop and apply new skills and techniques to

existing or emerging problems

Critical reflection on existing knowledge or practice and the creation of new knowledge
  Select and apply a range of standard and non-standard processes relevant to the field of work or study Select and apply a range of standard and non-standard processes relevant to the field of work or study Select, adapt and apply a range of processes relevant to the field of work or study Evaluate and apply a range of processes relevant to the field of work or study Mastery of the field of study or practice to an advanced level  
Application [of knowledge and skills] Complete self- management of learning and performance within defined contexts Complete self- management of learning and performance within dynamic contexts Advanced generic skills and/or specialist knowledge

and skills in a professional context or field of study

Developing identification with a profession and/

or discipline through application of advanced generic skills and/or specialist knowledge and skills

Independent application of highly specialised

knowledge and skills within a discipline or professional practice

Sustained commitment to the professional integrity and to the development of new ideas or practices at the forefront of discipline or

professional practice

  Some responsibility for the management of learning and performance of others Responsibility for leadership within dynamic contexts   Some responsibility for integrity of profession or discipline

Some responsibility for leadership within the profession or discipline

In order to capture anticipated SDL habits, barriers to learning and confidence in skills related to the paper. To do this I developed a Google Form survey which was delivered in the first lecture of the paper. First, I mapped out the types of questions I wanted to include (study group involvement; anticipated SDL hours; barriers to learning; and confidence in practical assessment and treatment skills). From there, development of the Google Form survey was relatively easy.  On opening a new form, a brief description was provided. While I had just done this verbally in the lecture, I wanted to acknowledge that the purpose of students entering their personal email was to receive in individual “snapshot” of their learning (which they could return to compare at a later date). Lecturers did not respond to individual reflections, rather, looked at the overall summary.

Benefits

I chose Google Forms to develop the survey for a number of reasons that were beneficial:

  1. It is free. While there are other online survey platforms available, they sometimes come with limits to access to some of the editing tools and/ or how many responses you are able to collect before you have to pay. Google Forms does not have these limits and has some third-party plugins that can be utilised to export data into other software platforms
  2. It is linked to Google Drive. As a novice to Google Drive, I have been trying to utilise it as best I can. Like other “cloud-based” storage systems, you are able to share a link to the document; and can edit to meet your needs as time goes by. Previously I have set up a link to a document/ form with a Bitly address or QR Code to find that it is “not quite right”, though adapting the form would require changing the link and code. With Google Drive, you do not need to make these changes as long as the original document you are amending is in the Drive.
  3. It is (mostly) familiar. Students here in New Zealand have been made aware of the use of Google Drive and Google for Education platform since primary school (year three- 6-7-year-olds). Therefore, access, the look, expectations for submission did not need too much explanation.
  4. Data can be exported. Again, similar to (1) above, the quantitative and qualitative data can be easily exported to third-party platforms freely. While analysis could be made in Google Sheets- I am personally still too familiar with formulas in Excel to give that up.

Constraints

  1. It requires smart devices or laptops to work. If you want to capture data immediately (as was the case for this survey to enable a 24hour turnaround of interpretation to direct integration in the tutorials)- then students need to have brought their devices with them. This could be pre-empted by sending an announcement to the student prior to the lecture.
  2. It requires reliable wifi. A couple of years ago- this would have been problematic in our University, though thankfully, not the case now. This is something to consider for those that are performing the survey at a distance or in remote, rural areas.
  3. It is not familiar with non-school leavers. As this was a class of third-year students, the majority had transitioned to having smart devices and use of technology. The format of online surveys was less familiar to those that had not recently left the secondary school environment. That said- I had no “mature” students identify an issue with completing the survey, and as I could see the names of the respondents, they had completed the form just as ably as their younger counterparts…

Reflection

As the survey was conducted in the lecture, the response rate was 93% (120/ 129). The summary of results was collated easily as was using Google Forms analytics. The result summaries were then used to develop the tutorials for that week (i.e. the next three days) and were presented to the small groups which are between 18 and 25 students.

