thru the pinard Podcast
a conversational podcast with @Academic_Liz with midwives & other birth professionals about their studies/ research & how it's changing our practice globally - email thruthepinard@gmail.com
thru the pinard Podcast
Ep 98 Caroline Hollins Martin pt 2 on Birth Satisfaction As a Lens for Change
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Ep 98 (http://ibit.ly/Re5V) Caroline Hollins Martin pt 2 on Birth Satisfaction As a Lens for Change
@PhDMidwives #research #midwifery #education @EdinburghNapier #birthsatisfactionscale
research link - t.ly/I6zN1
https://www.bss-r.co.uk
The professional journey of Caroline Hollins Martin reveals how a single observation about obedience in midwifery practice sparked a global revolution in measuring women's birth experiences. This fascinating conversation takes us from her PhD findings on midwifery obedience to the creation of the internationally recognized Birth Satisfaction Scale now validated in 23 countries and counting.
At the heart of this discussion lies a profound truth: hierarchical structures in healthcare often prevent midwives from providing truly woman-centered care despite their best intentions. Caroline describes how this realization led her to develop a practical tool that captures women's birth experiences in a user-friendly format suited to new mothers. This scale has become the international measurement tool of choice for assessing birth satisfaction.
Particularly illuminating are the discoveries about cultural differences in birth satisfaction. The scale manifests as a three-factor structure in Western countries but a two-factor structure in East Asian nations—reflecting how cultural expectations around obedience and choice significantly shape women's birth experiences. This research has expanded to include partner perspectives through matched scales that measure how birth partners experience the same events.
The conversation doesn't shy away from concerning trends in modern maternity care, including rising cesarean rates and the physiological implications of bypassing natural birth processes. "Oxytocin is the hormone of love," Caroline reminds us, highlighting what women may miss when natural birth processes are interrupted unnecessarily. She also addresses the challenges facing midwifery today, from retention issues to the need for expanded scope of practice.
Whether you're a midwife, researcher, expectant parent, or simply interested in how birth culture affects families, this episode offers profound insights into how measuring birth satisfaction can transform maternity care globally. Visit https://www.bss-r.co.uk/ to explore the scale and its applications for yourself.
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What about your results? What surprised you about the results of your PhD?
Speaker 2Well, it wasn't a surprise, because midwives are as obedient as any other profession has been. You know, obedience laboratories, obedience experiments have been done with. You know they are as obedient as policemen, the army, you name it. Teachers, all the different professions, the army, you name it, teachers, all the different professions. So, but obedience and hierarchy gets in the way of trying to carry out women-centred care. Yeah, because if women ask for things, you know midwives often can't give them, not because they are impossible to give or dangerous to give, because the hierarchy gets in the way of, you know, them having that freedom to deliver care the way they want, okay, or the way they should, and be adaptable do you think that's changed?
Oxytocin and Birth Satisfaction
Speaker 2I think we go backwards and forwards on this one. I mean, the section rate in the uk is going through the roof at the moment. Yes, I know, and these women and they've actually now started to offer women caesarean section for no reason, you know, and not understanding they're going to have a hole in their abdomen. Yeah, you know you can get all sorts of complications from the catheterisations and so on and so forth and it will restrict the number of children that you can have, and then there could be complications from scarring. You know women are designed to give birth naturally and they can all do it. Some can't. You know there's a time for cesarean section yep, but it's a time for not. And why are we offering women that?
Speaker 2and that even takes out the psychosocial component about oxytocin, its relationship to bonding, and you know love, yellow and what the love women feel for their babies. Oxytocin is the hormone of love. Yeah, that's what you say. Well, if you're not going through the labor, you're not getting that oxytocin. If you're not breastfeeding, you're not getting that lovely oxytocin for you. And that doesn't mean you're not going to love your baby. That's not what I'm saying, because you can't make a baby a woman and love her baby. But it's a big part of the relationship.
Speaker 1That's what makes you love men is oxytocin yeah, yeah, especially that first two years, that to kind of keep. Now I was reading something the other day that it was like babies quite often look like the, the males, because it's that they recognize themselves in the offspring. So they'll stay around for those first couple of years and then all the hormones change and it's like but that's right, they can, they don't fend for themselves, but they're at least walking now. So the, the hormone dump, occurs after that two years, um, from the relationship evolutionary.
