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The History of the Midwife

 

The following post is a guest blog by Nicole Allen:

woman carrying newborn baby

We all know the process of childbirth, but it’s no less magical. Advances in science make the procedure very safe for both the baby and the mother in most countries. It’s routine for most hospitals, except in rare cases when the patient experiences complications. But this wasn’t always the case.

There are countless faces of midwives whose knowledge was passed on from generation to generation. Even today, there are would-be mothers in some parts of the world with no access to doctors who rely on midwives to deliver their babies.

“Midwife”, the common term used for a birthing assistant, comes from Middle English and literally means “with a woman”. In France, they call her (or him; there are male midwives) a “sage-femme” or “wise woman.” The profession predates the medical and nursing professions.

The Prehistoric Way of Giving Birth

Our many-time great-grandmothers birthed their babies with the help of midwives dating back at least as far as biblical times and probably before recorded history. The earliest evidence of the existence of midwifery can be traced back to an ancient Egyptian papyrus (1550 BC). This shows that midwives assisted women in child delivery for more than 2,000 years without assistance from trained professionals.

pregnant woman holding petaled flowers

The American Way of Giving Birth

In the early American colonies, children were birthed with the help of skilled and practised midwives who came from Britain, who in turn transferred these same skills to other women in an informal manner. Later, when West African midwives reached the shores of America to be used as slaves, they assisted in birth too.

After their emancipation, African-American midwives offered their care to poor women,  in the rural parts of the South and were called “granny midwives.”

The American Indian tribes women continued to practice their own cultural birthing tradition, too, which sometimes included a midwife, female friend or relative.

The family experience of home birth narrated by Dervla Murphy in the book Untangling the Maternity Crisis supported the fact that most childbirth during the early 1900s was done at home. She was delivered at home in 1931.

Childbirth then was a regular occurrence at home and did not stimulate anxiety. Midwives were a familiar neighborhood figure who carried a big black bag during the birth of a neighbor.

person touching person's belly

The Medical Way of Giving Birth

In the last half of the 1800s, when medicine was professionalized in the US, midwifery became threatened as laws requiring formal education were slowly extended to midwives. Even though there were few midwifery schools, midwives were still needed and could not be totally eradicated since some doctors were unwilling to cater to poor populations. Some midwives continued to practice until the 1920s without government control.

It was in the 1910s and ’20s, the doctors started to lay down the foundation of a pathology-oriented childbirth medical model and usurp the traditional roles of midwives.

First, two studies found that the training most obstetricians received was poor and that hospitalization during birth would improve it. The poor, who most needed midwives, could go to charity hospitals instead. This would give the doctors more practice as well.

Then, in 1914, “twilight sleep”—delivery where the woman is anesthetized with a combination of morphine and scopolamine—was introduced. It was intended to relieve the pain and remove the memory of giving birth. This was widely accepted and desired by upper-class women.

About this time, a Dr. Joseph DeLee described childbirth as a destructive pathological process that damages the mother and the baby, and the only way to minimize this was through medically attended childbirth.

This claim made it impossible for midwives to facilitate child birth and made the use of ether, sedatives, forceps, and episiotomies routine. Child birth went from a physiological process to one in which the course of labor must be tightly controlled.

The value of midwives is being relearned, but there are new concerns.

Help for trauma

In more recent years, an aspect of the midwifery profession that is being looked into is the difficulties the midwives themselves experience during delivery. For instance, if s/he attends a traumatic birth, oftentimes s/he alone is there to handle it.

A 2015  study on the emotional and traumatic work of midwives and the commonly adversarial relationship with obstetricians (aptly titled “Midwives Overboard!”) shows that midwives may end up developing psychological and behavioral symptoms of distress, including compassion fatigue, post-traumatic stress disorder (PTSD), and secondary traumatic stress.

The United Nations Population Fund (UNFPA)’s increasing interest in the role of midwives underscores their importance in delivering children. Midwives play an important role in the achievement of its millennium development goals: reducing child mortality and eradicating maternal death. Midwives are a key element in the delivery of sexual, reproductive, maternal and newborn health (SRMNH) care worldwide, especially in rural areas.