Study work barriers

This survey found that less than half (48.3%) had not established themselves in study groups. As this was the beginning of a new year, students are rearranged into new groups according to the papers they are taking- therefore may have had an effect on already established groups. 44% (n=57) indicated that they would be studying alongside work commitments; 1% (n=9) with high-level sports commitments; 28% (n=36) had a family commitment that may be barriers to their SDL for the paper. These barriers were not surprising, though the extent to how many were required to continue to work, sport and family commitments was somewhat revealing. The work-study-life balance is one that potentially requires more emphasis as students enter full-time study and/ or when the academic level of expectations increases.

In a recent survey across seven universities in Canada, students expressed concern with balancing work, family, and education (20.8%), failing to set aside enough time for study while meeting personal, family and social obligations (14.4%) (Sauve, Fortin, Viger, & Landry,  2018). In a sample population of 2291 college and university  students aged 18- 26 years of age, it was found that working while studying reduced the amount of time spent in class by 47 minutes and on SDL by 56 minutes, with other extracurricular activities (i.e. sport) lead to 22 minutes less SDL. (Crispin & Nickolaou, 2018).

SDL Hours

It was also interesting to see the overestimate of SDL hours that students felt they would be completing towards this paper. While the majority (58.3%) mentioned 5-9 hours; they were some that thought they would be committing 10- 14 hours (9.2%) or 15-19 hours (5%). If combined with other papers to be completed in the semester, this would equate to up to 76 SDL hours alone… A summary of the results was able to be presented during the tutorial time, as was reassurance that our expectation of SDL hours was much less than what some had indicated.

Confidence of Skills

The main purpose of the survey was to help the students to identify early what skills they were confident with as they entered the paper. Skills that the students were “less confident” with were integrated into the planning of the tutorials for the first week using problem-based learning. Some students just needed a few pointers as reassurance that they did know the information required, while for others it was a “gentle reminder” to include it in their study plan…

End of Semester Review

We issued the survey again at the end of the semester to identify progression and to focus again on skills that they were less confident with two weeks prior to the examinations. These practical skills were focused on in the “review” tutorials that were again case based.  It was pleasing to see that students identified an average of 9% improved confidence in performing all 34 skills (range 2- 19%). New skills introduced in the paper were also rated on confidence, though could be reviewed again before the students enter their “intern” fourth year of the programme.

References

Crispin, L.M. & Nicolaou, D. (2018). Work and play take school time away? The impact of extracurricular and work time on educational time for live-at-home college students. Applied Economics, 50(24), 2698- 2718. Doi: 10.1080/00036846.2017.1406656

Sauve, L., Fortin, A., Viger, C. & Landry, F. (2018). Ineffective learning strategies: a significant barrier to post-secondary perseverance. Journal of Further and Higher Education, 42(2), 205- 222. Doi: 10.1080/13504851.2017.1343443

