This is the research blog of Dr Sally Pezaro. Dr Pezaro is working to secure excellence in perinatal services. Specialist interests include workforce, gender and midwifery research.
Recently, I was asked by Dr. Gloria Esegbona from the @art_of_birth to share some of my thoughts on birth trauma at the latest #artofbirth16 summit at Kings College London. My first thought, as always was…. do you mean physical? or psychological?… I was assured that her latest event would be addressing both. Time to learn & grow 💚💜❤
And so how can we as midwives prevent physical birth trauma?
I was quoted on this day when talking about “superhero midwives” – healthy, well-supported #midwives lead to healthy, well-supported mums. #artofbirth16…It is true…so many people wanting to do good….some burning out. Some traumatised.
I had some really great panel questions too…What I loved most about this conference was that I managed to receive lots of #Oxyhugs and create #myomos with so many inspiring midwives, doulas, students and others wanting to support each other, share and learn 💚💜❤.. I can’t wait to see some of you in the near future and learn more about how you have turned these lessons into practice. 💚💜❤
Until next time – look after yourselves and each other #GetYourGeekOn 💚💜❤
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#savingmotherslives
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 #MaternalDeaths as the president of the RoyalCollegeObsGyn 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”.
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 @MMHAlliance 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
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 💜💙💛
Another guilt trip about the importance of self care and being successful? That is why many people will read blog posts like this. We know we should be practising self care and succeeding, but do we really know how to thrive?
(I could not find a concept analysis for either success or self care – please let me know if you do)
We must presume that both success and self-care mean something different to each and every one of us. I am no expert on these topics…. is anyone?…But I think I am pretty good at caring for myself now and working towards success…having learnt the hard way. So I thought I would share some of my hints and tips. Feel free to adapt them, use them, completely ignore them, or ridicule them as ‘poppycock’.
Most people will expect to hear things like:
Take a bubble bath
Watch your favorite film
Curl up with a good book
Work hard
Network
But I am sure that you know about this kind of stuff already. So let’s look at self care and success for the academic, firstly by identifying the issues that some of us may face.
Tip One: Keep your eye on the goal. Visualize yourself being happy, frequently. How would it feel to publish that paper? Get that fellowship? Collaborate on that project? Create your own self-fulfilling prophecy rather than focus on a possible spiral of doom.
How to do this? – Identify what makes you happy, or what will make you happy. Then do more of what makes you happy, or have a real go at getting what will make you happy. I personally love my research work. I know that many other academics feel the same way. Happiness to me is succeeding, making a difference and making a real impact through my work. The stress I feel is associated with this not happening.
This stress and negative thinking serves no purpose unless it positively drives me towards my goal. Yet who wants to be whipped to the goal posts? I use visualization as a driver for success. I see myself feeling and being the way I want to be…and I allow myself to believe that this vision will come true. This makes me much happier than thinking about the alternative. So I stick with it.
The practice of meditation may also assist you to work through your thoughts, direct them towards a more positive outlook and allow your goals to become meaningful and achievable.
As these tips continue, think about your own goals for happiness…whatever they may be…think about achieving them in relation to these tips and your own experiences.
I behave in the way I want to feel or be… Surely if I continue in this direction. Good things will come…
Tip Two: The problem of job insecurity for early career academics baffles me as Job security for early career researchers is a significant factor in helping research make an impact. Yet this seems to play on my mind recurrently. It is always a worry. However, worry really does nothing to resolve this issue, and only seeks to get in the way of my progress. In order to progress, I will need to ‘work smarter’ and embrace confidence in my own abilities. Worry and negative thinking has no place in this strategy.
Negative thoughts often lie, and so I swipe them away one by one by placing them on a train that is passing the station (Visualization) – I then sit for a little longer, and imagine the way I will feel and be once I reach my goals. My mood and stress instantly lifts once I do this. I am more confident and feel much stronger. I am ready to be happy.
Tip 3: Say No and be proactive – We need to look at what successful academics do. From my observations, they often say ‘No’ to anything that doesn’t suit their own focused agenda (they remove the ‘noise’ and toxicity), they ooze positivity, they are confident, they are assertive, they tell people what they need to succeed and they hang around with the most inspiring people. Therefore, the most obvious strategy is for us to do the same. Say ‘No’ to negativity, and to the people and things which do not enrich us as people. Let people know what you need in order to thrive. Embrace those you feel drawn towards as positive people.
Activity: Making the best of me…
1: Ask yourself how others can get the best out of you
2: Offer what you can realistically do
3: Communicate what inhibits your productivity with others
4: Actively describe what you need from others in order to thrive
Tip 4:Express gratitude and forgiveness for enhanced wellbeing. Not always easy, but worth investing in. This task not only unburdens your mind, but allows you to see all of the good things currently going on in your life. Regularly write down 5 things that you are grateful for. Also…try to forgive yourself, and others…often.