To improve the delivery of patient care as well as the staff experience, maternity services must invest in the mental health and the well-being of all midwives, including nurse-midwives and obstetric nurses.

blue and black USB cable

Also check out this article: Oh baby: seven things you probably didn’t know about midwives

Author Bio:
Nicole is a freelance writer and educator based in the Michigan and believes that her writing is an extension of her career as a tutor. She covers many topics like travel, mental health and education. She is a key contributor at Chapters Capistrano where she covers topics like addiction recovery, holistic treatments and health education. When she isn’t writing, you might find Nicole running, hiking, and swimming. She has participated in several 10K races and hopes to compete in a marathon one day.

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A Call for Research Participants: Maternity Staff & Service Users Required

recruitment poster hEDS womens survey

We are currently looking for people who meet the following criteria to complete an online survey in relation to their childbearing experiences:

  • Women who have been diagnosed with either hypermobile Ehlers-Danlos Syndrome and (hEDS), Hypermobility Spectrum Disorders (HSD), EDS type III, EDS hypermobility type, or Joint Hypermobility Syndrome
  • Those who are over the age of 18 years
  • Those who have given birth in either the UK, Ireland, USA, Canada New Zealand, or Australia since 2007

If you meet the above criteria and would like to complete this survey then

please click HERE

What is the purpose of this survey?

  •          To identify the childbearing outcomes associated with hypermobile Ehlers Danlos Syndrome (hEDS) or Hypermobility Spectrum Disorders (HSD)
  •          To explore experiences of maternity care among women with hEDS/HSD
  •          To evaluate the impact of recently published maternity care considerations for that childbearing the context of a hEDS/EDS diagnosis
  •          To identify ways in which maternity care could be improved for women with hEDS/ HSD.

——————————————————————————————————————————

recruitment poster hEDS maternity staff survey

We are also looking for maternity staff  (anyone who provides clinical care to childbearing women) in the UK, Ireland, USA, Canada, New Zealand, or Australia to complete a 20 minute questionnaire about providing maternity care to women with hypermobile Ehlers-Danlos syndrome (hEDS) and/or Hypermobility Spectrum Disorders (HSD)

If you are a maternity staff member and would like to complete this survey,

please click HERE 

Please note: To participate, you DO NOT need to have knowledge or experience of caring for women with hEDS/HSD.

If you are a maternity staff member and would like to complete this survey,

please click HERE 

ED Society site

What is the purpose of this survey?

To explore awareness and knowledge of hypermobile Ehlers-Danlos Syndrome and (hEDS) and Hypermobility Spectrum Disorders (HSD) among maternity staff To explore what decisions maternity staff may make when caring for a women with hEDS/HSD To indicate how maternity staff could be supported to care for women with hEDS/HSD. A 2018 review was published which detailed maternity care considerations for women with hEDS/HSD. For participants who have read this review, this survey will also explore whether and how understanding and practice related to hEDS/HSD may have been impacted. Please note that if you have not read this review, you can still complete this survey.

Image result for online survey

Types of staff we want to hear from:

  • Consultant midwife
  • Senior midwife
  • Midwife
  • Student midwife
  • Nurse midwife
  • Maternity support worker
  • Junior obstetrician
  • Obstetric registrar
  • Consultant obstetrician
  • Junior anaesthetist
  • Consultant anaesthetist
  • Obstetric nurse
  • Physiotherapist
  • General Practitioner (GP)…etc.

If you are a maternity staff member and would like to complete this survey,

please click HERE 

@JennytheM poem

——————————————————————————————————————————

Follow this entire project online with #EDSMaternity

@GemmaSPearce @SallyPezaro@DrEReinhold@LaurenMPurdy

We will share the results when they become available!

Thanks to everyone who has completed & shared this survey so far!

Thanks

Follow me via @SallyPezaroThe Academic MidwifeThis blog

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

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What is Co-creation? Examples, definitions, meanings and insights from the #CoCreatingWelfare project

On the 10th of May 2019, I was invited to an event to celebrate the successes and challenges of Co-Creation, and the wonder of working together, fully, actively and with a shared philosophy. This was definitely an area I was keen to learn more about and a methodology I was keen to use in my research…I was intrigued.