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Description
I do find it difficult, at times, to engage students during a large lecture. Teaching a class of 120 to 190 physiotherapy students can be daunting- especially if I have got the “lunchtime lull” slot or are following on from a previous lecture that was content heavy. Asking questions to the students during a lecture sometimes feels… …forced, and at times it is the same students who are confident enough to answer, rather than a broad indicator of what the cohort are thinking. Wouldn’t it be great to have something that all students in the lecture theatre could contribute to? To have something that responds as answers are added? To have something that was visually appealing and could give a break to the didactic voice of the lecturer? So I entered “word cloud” into google and came up with MentiMeter (www.mentimeter.com).
Benefits
The use of word clouds provides a way for students to anonymously present their thoughts and “see” the collective priorities or important features of a given topic. It can also promote critical reasoning and be used as a platform for the lecturer to focus on the audience’s impression of a given topic. Word clouds have been utilised in healthcare education to provide reflection, integration of learning, critical thinking and development of interpersonal skills including online discussion (deNoyelles & Reyers-Foster, 2015; Volkert, 2018). The completed word cloud can then be provided to students as a study tool that summarises the discussed topic (Filatova, 2016).
I chose to use Mentimeter- a free online platform that produces interactive word clouds that are easily accessed by student’s smart devices, tablets or laptops via wifi. Any time that you want to ask the students a question, Mentimeter can be used to capture their responses on mass- live. A question is posed to the students, a code is provided, and students use the code to enter their answers. As answers are entered, they are pushed to the lecturers Mentimeter account and word cloud presentation. This immediately responds by centering the more “common” responses, while the less common (and sometimes irrelevant…) answers are pushed out to the edges.
Mentimeter does not limit the number of interactions or votes unlike other polling-type of platforms. Other than having word clouds used to open class discussion, the Mentimeter platform could be used for checking the student’s previous knowledge (quiz), reflect on their own knowledge (Likert scale), which when transferred to the lecturer account can provide an overview of feedback to help improve the next lecture.
Constraints
You are able to have THREE free Menti’s for your account, otherwise, you would need to upgrade (USD$7.99/ month billed annually as at July 2018). As the MentiMetor presentation is presented through the web, it, unfortunately, means that you need to keep swapping to/ from alternative presentation software (i.e. PowerPoint), rather than being embedded into a slide- though this is not too much of an issue.
There is also the requirement that in order to interact with the word cloud at the time of the lecture, students require an appropriate smart devices/ laptops and reliable internet connection. While this might limit some students, there is the opportunity to use peer’s devices and discussion can still be enabled with a few respondents to a given word cloud.
Deployment and Support
In a recent lecture with the physiotherapy students this year, I used menti.com  to encourage the students to engage- in this case, responding to the question- “how does the neuromuscular system change as we age?”. I positioned a slide with the link and code, which I left up while organising my end (www.mentimeter.com). This gave them some time to respond, though the link and code were still available when I swapped over to MultiMeter and hit “present”. While not all answered the question,  the number of student response was pleasing, especially as this was novel to them. It was also reassuring that as the more common (and appropriate) responses were gathered and centralised, with those that less relevant made smaller (and insignificant). When the question was closed down, I was then able to talk to the centralised concepts which lead on nicely to the next section of the lecture (see MentiMeter responses).
I have discussed the success with other lecturers, who have since gone on to use it for their own teaching and presentations (NT and NSW).
Future Application
In healthcare education, there is a need to integrate biomedical knowledge (i.e. pathologies and conditions) into case scenarios. Rather than provide all the clinical features that would help determine a given management, students may be given a “snippet” of information, then asked- “what now do you think?” By expressing their ideas through a word cloud,  the lecturer can be “student-directed” as to what they see as priorities or key features and be led by the discussion from there…
For future reference, I have created a tutorial video on how to create a word cloud using Menti (http://bit.ly/MentiWordCloud). I would be interesting to hear from others who have used Menti in their teaching and learning…
References
deNoyelles, A. & Reyers-Foster, B. (2015). Using word clouds in online discussions to support critical thinking and engagement. Journal of Asynchronous Learning Network, 19(4).
Filatova, O. (2016). More Than a Word Cloud. TESOL Journal 7(2), 438-448. Doi: 10.1002/tesj.251.
Volkert, D.R. (2018). Building Reflection with Word Clouds for Online RN to BSN Students. Nursing Education Perspectives, 39(1), 53-54. Doi: 10.1097/01.NEP.0000000000000159.

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Odyssey Simulators

Senses Places – the collective founded and led by Portugal’s Interdisciplinary artist Isabel Valverde – presented a program of work at this year’s Corporealidades Pós-humanas in Salvador, Brazil. Collaborators joined Isabel online at the Senses Places studio on Odyssey. Performers and audiences participated from Brazil via different portals including live streams and Second Life.

Senses Places uses different devices – wii-motes, motion sensors, webcams – to connect avatars to dancers and performers in real space. Dancer movements trigger movements in avatars online. These movements are then reinterpreted by dancers in real time (via projection), creating feedback loops and RL/VR interaction.

Here are some images documenting a Senses Places event at Corporealidades Pós-humanas, from Odyssey’s perspective.
(Images by liz solo – with Kikas Babenco, SaveMe Oh, Isabel Valverde)

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Odyssey Simulators

sensesplacesopensim_030Odyssey is proud to provide a home to Senses Places – a dance based mixed reality project by Isabel Valverde and collaborators. The project runs a mixed reality participatory environment on the Odyssey Simulator in Second Life and this week presented performances and demonstrations at the 2016 Open Sim Community Conference.