Speaker 2That makes sense, though, because we've all lived in tribes and we wouldn't be living in isolated families and these loose networks. You know where you've got people who live well away from home and they've no, no support, I mean, and their partners with them or their husbands, whoever is with them. You know, it makes sense. And the other thing is, men have got many seeds to sow. Women have only got one to choose, so we're more selective about who we're going to fertilize that egg. Yeah, do you know what I mean? So, um, yes, evolutionary wise, it makes sense, doesn't it?
Speaker 1it certainly does. How? What was your pathway then into the birth satisfaction scale?
Speaker 2right, I got into writing psychometric scales.
Speaker 2I had done the birth participation scale, I had done the obedience scale for my PhD, all with validation, psychometric validations and then, um, when I was working at Glasgow Caledonian University, um, I had I'd worked at Salford, my first professorship was in Salford and what I had got was I worked with a professor called Malcolm Granite he's actually an engineer, but he developed these activity monitors and I've written a paper about positions in labour.
Speaker 2You know it's positional work in labour and I thought we don't have any scale. I developed the first birth satisfaction scale. There is, there's a lot more of them now, but they're very, very complicated, which is why my birth satisfaction or our birth, because professor colin martin owns this as well our birth satisfaction scale is, um, the international tool of choice according to the icom standard set for pregnancy, which has got one for all the different areas, because it's easy to fill out, it's easy to use, it makes sense, it's got a comment section if you want to put one in it, but it's got a licker scale across it and it's got a scoring system attached to it because we all know women post-birth have an attention span of a fruit fly so and they've got a baby to look after.
Speaker 2They're not wanting to fill out research, no scales. We all know that research has shown women are much more attentive to what their midwives have got to say before childbirth than after. Now you can see why that would be. They're busy, busy, busy people. So, um, yes, I thought we don't have a scale to measure women's experiences of labor and I could already see the connection with the end ripost, postnatal depression scale and correlations cause and effect. I could see all these things. There was no evidence to validate that, you know.
Cultural Differences in Birth Satisfaction
Speaker 2We now know that birth satisfaction is definitely linked and correlated with um ptsd, because we've had we've had the tools to measure the difference and that's where the birth satisfaction reviews, you know, revised. This has come through and there's actually a big study going on just now in, I think, 17 countries called the intersex study in the UK and one of the tools they're giving out is our birth satisfaction scale. Nice, and it's about it's Susan Ayres that is the PI on this project. She's the one one that developed the CityBits scale and she's looking at the relationship between birth satisfaction and PTSD Papers are starting to come out. A lot of other things as well, because it's a multi-million pound study across Europe. I mean, we've got a Swedish BSSR out of it, we're just about to get a German one. We've got Spanish. You know all these different birth satisfaction scales. We've 23 validated just now, but we've got at least 12 on the go in the wings.
Speaker 1Does culture come into play with the interpretation? Then, when you're doing it in different cultures Because I saw that you've got, was it? You've got Vietnam, you've got, where are we here? So there's Japanese, so you've got some Asian cultures and then Swedish, hindi, indian Some of those cultures have a huge impact on what women expect, and I did a few weeks in the Philippines and just seeing what they thought as normal was completely different to what they thought of as normal was completely different to what we think of as normal and here. So how does culture play into those validations?
Speaker 2and in other countries, well, first of all, for anyone that's listening to this, we have a website which is https, the dots and the doubles, the bssrcouk. All the papers that have been published from this validation papers, translation papers and impact papers are on that website and I keep that site up to date constantly. It's part of an impact case study. Yes, so, yes, there is a big difference. Yeah, but remember that the scale is like a self-referral scale, so our satisfaction is about the woman, yeah, so, and what her experience of labor, so it's her perceptions of her event. So it really doesn't matter what culture you're in, but a more interesting factor which is very statistical. I'm not going to labor about it, excuse the pun, because, um, if you want to see midwives glazing over in a classroom, start talking about psychometrics. Oh, yeah, form of statistics. But the factor structure of the scale is very much related. In the Far East, the scale has been so far showing out to be a two-factor scale, okay, and in the West, it's showing out to be a three-factor scale. Yes, the factor structure is different, and I think it's because I've done a PhD in obedience. I think it's deeply connected to obedience and expectations, like in the Far East, the most obedient country in the world is China. Far East less so the Japanese, but in Vietnam, very obedient people. So they don't expect or anticipate to have choices. Yes, yes, so you know, they, they know, and I know that because I've been in labor suites in Vietnam.