The event was funded by and centered around the 3-year European project ‘Co-Creating Welfare’, designed to improve the implementation of Co-Creation in the welfare sector. This event happened toward the end of the project. It was conducted in partnership with colleagues in Denmark, France, Portugal and the UK, and led by Dr Gemma Pearce and Paul Magee from Coventry University.

ccw-project.eu

Access full details to the  project here. 

project partners

Here is Dr Gemma Pearce in action (@GemmaSPearce )

Here is Paul Magee in action (@Paul_IDTU )

Paul Magee

definition

Six principles for co-creation

1. Co-creation is innovative and aims to create new prosperity in a local context
2. Co-creation creates new qualities through combinations of different resources
and skills
3. Co-creation is a dialogue-based process, where the different actors define the
challenge and the solution together
4. Co-creation propagates initiative and the rights for all to participate
5. Co-creation creates an understanding of interdependence
6. Co-creation requires openness and willingness to take risks

“The Danish NGO “The Voluntary Council”

brown dried leaves on sand

Presentations from co-creators showcased their collaborative activities, barriers, opportunities and provided tangible case-studies of practice with practical, bite-sized tools to compliment delegates’ own work.

Obviously, as a midwife I was keen to hear

Always Events® are defined as “those aspects of the patient and family experience that
should always occur when patients interact with healthcare professionals and the
delivery system.”

Always Events is a trade marked product owned by the Institute of Healthcare Improvement. It was originally developed by the Picker Institute in the USA – http://www.ihi.org

 for more…

NHS Mandate states that by 2020 we must: ‘improve the percentage
of NHS staff who report that patient and service user feedback is
used to make informed improvement decisions’

⁦The amazing ⁦⁩ shared insights about participatory appraisal as a tool for engaging with communities. Mapping creatively leads to different outcomes 👏🙌🎉😀

   created a lovely space for learning, sharing & thinking time. Follow  for more.

One participant said…

“thanks all, I’m energized & inspired.”

A great presentation from Trupti of all about the project and what they have learned so far about co-creation!

A fun, innovative approach to engaging staff and students in curriculum and course design 😃 was explained by

inspires us all as she shares her research in in health technologies.

So then we got to immerse ourselves in co-creation… What did this look like?

white and black Together We Create graffiti wall decor
 

Being introduced to the ‘CUBE’

A Co-Creating Welfare Activity

You can learn more about the CUBE via the video below…

Using the CUBE, we were asked ‘What gets in the way of a truly co-creative culture?’...then we were engaged in co-creation activities facilitated by &  outputs were co-created by  …The following videos summarize what followed…

 

Participants were also asked to use the CUbe in co-creation facilitated by &  …here is a a summary presentation of this activity by  ..

 

And again..the CUbe was used in co-creation, facilitated by &  see the outputs here presented by

 

…and yet more insights presented here by

 

Some were inspired to break down barriers with Playdoh…

 

Some used Lego to co-create. The following was co-created by  &  

So what makes co-creation different?

charts

Through Co-Creation, all stakeholders are involved in shaping the decisions that impact them….

What did I learn?

love to learn pencil signage on wall near walking man

What is co-creation not…

-Not financial
– Not top down decision-making
– Not telling and selling
– Staff dictating terms of reference
– Cannot be forced
– Staff persuading/influencing people about the change area
– Not managerial
– Not about exclusion
– Not about paying lip service
– Not driven by organisational priorities
– Not having a shared goal or purpose
– Not being asked for service user input and then the project not happening
– Not one person’s idea
– Not about reaching an outcome in a defined time
– Not institutional or increasing red tape
– Clients not receiving feedback about the changes
– Not ticking an inspectorate box

What is Co-Creation?

Some people may call it cocreation, co-creation, coproduction, co-production, codesign, co-design, coproduce, co-produce and/or co-construction. People who co-create are ‘Co-creators’, and this is how they define Co-creation….

