Ep 91 Ans Luyben part 2 on midwifery's impact and building educational communities

Ep 91 (http://ibit.ly/Re5V) Ans Luyben part 2 on midwifery's impact and building educational communities

@PhDMidwives #research #midwifery #Netherlands #Switzerland #Germany #education @bournemouthuni

https://www.researchgate.net/profile/Ans-Luyben

What happens when the academic journey takes you across borders, and your biggest triumphs and challenges are shaped by unfamiliar surroundings? This episode offers a heartfelt exploration of the PhD experience, shining a spotlight on the emotional and practical hurdles faced by students studying abroad. Ans continues to unpack stories of resilience and commitment, where supportive supervisors and a sense of duty to research participants become vital lifelines. We also contrast the cultural nuances of celebrating the milestone of completing a PhD in Scotland's communal ceremonies versus Holland's personalized moments, and ponder the impact of digital submissions on the joy of achievement.

We then shift gears to explore the often-overlooked world of midwifery, where relationships hold more power than hospital walls. Ans highlight the ethical environment necessary for antenatal care and argue for the acknowledgment of midwives' profound impact, especially in countries where their contributions are undervalued. This segment calls for midwives to transcend institutional boundaries, strengthening their bonds with expectant mothers and redefining healthcare's relational dynamics as a competitive advantage.

Finally, Ans delves into the broader themes of academic recognition and community building. The undervaluation of doctorates, particularly among women, and the transformative journey of a PhD, open up discussions on the unique skill sets developed and their potential to drive organizational growth. We also reflect on the essential role schools play beyond academics, as crucial social ecosystems where children learn the importance of caring for each other. This thought-provoking episode invites listeners to consider the multifaceted nature of education and the profound impact of community-focused learning.

Transcript

PhD Journey and Celebrating Completion

Speaker 1 0:27

How did you keep your sanity and how did you balance it so you were able to reduce your teaching load a little bit, but were you able to do that for the whole seven years? Or what were the things that you did when you reached that point of why am I doing this, why do I keep going, type thing?

Speaker 2 0:44

I think it's difficult. I talked with somebody else who did her PhD in Edinburgh on postnatal care in Switzerland and I talked with her because I got to know her here, because of that, because she knew that professor in Edinburgh, and I think part of a PhD is always the points that you might have that every three months or every six months that you feel like you don't see through anymore. Is this worthwhile? What should I do now? I think important supervisors play an important role, although they also have to jump in so now and then to save you. I think this helped. That she told me.

Speaker 2 1:39

I think what was very important to me was I felt an obligation against the women that I interviewed. That was very important to me and, on the other hand, what was giving me some balance is I worked and I did my PhD, and most often so now and then I think at this moment, why doesn't it work anymore now? But when I had problems with my PhD, most often there were good things in my work, and when I had problems in my work because this was also shifting and going into tertiary education with discussions, I also then I had good things about my PhD and I really think what I said fieldwork and interviews with those women. Sometimes I said to somebody the homes that I come into, you come back as a guest. Then I said the, the homes that you come into and how people organize that.

Speaker 2 2:45

I would have to. I should have taken pictures from that. That was so interesting. And and you're basically I mean you're, of course, you're asking people about an important part of their biography, but you're at that moment you're in their biography. Basically they're sharing those things with you, they're showing who they are and telling their story.

Speaker 1 3:10

That's, that's, that's just amazing, absolute privilege, and I agree with that, and that's a common thread with a lot of people that when they feel down, it's the, the participants, time and participation that keeps them going as well. Um, so how did you celebrate when you finally finished it, passed it, it's all official.

Speaker 2 3:35

I didn't celebrate too much. I would say I was in Scotland and I just had had a herniated disc, I think in September or something, so I could fly. But my mother came over with my brothers, which was nice, so we went out to have lunch to have no, in Scotland you would say tea. So it was kind of a dinner and evening.

Speaker 2 4:16

I was a bit afterwards. I was a bit. I mean, it's interesting to take part in such a celebration, but it's a university, so you're one of many In Holland I knew from Holland and that was a bit disappointing maybe you are taking this picture of. In Holland you do a doctoral examination or a doctoral defense. Val did this afterwards in Leuven for her theology study and that's really something special because this is only you and this is only your defense and afterwards people celebrate. So it feels a bit to me. So it feels a bit to me. It feels a bit like a marriage or whatever. In a way it's okay. I mean this. This is special because you don't know the culture, but it also makes it a bit simple you're one of the numbers, yeah.