Tip 5: Address your work life balance as a fluid entity. I believe that the idea of a separate home and work life is changing. This is a good thing. It takes the pressure off and allows you to be a whole person, rather than one split in two…See yourself as a whole being, a working, living and family centred being. You cannot slice yourself into pieces.
Living in the ‘now’ rather than being at either home or work also allows us to enjoy more of ourselves and our lives. Notice where you are, what you are doing…Smell the flowers, look around you as you move, work, play and just allow yourself to ‘be’.
Tip 6: Eat Sleep move, repeat. It really is that simple, but utterly essential for optimum productivity, stress reduction, health and wellbeing. Eat nutritious food regularly, sleep 7-8 hours a night and move…Exercise, walk, swim, run, cycle…Be outdoors as often as possible.
Tip 7: Write. Write your thoughts, your feelings, your ‘to do’ lists, your ideas, your goals down regularly. This not only means that they are out of your head, allowing your mind to be quieter, they are also made real…They are good to share..and worth addressing (when you feel able).
Tip 8: Talk about who you are. There is a tendency to talk about work first. What we do, what we are working on and what we are planning to work on. Start new conversations with how you enjoy your hobbies or your favourite music. This lets other people know that you are indeed human, and it also gives you an identity other than your work persona. Be authentic. It is healthy for you, and others to know the real and whole you. You are fab 🙂
Tip 9: Help other people and accept help yourself. Lift one another up, support colleagues, show gratitude, offer support and guidance where you can. Be a mentor. Be a positive role model. Be the change you want to see in the workplace and accept all of this in return. This will not only make you feel good, it will change the culture of your workplace, and bring about reciprocity for everyone’s success.
Tip 10: Celebrate the successes of yourself and others. Yes. Focus on the great things that you and your colleagues have achieved. However big or small, these feelings of success will snowball into a self fulfilling prophecy, where you feel valued, supported and part of a team that cares. Some people will feel uncomfortable about doing this, and feel icky when they see others wallow in their own brilliance. But what is the alternative? We all talk about how rubbish we all are? How will that make us feel?…
Spend time reflecting on what you have achieved. Write them down…use these achievements to inform your own vision of yourself…This is who you are. You are great.
As long as the feelings of celebration and success are reciprocated and directed towards others as well as yourself….Let the high fives roll.
I do hope that these tips will resonate with some academics looking for something new to try. In the spirit of sharing, please feel free to add more tips below.
You deserve to be happy – Until next time, look after yourselves and each other ❤💙💜
In a digital age, where the work we do is ‘produced’, ‘co-created’ or ‘delivered’…sitting at a certain desk in a certain office from 9am-5pm may no longer have place in progress…
Inter-dispersing work into our busy lives is now becoming a reality, much to the delight of creative, dynamic and highly motivated employees.
Personally, my own productivity soars when I work from home. Usually with music or a documentary in the background, I find myself focusing in on the task in hand…I lose myself happily in my job…Things get done.
I try only to come into the office for the following reasons (If I can help it):
Face to face training
Productive work meetings
Networking
Face to face lecturing
Collegial support
All of the above could also be done remotely, yet there is of course merit in the human touch, human contact, improvised, idea generating and creative conversations in the workplace. Plus, its always nice to share some cake and a beverage :)…
I am not trying to avoid the commute, the parking issues or the considerate headphones, I am trying to maximise my productivity, because I love my job.
Question…
Jogging with a co-worker and exploring a new idea
Chatting with the hairdresser about a potential collaboration
watching a documentary and being inspired to try something new at work
Making an exploratory phone call about a new innovation on the school run
Finding a great piece of music to use on a project whilst at the theatre
Practising a conference speech list whilst walking around the supermarket
A 3 hour lunch with a valued colleague
Can we clarify these products as ‘work’?…would we produce more in the office?
Don’t hire the best people and then tell them what to do…
Instead ask them (and yourself) the following questions:
What do we need in order to produce our best work?
What inhibits us from producing our best work?
Everybody’s needs may be different, and that’s OK… it is our personal ‘best’ that we are trying to set free… At the same time, we must also guard ourselves against ‘work’ obstructions. Does this work for a front line worker?
In the healthcare settings, we often need to be wherever the patient is. Yet our ideas, innovations and ‘work’ can occur as fluidly as ever throughout our inter-dispersed lives. For this reason it can be challenging to find a healthy balance between work and life…. Unless we loosen the ideas around where work occurs and where life happens.
People caring for other people
People sharing ideas
People trying new things
People creating amazing things
People doing what needs to be done
These things often happen at any time in any place. Work and life is a thing we do…not a place that we go to (necessarily)….and as Mary Poppins once said:
“With every job that must be done… there is an element of fun, you find the fun and – SNAP – the job’s a game”
Would love your thoughts on this…but…
Until next time, take care of yourselves, and each other 💙💜💚
The Art of Birth is promoting art in the science of 
Dr Sally Pezaro 