-Meeting people – Connecting, talking, sharing
– Developing shared understanding and vision
– Active engagement
– Making people feel heard
– Having shared processes and shared outputs
– No assumptions
– Patients are humans, not processes or policies
– Importance of listening
– Ensuring you get input from a range of groups, not just those most easily
accessible or articulate
– Developing a shared list of objectives
– Opportunities for clients to make a change
– The importance to allow time to build relationships
– Accessible and flexible
– Creative
– Celebrating success together
– The process that facilitates stakeholders to have equal status and value in
the creation of a process, product or service
– Helping staff to also feel heard and on board
– Adaptable approaches to client engagement
– Ensuring we meander everywhere
– Importance of equality of voices in shaping services
– Making clients feel valued in their care and giving them purpose
– Importance of not over-defining scope which can limit creativity
– Seeing things from peoples’ perspective

please stay on the path signage

Example rules for co-creation

-Contribute to the co-creation community through their experiences, skills and time;
-Distribute leadership responsibilities and collectively share co-creation community-Engage in insightful and non-threatening discussions of ideas and experiences;
-Be respectful and use appropriate language in team discussions;
-Listen and respond to each other with open and constructive minds;
-Be willing to share challenges, lessons learned, constraints / barriers faced and
successes;
-Not be afraid to respectfully challenge each other by asking questions;
-Will refrain from personal attacks;
-Be committed to build on each member’s strengths;
-Be committed to help others to improve areas that need further development;
-Use short, clear sentences and avoid using obscure expressions without an
explanation;
-Be committed to search for opportunities for consensus or compromise, and for
creative solutions;
-Be willing to contribute to an atmosphere of problem solving;
-Promote their personal and professional goals through participation in the cocreation community.

(Centres for Disease Control and Prevention, 2016)

 

What does a co-creation event look like in practice?

English Co-production Network Exploration Event from At The Moment Productions on Vimeo.

takeaway

My Takeaways…

cococo

Breaking down the co-creation process into three manageable chunks certainly makes it easier for me to think about how to structure my own co-creation activities in future…

  • Stage One: Co-Define

  • Stage Two: Co-Design

  • Stage Three: Co-refine

postcard toolkit

Free information loaded postcards to takeaway means that I can now refer to what I have learnt on the go to support me in co-creating ‘on the move’…

Seven co-creation activities to use in practice…

  1. The Q Sort Activity, which is an activity to experience collaborative work and collective problem formulation.
  2. Role Play Activity, which is an activity to experience how to collect ideas and knowledge to solve a concrete challenge.
  3. Story Cubes Activity, which is an activity to experience the creation of common narratives related to a challenge or solution.
  4. Fish Bowl Activity, which is an activity to experience collaborative problem solving.
  5. Meta Plan Activity, which is an activity to experience how to draw on the existing knowledge within a group.
  6. Pecha Kucha Activity, which is a dynamic presentation method.
  7. The Cube Activity, which is a method to support a creative brain storm activity.

I am also fascinated by the amazing ‘SPRINT’ methodology (from Google Venture) introduced to us by the inspiring @dietercise . I will certainly be implementing this methodology into my future work. Learn more via the media below…

Image result for sprint methodology

How does SPRINT work in practice?

Get access to the full co-creation toolkit associated with this project here. Currently, this site shows the project process, but in Sept 2019 it will be revised and updated to it’s final version.

Lastly, it is important to remember that…

Thank you to everyone involved in the #CoCreatingWelfare project for supporting the development of personal and inter personal skills in co-creation for all!

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

Follow me via @SallyPezaroThe Academic MidwifeThis blog

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

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What is critical analysis?

So…you want to know how to write a critical analysis essay? As an academic, I am often asked the following questions:

Image result for questions

man wearing white top using MacBook

Critiquing doesn’t mean that you are simply critical in identifying everything bad. After all, one can be a ‘critically acclaimed’ actor. Instead, one has to tease out both the good and the bad. You will also need to decide how much value you will place on any evidence you find, look at the alternatives and decide how you might apply your findings in the real world. Your arguments should be backed up with evidence throughout.