Speaker 1 5:10

You're one of the numbers, yeah, which is You're one of the numbers, yeah. Which is why I think the way people celebrate is important, because it needs to be celebrating submission, celebrating getting back kind of confirmation. The graduation, like that whole process, is important to acknowledge the work that's gone into it, but also to thank the people that have been there to support you.

Speaker 2 5:31

I think, yeah, I think you're true, but I don't know how to make that happen, because I mean, basically, in a celebration in a big university, you're one of the bachelors, you're one of the masters. It's not particularly about this huge PhD thing that you're doing.

Speaker 1 5:50

And it used to be like my my Masters was. I submitted my Masters, I think, 2010, and it was a physical document, three copies off-bound, that I took to the office and I physically submitted, and so you were able to do a big hurrah, you could have some balloons there, you were able to have this celebration.

Speaker 1 6:14

Now it's all online, so with the software system like you can have, and there's so many people who click the submit button with a glass of champagne, but they're in isolation and, depending on which learning platform they're using, they may get some little streamers that come up and go congratulations, you've submitted. But that whole process, that whole theatre around submission, of being able to physically do it, has now kind of disappeared, and that's really quite sad.

Speaker 2 6:45

The celebration is wanting, but what it makes a bit. If you're and and maybe this is coming back in our phd survey as well if you're going abroad, you kind of you have your environment and your environment shoots you're taking, you're going out of your environment and you're coming back into your environment and your environment is not living particularly through this whole thing with you, which is a difference when you do this in a university next to you or something close to you A degree of separation yes, it's a bit of the same thing.

Speaker 2 7:22

I guess that I saw in my data, but I've also read about that in other studies. It's a feeling of displacement, um, people and and that's the problem also with women going in the hospital to give birth and then coming back again um, the people and and that's that's a different, as that's, that's an other aspect than giving birth at home. You're taking out of your environment and basically giving birth and being pregnant, giving birth is a life event and you have to look at the dead. This is not a medical event, this is a life event. This is a like dying, I mean, and then you're taking these people, go out of their environment and they're coming back again and the first days after postnatal care, when they go back home, they feel displaced.

Midwifery Relationship and Ethical Environment

Speaker 1 8:19

Especially for the rural and remote people who have to come in at week 36 because their local services are not able to care, or if you've got a pre-existing-existing condition and then suddenly you're shipped away from your social support network, away from your family, and you're in a strange place. You've got to try and work out separated, possibly from kids, from partners, from all of the added stress exactly, and there is that complete kind of disconnection.

Speaker 2 8:51

I think we have to, because I mean, we're talking a lot about mental health. You have to take this into account. This is important to them. I mean the second part of my model. I create two-pronged theory. Because you're creating a model, it's called modeling the model. On the theory, because you're creating a model, it's called modeling the model I didn't like the term that much because it's also used by Kenneth and Klaus, I think, about bonding and stuff like that. This is a different kind of framework. This is a different model.

Speaker 2 9:25

The second part, which is an important condition for effective content of antenatal care, is a familiar environment, and I read yesterday an article about emotional safety from an Australian person I cannot remember her name anymore and I think this is very close to what I found. I called it a familiar environment and I'm basically convinced that it is an ethical environment. It's an ideological environment. People look for somebody who are a philosophical environment, who share the same philosophy as they do, and that's explaining why not all midwives are good for all women, because I mean they pick their women and they have to see. Can you offer me this environment? I mean, the relationship is the environment, the house that they need to give birth in. It's not the walls. It's not the walls of a hospital. It's the environment that the people who are looking after them are offering them, and this is important for feeling safe, and that's why we know continuity of midwifery, continuity of care, is important.

Speaker 1 10:38

Yes, because it's hard to build that instantaneous, and I was just reading through something that Diane Minaj did for her PhD, which is on compassionate birthing. Compassionate birthing, and one of the takeouts that she had was that women know within a couple of seconds of you walking in the room if you are there for them or if your brain is still outside and you're just a checklist for them I I think that I couldn't, even that I interviewed could not stop with antenatal care.