Here are some images from one of the performances at the conference.Dancers and other participants in RL (real life) link to their avatars via a webcam interface. The webcam picks up mocap points on the dancer’s body and translates the movement (via the internet) to the dancer’s avatar in world.

ABOUT SENSES PLACES from sensesplaces.org

Senses Places is a dance-technology collaborative project creating a playful mixed reality performance environment for audience participation. Generating whole body multimodal interfacings keen to a somatic cross-cultural approach, the project stresses an integration of simultaneous local and remote connections, where participants and environments…

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Written by Dr. Jim Lusted, Learning Designer/Senior Lecturer in Sport Studies

In November 2017 I took up an 8 month secondment as a Learning Designer (LD) with the Learning Technology team. I had been a Senior Lecturer in Sport Studies at Northampton since 2009 and saw this as a great opportunity to try something new for a while. This blog gives you a flavour of my experience of the LD secondment, what I learned about working in professional services.

Why a Learning Designer secondment?

I was attracted to the secondment for three main reasons. First, I had really enjoyed working with the Learning Technology team as a lecturer and had valued their support – through things like CAIeRO course design workshops, ABL development sessions and helping me solve NILE problems. I felt I could fit quite nicely into their team and would enjoy working with them. Second, I had become more interested in teaching and learning practice – particularly as a result of the University’s shift towards ABL, and felt the secondment would be a great way to develop my own skills and knowledge in this area. Third, in my role as programme leader I had enjoyed mentoring new and less experienced colleagues, so I wanted to see what it would be like supporting staff in a more formal role. I must also admit that after 9 years of working in the same role I also fancied a change of scenery – I was eager to try something new.

“…I learned more about T&L practice in my LD role than I had probably done in my whole teaching career up to that point – I had the head space to think about my practice rather than just be chasing my tail teaching sessions every week.”

Download and read Jim’s full reflections

Posted by & filed under birth rights, birth stories, birth story, birth trauma, midwifery, mother, mum, mummy, personal.

I have always had a passion for matters around pregnancy, birth and babies. For years I have enjoyed being a midwife, clinically in research and in teaching. My passion started at around 4 years old when my brother was born. Mesmerized by a growing belly and the fact that another human was coming in to the world, I read my mother’s antenatal books from cover to cover. Having just experienced the birth of my own baby, I felt compelled to write my own reflections and experiences down….

Please note: For personal reasons I would request that close family members do not read any further.

*Long post alert*

What happens when the midwife has a baby? We are people just like any other having a baby…right?…probably. Did I know too much?…Did that affect my choices? did I have a better choice and/or experience because I had ‘insider knowledge’?… One thing is certain. Having a baby as a midwife was unique for me.

The stick turned blue

Yes, our little Autumn baby was planned….and thankfully, we had no trouble conceiving our little darling, who was due to arrive conveniently after I had  been awarded my PhD. But my period being late and the pregnancy tests showing up negative confused me. This was my first experience of feeling as though ‘I should have known better’! … Of course, though I knew that all I was looking for was a little Human chorionic gonadotropin (hCG), the cheap sticks I had bought clearly were not sensitive enough to detect it…it took a friend to prompt me to spend a bit of extra cash on the test. Of course a fancy pants digital stick did the trick….Silly me. The midwife should have known better (was one of my first thoughts… and a recurrent theme throughout my pregnancy)! The pressure was on!

Of course when the stick did officially ‘turn blue’ my heart jumped into my mouth, knowing that this was an ‘oh sh*t’ moment. No take backsies. Yet, I have no idea why I panicked …it was planned after all! Perhaps it was because..

  1. My parents would know for sure that I was sexually active (ridiculous I know…especially as we have been together 18 years)!
  2. I really would need to finish my PhD in time
  3. Life was about to change for ever
  4. I think this pregnancy is a good thing (probably)

My unicorn was on her way..