Types of evidence ranked in order of quality from high to low…

1280px-Research_design_and_evidence.svg

A linear representation of critical analysis

critical analysis
Adapted from Plymouth University (2008)
woman in gray top

The critical analysis cycle

Critical analysis cycle
  • Their tone is personal and familiar rather than academic in nature
  • They rely too heavily on the work of others without presenting their own evidence based arguments
  • They make bold statements without citing their sources of evidence
  • They rely too heavily on description without analysing and evaluating the materials under critique (We can read the material ourselves if description is all we want!)
  • Their arguments lack structure and there is limited evidence of wider reading

brain-1295128_960_720

So how can we move from being descriptive to being critically analytic? The table below outlines the difference between the two…

Descriptive

Critically Analytic

States what happened Identifies the significance
States what something is like Identifies the significance
Gives the story so far Evaluates strengths and weaknesses
States the order things in which things happened Weighs one piece of information against another Makes reasoned judgments
Says how to do something Argues a case according to the evidence
Explains what a theory says Shows why something is relevant or suitable
Explains how something works Indicates why something will work best
Notes the methods used Identifies whether something is appropriate or suitable
Says when something occurred Weighs up the importance of the component parts
States the different components Evaluates the relative significance of details Structures information in order of importance
States options Lists details Shows the relevance of links between pieces of information
Lists in any order States links between items Draws conclusions Identifies why the timing is of importance
Gives information Gives the reasons for selecting each option
greyscale photography of skeleton

Looking at other examples

And remember…

  •  If you are a student writing an assignment, use this guide together with any assignment specific brief, guideline or marking criteria you may also have been given relating directly to your course.
  • It is also important to think about how you will apply your critical analysis to ‘real world’ scenarios – This requires a critical thinking approach, which many writers neglect.

keep calm and critique

Follow me via @SallyPezaroThe Academic MidwifeThis blog

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

References

  • Plymouth University. (2008) Critical Thinking. Plymouth: Plymouth University. [online]
    Available at: http://www2.warwick.ac.uk/study/cll/othercourses/itt/resource_bank/studyskills/study/rea
    dingskills/8_criticalthinking_summary1.pdf [Accessed 3.6.2015]
  • Foucault, M. (1981/1988). Practicing criticism (A. Sheridan, Trans.). In M. Foucault & L. D.
    Kritzman, (Ed), Politics, philosophy, culture: Interviews and other writings, 1977-1984 (pp. 152-158). New York, NY: Routledge.
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Midwifery Awards – A time to celebrate each other!

The success of our article published in the British journal of midwifery led to us being awarded ‘Highly Commended’ status in the category of ‘Team Impact Commitment’ via ‘The Real Impact Awards’ hosted by 

You can read more about that here. You can also download our article for FREE via the link below.

‘Hypermobile Ehlers-Danlos Syndrome during pregnancy, birth and beyond’

However, following the publication of this article, there were a number of nominations made for me to be awarded ‘Midwife of the Year’.

Image may contain: text that says "C BJM The British Journal of Midwifery Practice Awards 2019 Finalist"

Image may contain: text

THANK YOU TO EVERYONE WHO NOMINATED ME

On the 13th of February I attended the British Journal of Midwifery Conference and Awards Ceremony. The  was an inspiring event with many wonderful speakers. I was espeically gripped by Patrick O’Brien, asked ‘Should all women be entitled to a Caesarean section on request?’ – You can read more about his point of view here.

I was also in awe of Professor Marlene Sinclair asking ‘Is vaginal birth after caesarean section ever normal?’…Spoiler…yes it is! Speaking to Marlene before her presentation, she was so nervous. But she took the crowd by storm and walked away with a lifetime achievement award. So well deserved! Here she is below with Professor Dame Tina Lavender, who was also inspiring when sharing the impact of the new WHO Intrapartum Care guidelines.

The day was truly inspiring, and a vibe of kindness and compassion towards each other permeated the room. However, the quote I am left with was shared by Marlene. It reads as follows:

“If you want to go quickly, go alone. If you want to go far, go together.” ~African proverb.