Speaker 2 11:10

They they talked about the whole experience. So you start building up this relationship early. In antenatal care they look for you, they know they will be dependent on you. It's Birken who wrote a thesis. That was a nurse in Canada, wrote a thesis and called it one for one. The same thing as a mother does for a child, she's looking for you to do for her. She's looking for you to provide that environment so that she. It's compared to what's called, again, the stage before something gets the butterfly the japanese or the chrysalis formation stage.

Speaker 2 11:58

yeah, so you, you, you have to be there for them to be able to give birth. And in switzerland they said at the end of the I talked with somebody who had a midwife and it's called in Switzerland, that is something someone who you get to know at the end of the pregnancy and guides you through giving birth in a hospital, most often to antenatal care. Often they do antenatal care afterwards. And somebody said to me well, you know, this is just a dream come true, somebody who is always there for me. And you have to take this out.

Speaker 2 12:43

The term somebody is important, the term there is important. This is space, the in reach, it's kind of. To me it made the impression as a possession. They like to possess you, they have you, somebody who is there to have somebody. That's what they said to have somebody. And then the always is important. And that meant to them, because I saw a couple of people I tried to interview people who were only cared for by a gynecologist, and this was very hard to find. They didn't leave their gynecologist, but they always had in their environment a midwife. Or they met somebody in the supermarket who said to them hey, you know congratulations, you're pregnant.

Speaker 2 13:32

You know I live there and there you can always.

Speaker 2 13:35

If you have any questions, you can always call me so they had somebody who was there and then I said to the midwives I don't understand you. I mean they do so. I mean it's also compliments for a lot of midwives in switzerland, it's also a compliment for a lot of midwives in Switzerland. It's still for them, it's still a historical part. But what is true is they are not being acknowledged that they do this for women. They're not being paid for this. This keeps a system in place that's not working and they do this for free.

Speaker 2 14:14

And I saw that and I thought I don't see that A lot of them afterwards are part of that family. That's somebody said to me that's a historical part. So they're still living some part of that. But I was amazed. I was amazed there was always. I tried to talk. I said because grounded theory, that's the way you sample. I said I need somebody who's only cared for my gynecologist and then I started to interview them and then they said well, you know, and then I got to know this midwife and I thought holy shit it just works for them.

Speaker 2 14:55

So I mean, I sometimes think we midwives are not aware anymore. I saw that in a follow up study that I did doing a survey, the pilot of a survey in several parts of Switzerland with the women's health experiences questionnaire MESS I believe it's called from Canada. I could use that questionnaire. It's very large and I talked with women again and I talked, we looked into pain relief during labor and they rated epidural anesthesia very high. But they rated it at the same height, at the same value as their husband, their partner, somebody who was there to guide them. That's relative. And then I thought midwives should be aware that they have to come out much more out of the institutions where they are at, because this makes them invisible. They have to relate much more, because the market aspect of midwives is not knowledge. I mean the way midwives work is completely a contrast to the economy that we're working at just now. Their thing to compete with others is the relationship that they have with women.

Speaker 1 16:32

So has that helped drive? When you look at your publications? You've got a lot of involvement in publications around midwifery autonomy. So has that kind of come from these experiences of what you've seen in different countries in understanding and kind of pushing that conversation?

Speaker 2 16:53

Yes, no, not really. I would have liked to have done more in women's experiences thing, which is not so up to date in Switzerland. It's not so important in Switzerland I mean, in Holland it's certainly after my PhD, but because I'm not quite sure, maybe because, also because I did this, they are very much into women's experiences. In the UK they had a history of women's experience, particularly because of Jo what's? She called Jo Green who did this stuff, and I think what happened, of course, I mean another part that has been very important is my work in education. I've been in education about. I mean, that's also the reason why I went for this master. I worked in education almost all the 40 years that I've been a midwife, either in practice or in school, and I was part of the education standing committee as well, from 2008 to 2017, I believe. So we did a lot of those things and I understood a lot of those things. So midwifery education is also very important to me and I think the role of a midwife is very important to me. Based on my Dutch background. I think women are also very much important because during my secondary school, I invested a lot in joining projects about women's emancipations and things like that, because I had teachers and lecturers who did this kind of stuff. So I think in Holland a gynecologist has said a midwife stands for a hundred women. So I think this is all very important to me.