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Choosing my care givers

Unlike many women who my just meet the nearest or most convenient midwife. I had the luxury of knowing a myriad of great midwives who could provide great care for me and my baby. I also had the luxury of knowing how and who to ask directly for what I wanted. I felt spoilt. This felt like a luxury that many women don’t have…but it was also a perfectly reasonable thing to be able to do. I was able to chose a midwife who I knew was ‘on the same page’… and who would care for me continuously throughout…Do all women get this opportunity?

Pregnancy symptoms

For years I have been caring for women with ligament pain, pelvic pain, odd sensations ad physical stresses and strains. Being pregnant myself meant that I could finally feel what I had been describing… ‘Ahh…that’s what hey mean by feeling a ‘twang”

One great benefit of being a pregnant midwife is also knowing what symptoms to worry about and what symptoms not to worry about. I imagine that this may have enabled me to experience somewhat less worry than others experiencing such things for the first time….In the beginning anyway!

To tell or not to tell…that is the question

Other than the midwives I knew, there were other care givers throughout my pregnancy who were meeting me for the first time. They all began with the usual spiel about risks/benefits/routine and procedure. The question is (or was).. do I let them go on talking like I know nothing.. or do I let them know that I am a midwife who is used to spouting this spiel myself.

In not telling them, I felt like a fraud.. Like I was making a fool of them… But in telling them of my profession, I felt as though I would be giving up my status as a ‘regular’ maternity service user. My cover would essentially be blown.

A desire for honesty got the better of me. I told all new care givers that I was a midwife. The following happened:

  1. Clinicians dropped any facade of being ‘ultra professional’ – They became more friendly… like we were ‘on the same team’.
  2. I was told frequently ‘Well you know all of this already so I won’t repeat it’

As they did this, I felt a mix of emotions. On the one hand…I felt truly part of the team…a sense of power and autonomy…On the other hand… I felt like I no longer had the safety net of being ‘nurtured’ through my pregnancy. Was I missing out?..I’m not sure. But I was no longer treated as a ‘regular pregnant woman’.

Choosing my own care pathways

In my experience as a midwife, I have seen how some professionals can dismiss the thoughts, feelings and desires of women wanting to make decisions in relation to their own care pathways. For more on this, please see Michelle Quashie @QuashieMichelle 

As such, I sometimes had to fight hard to make sure that the women in my care got what they wanted. I was expecting to have the same fight.

However, I found that once people realised that I was a midwife, they were more willing to trust that my own decisions were informed decisions. They seemed less intent on trying to persuade me one way or another. They seemed to respect and accept my choice more than I had seen some maternity staff respect the choices of other women.

For me this highlighted issues around respecting women’s choice. When do we feel that women can make their own choices without question?…and when do women’s choices cause clinicians concern?….

Whatever the opinion of others… I, as a midwife could seemingly make any choice I wanted with ease…. Is this the same for all? I think not.

Image may contain: ultrasound

Birth choices

I have actually known what my own birth choice would be for a long time now. My main fear was that my choice would be made unavailable to me. Pre-conceptually I had consulted the obstetric team to discuss my birth choices…Would they be facilitated? because if not…did I really want to get pregnant in the first place?… the answer was ‘Let’s wait and see once you get pregnant’…Damn. I was really looking for a signed deal beforehand.

Once I became pregnant of course, they held all of the cards. I was pregnant…. trapped… The baby had to come out somehow, but I was beholden to them.. as they were the ones who would decide whether or not to facilitate my choice. This also altered the power balance and really made me feel vulnerable… at the mercy of those with the power to say yes or no. It was not a nice place to be.

My midwife, and my consultant midwife were 100% supportive of my decision, but they were not in a position to sign on the dotted line. I wanted a beautiful planned cesarean section. Something which goes against the grain for some.

When it came to meeting the consultant team, I was nervous about what they would ‘allow’. Now… I hate the word ‘allow‘ in maternity services, but this is how it felt. I was asking permission to have this… asking them to facilitate this. They had the power to say no. As a midwife, I believe I knew the right things to say to maximize my chances of them agreeing to my birth choice. I also had all of the up to date guidelines and research to back up my arguments should I need them. I was still nervously holding my breath.