Speaker 2We have projects at the respectful midwifery care project going on out in Vietnam and, having been in the delivery suite, these women, by the way, they they're lovely, the people are great and their expectations are just what they do. Yes, you know how they labor and so on is just what they do out there and they don't know any different and it's fine, it works for them. However, it could be a tad more respectful in the sense of what we would, but that's a very western concept and it's the world health organization that has asked for this. Um, you know, but it all works for them. So their expectations are cultural, embedded, just as you exactly say.
Respectful Midwifery Care Globally
Speaker 2Same in africa. I've been in delivery suites in malawi and you know what they do is slightly different as well, you know, and how it's here's delivered, but any midwife will know that because they do cultural cross studies. But it obviously works. In their country the interests are always to improve mortality and morbidity and in relation to respectful care, as women are more likely to attend for their clinic appointments and their treatments and so on, if they're treated with respect, you know, and that's kind of the premise underpinning respectful midwifery care, along with many other other things and the consequences of that we know is to do with better weighted babies and less pre-term births and kind of.
Speaker 1There's a hope just that those conversations and those prenatal appointments and antenatal sections um sessions that that has so much um influence on the journey that that woman has and the health of the fetus and the neonate ultimately, if you're bleeding during pregnancy and you don't go because you're scared, yeah, you're in trouble.
Speaker 2You know, I mean you. You know what that? Well, all midwives know what you know vaginal bleeding means during pregnancy, even if it comes to nothing. But there's a list of reasons why that happens or their blood blood pressure being up, they've got a headache, they don't know where they are going with their midwife. Or malnourished All the things that continuity of care research Mary Renfrew's Lancet series said about the continuity of care frameworks.
Speaker 1Can you believe that? That's kind of like 11 years old now, I know I remember it being launched.
Speaker 2It actually changed the whole social policy in scotland. It was huge. We brought out best start document, yeah, which is introducing continuity of care. In england it's called better births. Yeah, it's the same thing. It's all about providing continuity of care. Then covid came and got in the way.
Speaker 1Yeah, and that kind of completely changed the system.
Speaker 2It became firefighting because so many people were off sick, it became firefighting, and so on and so forth.
Speaker 1I would talk about that in class this week that one of the good things about COVID was it fast-tracked telehealth and the increasing of telehealth. From probably about 10 years planning they suddenly go no, we have to bring this in now. And we've still got it and now we know what the advantages are. It was slowly coming in but it just fast-tracked it absolutely totally.
Speaker 2You know, I mean I, I was probably my team would probably be zoom and teams illiterate, for covid never used it. It was all face to face with websites for your power points and you know module tools and so on. And now we do a right hybrid job and it's great because you know students can dip in and dip out and accommodates people in different ways. So we've come to a middle point.
Speaker 1Now you know where we're doing a bit of both what exciting things are you looking forward to in the next couple of years in terms of midwifery, in terms of your life? Whatever you're doing, okay, my life.
Future of Birth Satisfaction Research
Speaker 2Well, I'm 62, so I'm probably starting to near the end of my career. I will never give up my birth satisfaction. Work, that is my surprising passion. Yep, you know, that is something I will, even if I retire. I'll go emeritus at my university because the rules are you need a tenureship and something to give them. Well, I have that. You know. My site, my website, all that work for impact case study for the ref. I don't know if you have that in australia, research excellence framework is where you get points for your university and they get money from the government based on, yeah, anyway. So ref returnability, we talk about it, you know, as in the uk. So, um, I will keep on doing that until I'm demented, you know, and no longer able to, and I would like to think somebody will come and take off my hands. Who's really, really motivated and interested by then. I would say our hands, because there's Professor Colin Martin as well. He has actually already retired, but he spends two hours every day doing this out of pure passion. Yeah, he does actually do work. He speaks fluent Czech, he, and he works for pilsner university just now. So he, you know his location's there. I was going to add, right.