Speaker 2 19:07

And then, from going back in practice, I saw things that I could not imagine. I mean, my first study, which ended in a master's study of somebody else, was a survey on why young midwives left the profession so early. Because I was working in a hospital. And I heard that they kind of said well, you know, I'm working this year 100 percent, but I don't want to do it next year, or something like that. And I thought, huh, it's still happening, it's still happening. So the question is why? What do they need to stay in the profession? And that was a question.

Navigating Challenges in Academic Pursuit

Speaker 2 19:44

And I think then I, through my whole course, after going back in practice, I also saw the limited value that a master or a PhD had for midwifery practice or for healthcare practice. You were hardly acknowledged and the people in practice don't have a clue from what they can do, what your competencies are. There are national frameworks, there is a European qualification framework, there is a Swiss national qualification framework, but I heard the same thing about people in the UK. Yes, I hear I mean they are acknowledging it's a bit more, but you have to take into account that they are maybe 20 years more farther than us, but it's still a big thing. I mean, I talked with Billy Hunter hunter and then I went back into practice and said well, you know, I've done my phd and I've done my phd in midwifery, and then I don't care that, not much for that and that's preventing people from actually thinking about taking the pathway, because they can't.

Speaker 1 20:54

as we've had conversations before and we'll talk about your current research as well next but if you can't see what the pathway is after you've completed and you can hear that people are frustrated because they're not being recognised, then why would you take down that pathway? And I think that's one of the big issues that we both agree needs to be addressed.

Speaker 2 21:18

I think I talked with somebody from basel and then somebody who did a master, and I said, uh, we talked about doing a phd. And she said, well, if I'm looking at you, why should I do a phd? That is so sad. And I I mean basically, um, I'm being back to practice now and basically I'm working on the same conditions that I worked before doing my PhD, where I told you about the things that I did in the 90s. The good thing about that was nobody noticed, so I was kind of a free bird and I could do those things, and they might have said, well, she's weird, I'm still weird, I guess I'm still weird. I guess I'm still weird, uh.

Speaker 1 22:01

But I mean, um, uh, do, do whatever you cannot not not leave to do and if you see it, you can be it, but if you can't see it, you don't know it exists I think it's.

Speaker 2 22:16

It's a bit. I. I had a very good experience I talked about last night. I worked in a small hospital and maybe you have to work in a small hospital for people to notice. And then the CEO said after half a year or nine months to me you've done your PhD. Why is this not at your batch? Why is it not on your batch? And he, that cannot happen. We have to do something about it.

Speaker 2 22:40

And I was totally somebody notices, somebody is thinking about this. I mean, you can be a, you can be a member of the of the train rail, you can be a member of the of of swiss air and they will put your doctorate title in there. But I mean you're working in the main area, in the main field where you are an important player and they have kind of well, you've done your doctorate, but we just take it away. That's something that I don't understand. But I heard from somebody who a female person who I worked with at a school in research, and she told she said kind of the same thing about and she did this in physics and she went, or bio something, biochemistry or something like that, and she said about the same thing. I mean they're thinking you're part of the plant is you're female, so it might be that your husband has a doctorate. That's possible. That's the assumption If you're a female.

Speaker 2 23:56

If there's a doctor in a couple, it will be the male, but if there's a doctor in a couple it will be the male, but that you are a female and you've done a doctorate, well, they don't know what it is. I mean, basically, people will translate it as you can do scientific work, and then I think it's so much more, it's life-changing.

Speaker 2 24:14

Because, it's a different way of working. It's a different way of working. It's a different way of thinking. I said to somebody well, basically people who've done a PhD you throw a mess at them either a mess materialistically, or a mess in your home, or a mess in your organization and say, okay, try to make something out of it. That's PhD work and that's all the competencies that somebody with a PhD has I, I, I taught.