There was some resistance, I had some extra appointments and some hoops to jump through, but with some firm words and some strong midwifery back up, I was able to get my birth choice ‘agreed’ or ‘allowed’.  Though the clinical reasons for my birth choice are too complex to explain here, it felt as though my decision making was not so trusted by other professionals in this case. I also had to repeatedly sit and listen to the list of risks involved, and be repeatedly asked if I had wanted to change my mind. Would this be the case if I had chosen a vaginal birth?

The sense of relief was immense…I could finally start to look forward to the birth and enjoy my pregnancy!

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Though this relief could have come much earlier for me… having the obstetric team on board pre-conceptually would have made my experience so much better!

What I really wanted to do was have my birth choice go unquestioned. I wanted to know all of the facts and then be trusted to make my own decision. Doesn’t every person want this?…

A “good birth” goes beyond having a healthy baby…

But I felt as though I may be denied my choice if it did not conform with what the health professional believed was the ‘right’ decision… This was utterly terrifying. The consequences of my choice being denied would literally mean that I would have less control over what would happen to my body. This was a horrifying thought. I would literally be forced to have a vaginal birth against my will. This is literally how the reality  felt.

For more information around birth rights see: @birthrightsorg

These experiences in relation to birth choices got me thinking about ‘informed’ choice in maternity care…

Everyone is ever so concerned about gaining ‘informed’ consent (and rightly so)… but is it disconcerting that we forever talk about the risks of Cesarean section and rarely the benefits? Equally…do we (as healthcare professionals) inform women of the risks of a vaginal birth? or a hospital birth? Wouldn’t that be ‘true’ informed consent?

As a midwife, I have to admit that my favorite type of birth to be in attendance of is an uninterrupted home birth….they are fab!… but that is my preference as a midwife. My preference as a mother was a cesarean section, and I have to ensure that I remain objective in respect to all women’s choices regardless of these facts.

At the end of the day.. a baby is coming out of you. There are a variety of ways in which this can happen. Should there be a default or ‘preferred’ way? or is this ‘preferred’ way subjective to each and every woman? If so then we must stop talking about the ways in which we might prefer women to give birth…and instead celebrate women’s choice in pursuit of their own subjective ‘positive birth’.

See here about the myths associated with positive birth

In my case, I felt a solidarity with Helen George from Call the Midwife, who was shamed for choosing to have a cesarean section. I also identified with some of the reasons she gave for her very personal choice. Of course there are many other reasons why women may choose a cesarean section. Some have been explored in the following paper:

Why do women request an elective cesarean delivery for non-medical reasons? A systematic review of the qualitative literature

From my perspective…the ‘rights’ and ‘wrongs’ of one’s birth choices are too subjective to ever cast judgment upon.

Challenging poor practice

The care I received from the English maternity services in my area was fantastic….For the most part. Unfortunately I did encounter one incidence of poor practice. Sadly this episode warranted escalation.

As a midwife, I know my duty is to take further action (escalate) mistakes in practice where appropriate. However, as a mother, I was nervous about escalating the poor practice of someone whom I relied on for my care (and to facilitate my birth choices). Would they take revenge? would I loose my place of birth? or would my birth choices be taken from me?…It was a very vulnerable position to be in.

“After all…If you complain to the chef..they may spit in your food.”

Thankfully, with the support of my midwife, I am now working with the General Medical Council (GMC) to ensure that other mothers and babies can be protected from the same actions being repeated.

Aside from this… as a midwife, I feel highly privileged that I was able to spot this poor practice and call it out. Another pregnant woman (non-midwife) may not have spotted this poor practice, and been put at risk unknowingly. This highlights how vulnerable women may be, as they trust us all with their (and their babies) lives. Here the role of the midwife as an advocate becomes even more important for those who cannot always safeguard their own care.

Patient & Public Involvement in research

INVOLVE briefings state that there is an important distinction to be made between the perspectives of the public and the perspectives of people who have a professional role in health and social care services. As midwives are not considered to be patients under this guidance, I have felt unable to participate in Patient and Public Involvement (PPI) activities during my pregnancy. This was difficult, as I would have loved to have participated in PPI whilst pregnant in order to contribute to the improvement of maternity services from a user perspective. This issue is worthy of further discussion… after all, health professionals can be ‘patients’ too right?