The awards were equally inspiring, and I came away with a ‘Midwife of the Year Award’ (2nd place). How amazing is that?!!

Coventry midwife is named runner-up after helping hundreds of women access care

Coventry University also ran two media stories surrounding my success. You can read these HERE and HERE. Thanks to everyone for making me feel special 🎓❤ It really is awesome to raise the profile of our research in this way!

I also wanted to thank Sandra Godley & the team at BBC Coventry & Warwickshire for having me on the radio show ‘UpBeat’ You can listen to us chat about midwifery, research, #EhlersDanlosSyndrome & more below…

🎓😁🎧🔈📻

(I come in at around 12 mins 30 seconds) #EDS

This work has also won us the Wendy Savage Travel Bursary to be presented at the leading and Inspiring excellence in maternity care meeting on 5 March 2019. This event is hosted by the Royal Society of Medicine’s Maternity and Newborn Forum, and boasts an impressive line up of speakers including Professor Mary Renfrew, Professor Jane Sandall, Professor Jacqueline Dunkley-Bent OBE and Kathryn Gutteridge. I will also share our work at this event, and will cover it in a separate blog post.

So the spring of 2019 has been a really exciting time for our research, and I am sure that we are only at the beginning of something really exciting! Thank you to everyone who supports us on our way. It is great to celebrate with you all!

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

Follow me via @SallyPezaroThe Academic MidwifeThis blog

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

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‘Leading and inspiring excellence in maternity care’ at the Royal Society of Medicine #RSMMaternity

‘Leading and inspiring excellence in maternity care’ was the First conference led by consultant midwives held at the Royal Society of Medicine.

 

 👏👏Thank you to our hosts…  &

“‘Once a consultant midwife always a consultant midwife…’ – 

Evidence, research and leadership remained strong themes throughout the day…

The key attributes of the   were also presented to us by the fabulous professor @maryrenfrew as we all reflected on how we could drive the profession forward…

Professor  also encouraged midwives to apply for funded PhD opportunities- for more information on this, explore

Then, ⁩ presented the ⁦⁩ this year is the year of the leader!

…and of course…continuity of carer entered the conversation too..

However, the three most exciting parts of the day were as follows:

Sharing our research with an audience of really awesome midwives…..

Sharing the panel with some really awesome midwives….

But most of all… meeting the legendary @wdsavage ‏ , receiving first prize and winning the Wendy Savage Award…Thank you! This  award will enable us to share our work even further as I head to the MAMA Conference in May.

For me, reflections of the day included how I might lead change for childbearing women with hypermobile  and support the midwifery profession to thrive in their wellbeing. To that end, I have begun working on the generation of new evidence to support midwives in work-related psychological distress and evidence to support new understandings in relation to how we care for people having babies more effectively.

🎓😁🙌❤

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

Follow me via @SallyPezaroThe Academic MidwifeThis blog

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

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#EDSMaternity #hEDS to #pint19

 is a worldwide science festival that takes place 20-22 May and brings researchers to your local pub to present their scientific discoveries.

Over 500 events in >30 cities

This year I have been invited to present our scientific discoveries in relation to hypermobile Ehlers-Danlos syndrome (hEDS) in the context of childbearing to a Pint of Science audience in …Coventry!

#EDSMaternity #hEDS to #pint19

Date Wednesday 22 May 2019
Venue Backhaus & Co. Unit 7 Fargo Village, Coventry, CV1 5ED
Theme Our Body
Talk Title Hypermobile Ehlers-Danlos Syndrome in Childbearing
Who is invited? Everyone… please spread the word!
Talk time 8:15pm

 

 to ! under the theme: Our Body – medicine, human biology, health

Pint of Science 2019

The overall theme for : “What Next?”

  • What Next for science?
  • What Next for Pint of Science?

Find out 20-22 May.

😍

We can’t wait to see you all there @pintofscience 

Tickets for #pint19 are on sale from today (8th April 2019)… All tickets will be £4. Click here to learn more.

🎓😁🙌❤

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

Follow me via @SallyPezaroThe Academic MidwifeThis blog

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