Speaker 2 24:53

Yesterday evening I thought I have a big respect for I know a head of a program in the French-speaking part of Switzerland and she started as a head of a program. At a certain moment. She met things in her work that she thought this is just too much For everything. I have to collect, all the things I should have known for working at this level, and then she decided that. She said, ok, I'm going back to being a lecturer and I think somebody else has to take up the job, either a master or a doctorate and I thought that was very reflective. It was a very good thought. I think at this moment still she's very happy with it and I thought that was the most realistic thinking process that I experienced in all those years. Happiness is nice and I don't think. I think you have to be aware that not everybody with a doctor brings the same things with them, but I think for everything, you have to talk with people and get to know who they are and what they bring you what's next?

Speaker 1 26:06

what are you doing now?

Speaker 2 26:08

okay, what's next? What I'm doing? I still have to say why I came to to um. Uh, the first thing that we did in 2019 is that and you've read the article, I think maybe is about professionalization of midwifery, following the steps that we made, and I think it's the first article. It will be interesting to see after 10 or 20 years where we are then.

Speaker 2 26:35

And then Yuri gave birth to a thesis about autonomy and Fel and I worked with him on that and I think that has been a tremendous experience. I am very grateful to his supervisors as well as him for asking us. I think it was a good experience to learn to know. I think it was a good experience to learn to know, he said well, you know, I have two supervisors who are pretty young in this kind of work, so I was looking for other, more experienced people to work with us, and I think that's a good mix. And that has also been the reason why we have been thinking about this network, because we're seeing the same names turning up again and I think there are much more people with valuable experience through this PhD who could value, be contribute to other PhDs or to examination work or to organizational work in whatever Victoria talked about, to WHO or whatever, and might assist in the further development of the profession and the things that we're doing now. So that has been a very good experience.

Speaker 2 28:02

And then I came up with these two new projects, and the one is about what happened with, I think, part of what I told before what is happening with the people doing a PhD Because I saw an article about master students thinking about doing research work and I thought, oh, stop, now we have to think about it, and that's my experience as well. Basically, it also it went too fast, I think, for a lot of midwifery associations to think about. What are we going to do with the master people? What are we going to do with the PhD people? To make up their mind, how can they be valuable for us? And I talked with somebody from the Dutch association and they are in a process of doing that, which is great, and I thought well, let's see what are the experiences of the people who did have PhD and also particularly see what kind of pathway there is, like you said. So, more thinking about the history of midwifery or the history of women's health and the progression that we made as a profession is because we still are very much lacking a description of what, where we are at, what are we, what are we working at, and also a part of the history. So I was thinking about interviewing I talked about that with you and I still like this very much interviewing all the midwives who has been part of the progression of this profession and give them a place to tell about their experience part of what you have heard as well but also what were the challenges they met? How have they overcome that? How did they deal with political stuff? I think I've seen that from the United States in their conferences that they had workshops about working politically, and I think we have to learn that from each other, because I learned from my PhD when I went back into practice and I saw these things.

Speaker 2 30:44

I've also talked with, for instance, mary Rantreau about her experiences and I heard a lot of things that I went through the same way, but 20 years later. So I think, um, maybe not for me particularly, but also to let other people know in their 20s or their 30s or their 40s, hey, this is the experiences that we made. Yeah, you shouldn't have to grow through this again. I mean, you have. I might have been a pioneer. I I heard an interview with somebody talking about pioneer work in another thing, in sports, and I thought, well, she's talking about the same things as I know. This is she's talking about the same things as I have experienced and it's very hard. You're in a very lonely place. I said I wrote a mail to an esteemed colleague of mine a couple of weeks ago, who sent me something back on the survey and I said, well, sometimes it's very hard to play solitaire, yeah, yeah, and I think the best thing that you need them. And I think I talked with Julie because we are also.

Speaker 2 32:02

We have now the heritage of a decade of very solitary being through the pandemic, but I would say also before, through technology, or the last two decades. The last two decades, a lot of us are doing this in a very lonely way. You don't have a network. You don't have. You might have a few people that support you, but you don't have this community. And I think we I see things turning up with online workshops of thinking for collaboration, cooperation. How do you do this? And I'm just just shaking my head and I think this is something that you should have. You should already have those skills, but maybe this, you should have those skills, but I mean, I'm part of a bigger family, so my mother would always say, well, you're not alone in this world, and I think some people have that feeling that they are alone in this world. There's something else that I have to tell you about Another project that I saw about loneliness in the UK. That's really interesting to look at and we are. I think we have to.