Antenatal education

My husband is surely sick of my chums and I always talking pregnancy and birth…and of course passion for the profession can get a little sickly for some. So, I wanted the father of my baby to hear what I already knew from someone other than me. I didn’t want him to rely on me for information…after all, I may come across as a know it all rather than an equal partner in his parenting journey. So we went to NCT classes.

The classes were great and the information was sound….Yet, as a midwife… I could feel myself wanting to ‘approve’ of the information given out to the group.

During the challenges set out for us as a group, I was anxious. What if I got a question wrong? or stuck an anatomy sticker in the wrong place?

oh the shame!

Thankfully, I made no mistakes and my midwifery knowledge held strong. Yet again, I felt compelled to disclose my profession to the group. Not to do so felt dishonest somehow, like I was tricking them into thinking I was new to pregnancy and birth from all perspectives…and not just from a parental one. As such, I was relied upon at times for the lived experience of maternity services. People were also generally glad to have me on their ‘team’ during group challenges.

At the end of the course, I think my husband was glad to learn from someone perhaps more objective than myself. I also think that hearing the facts from another birth educator strengthened my husbands faith in what I had been saying all along…For example.. he now trusts that it is indeed OK to have a glass of wine whilst breastfeeding (Very important)!

And just like any other mum of course… I needed to meet other people sharing the same journey as I was.

And so little ‘Loveday Alice Pezaro’ came into the world. I had the perfect ‘positive’ birth (for me).. The breastfeeding is going wonderfully…and we are now knee deep in baby sensory groups and Costa Coffee chats. This experience from the other side of the fence has provided me with more empathy for women and more passion for womens rights in childbirth. The journey was less scary than I thought it might be. But…………………

What if I can’t breastfeed?

This was another real fear for me…having supported so many other women to breastfeed… what if I couldn’t do it myself? I mean… if the midwife can’t do it…What hope is there? 😮😨😩

These types of fears and anxieties resonate with other midwives who find themselves becoming mothers…In fact, the very pertinent research of my friend and mentor Dr. Sarah Church demonstrates how;

“a reliance on professional knowledge may create opportunities for choice and increased autonomy in some situations, although the need for intervention during childbirth, for example, may challenge the degree of autonomy exercised by midwives and the choices available to them. As knowledgeable experts, midwives demonstrate a very different understanding of risk and safety in relation to their own experiences of childbirth. Professional knowledge may increase their anxieties which may not be addressed appropriately by caregivers due to their professional status. The use of knowledge in this way highlights potential conflict between their position as midwives and their experience as mothers, illustrating that midwives’ ability to exercise agency and autonomy in relation to their pregnancy and childbirth experiences is potentially problematic.”

Final thoughts and reflections

  • Being pregnant as a midwife increased both my anxieties and my autonomy.
  • My professional knowledge impacted significantly upon my own perceptions around risk and safety in maternity
  • As a midwife I knew how to best ‘get’ my birth choices.
  • I felt vulnerable at times, especially in calling out poor practice.
  • I felt as though I was treated differently because of my professional background
  • The pressure to ‘get it right’ was always on.

In conclusion, the whole experience of childbearing was much better than I thought it would ever be. I feared much more than I needed to, and in retrospect, I had a wonderful experience. If only I could have anticipated such good outcomes in advance…the fear of the ‘worst’ happening may have never been an issue. One thing is for sure. My experience of being on the other side of the fence will enrich my midwifery practice forever.

On another note..There are so many wonderful midwives and initiatives out there making births better for women and their babies…There are not enough words to mention all of their wonderful work in this single blog. But I would urge further reading around the following groups:

@birthrightsorg

@MatExpBazaar

@NatMatVoicesorg

@BirthChoiceUK 

@birthpositive 

…and Many more (happy to add to this list if suggestions are given)!

My baby ❤ ‘Loveday Alice’

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

Follow me via @SallyPezaroThe Academic MidwifeThis blog

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