Speaker 2 33:41

These next two decades must be about more collaboration, more building of a community, and not in an artificial way, but in a doctor that I know, a gynecologist because I saw those differences between Switzerland and Holland in terms of becoming a mother, and then I said, well, in Holland you're much part of a community. If somebody goes to an antenatal care visit, in Holland, they go out, or now they have their cell phones, of course, and within 30 or 40 seconds they will call a friend to tell about what happened to them. The people that I interviewed in Switzerland didn't do that, because privacy is a very important part of Swiss life and it takes a bit longer until they are building this community. If they are building a community, it's a very knitted community, I would say with what I've seen. And then I said well, while you're becoming a mother, you have these choices Either you have your privacy or you're part of the community. But then you also have to take care that you will hear stories that you don't like. What people will care for you or people will look after you in a way. Maybe you say, okay, there's a bit too much, please keep, keep busy with your own things. That's, that's, that's what you, that's what, what you buy.

Speaker 2 35:01

Then if you are more into community and I think that's I see cultural differences, but I think as a global community, we probably will have to go to a more collaborative approach, to more cooperation. Also because what I saw is people building initiatives, that I think there's an initiative, there's another initiative, there's another initiative, and basically they're all the same. So why don't you do it together? And I think that was a nice way of meeting you and I. I see things that we can do together, uh, which is more, much more valuable, and I I also think it's it's very important that you can talk over your experience.

Speaker 2 35:54

I talked, I said, a week ago to a colleague of mine. My mother said my mother comes a lot to this in holland. Sharing is a very important thing. So my mother, I, I, I went somewhere and I could stay somewhere. That they said, okay, but we don't talk about work. And then my mother, when I thought, because that was okay for me at that time, and then my mother, mother said to me well, you know, when you're coming back home from work, you need to talk about it, need to debrief, but that's why I like conferences.

Speaker 1 36:29

Conferences are great for that ability to talk to people that you find they're doing something interesting and then you end up with a group of people who are interested in the same thing and morning tea and lunchtime conversations and that connection that you can make with people at conferences is just brilliant.

Speaker 2 36:49

But I also think after the pandemic, because I realised not only for all the people, I think for all the people what I I saw was was very bad the, the loneliness that they had and the lack of sharing and being that community. But I also realize in the past years, and particularly now with this survey, where I reach out to a lot of people, that I think, okay, yeah, really I basically know that person, but we haven't been in context for for so long. I get to pick up people from that network again and talking things over. I think that's very important and to get out. I think computers are.

Speaker 2 37:33

The Internet is part of a good thing sharing like we do now, sharing like we do now but it also is a very for some people. It's a medium that's bringing loneliness to them, because, I mean, a lot of time is spent on computers or in social media, and I don't say social media is always a good thing and I think we are people and we shouldn't forget the human part of being a person, a human part of being people, and that's talking with things, and sometimes we have to hear a story about an illness that we hear five times. Sometimes that's important to this person and sometimes it's the joy. And I think the good thing about emotions and talk and having a community is you can share those things, and I mean negative things I don't like the word better, negative, but those things. Sharing those things make the negative less.

Importance of Building School Communities

Speaker 1 38:43

Well, we need the negative to know what's good, because without the negative we don't know what's good. But also, that's that beautiful balance of the art of midwifery. More than the science Mind you, there is also a science in communication and working with people as well. So it balances out. Mind you, there is also a science in communication and working with people as well.

Speaker 2 39:01

So it balances out. I think that's why I thought about the model that I made of modeling. The model is it's an educational model, it's not a medical model, and I think in education the sharing is very important. The building of a community is very important. It's not just about the knowledge Through education, there's a lot of building of an attitude, looking after other people. I think that's very hard for some people working in schools. I heard people from primary schools as well. There are really things that they have, because then you have this big community that children may be at home. One or two people that might be so for some children. This is this big community that they haven't known before that time. So I think what we forget to acknowledge is school is not just about knowledge.

Speaker 1 40:06

No, it's a lot of social things.

Speaker 2 40:08

School is much more than that.

Speaker 1 40:11

Thank you so much for your time tonight.

Speaker 2 40:14

Yes, it's very interesting with you. We can talk hours. I believe we can make an own podcast, we can.