Speaker 2Okay, the birth satisfaction skills become a new entity and anyone that's listening to this podcast, we'd be happy to work with you on this. We are now doing matched partner versions. Oh, so we bought the we don't have a partner Australian BSSR, because this is a new concept around the corner. We worked with this fantastic psychologist in Pilsner University called Alina Lachmanova, and she's absolutely a driver. I mean, she's an amazing woman, you know, she's a professor. She said you know, we had a partner version which matches question by question turned around for the partner, because we don't know what partners experience of childbirth and we know they can get traumatized. I know that because of the study I did for my master's at glasgow in psychology. So, um, she has trans.
Speaker 2There's a translation system you go through and then you have to collect 200 and validate it. We have a match set of czech republic oh nice, a woman's birth satisfaction scale revised. And we have a partner birth satisfaction scale revised. So it's lgbt friendly. You know, you friendly, anybody can fill this out. It's absolutely fine, as matter what gender you are, but if somebody's got a partner, they can complete this To look at how they saw that experience as well. So we are now. Currently there's a Russian chap working in Israel who's doing a match Hebrew one. We have an Israeli Hebrew BSSR, so he's doing a partner in Bulgaria. So this is the new world. If anybody wants to do a partner version for us, we don't have a UK, we have the unvalidated. If anybody wants to collect data, just take it through the translation system. It's a great opportunity for a master's, a PhD.
Speaker 1That's what I was just thinking, yeah.
Speaker 2It's more of a PhD, I would say because it's a phd. That's what I was just thinking. Yeah, it's more of a phd, I would say because it's a lot of work, you know 200 to validate.
Speaker 2Yeah, yeah, it's got quality, you know, but for the validation we need 200 fully completed skills and it needs to be translated. And there is. You know, even with the english version there's differences, because the uk version uses the word unscathed. That's quite a common word in the uk. It means I came through childbirth word unscathed that's quite a common word in the UK. It means I can't do childbirth virtually unscathed. That means I didn't have any damage. The very Scottish word actually. But Australians don't know what that word means, so they we change the word unharmed, right? You see, you've got a Scottish mother or you've got Scottish family members. They all use this word. So you've probably learned it in your childhood that's where that will come from and the americans the same.
Speaker 2You know, same story with the americans. You know they changed it to unharmed, so we've got there. Then they're validated, these versions. But obviously the, you know, in czech republic had to be translated into czech republic. It goes through a forward translation method, a back translation method with different types of people anyway, and so that's the next work.
Challenges in Modern Midwifery
Speaker 2But I've had a little light bulb moment just the other day. If we work on the partner stuff, you can see, even when I'm retired I won't be retired, I know. I think we could develop a midwifery version. For the midwife, yes, because she the three people that are present at childbirth well, I'm not in all cultures, because there are cultures where men are definitely not present. Okay, so you know, three perceptions of the same experience and the reason that I'm interested in that is when I was a newly qualified staff midwife, my first post was in the labour ward and we had a woman came in and she had an occipital posterior position which everybody knows.
Speaker 2The mechanism of labour is more painful and they get terrible backache and it's backbiting. You know, students don't see that so much today because they end up often begging for epidurals, but in our day. I was in the pre-epidural era. I was introduced during that period. You know the pain you could see was significantly different with an op position. It became more significant to talk about that mechanism. Yeah, and I looked after this woman in labor and she was a member of the national childbirth trust. I don't know if you have that in america, in australia, sorry, because, um, it is a pro-natural childbirth group, natural, pro-physiological methods, not having pain relief and very Michelle O'Dent orientated. You know you signed up with Michelle O'Dent in the hospital in France. You didn't get any pain relief. Yeah, you know they dipped them in water and did all sorts of natural methods.
Speaker 2I remember looking after this woman and I remember going home. I can still remember her name this is how vivid I won't be saying it, obviously for anonymity, but she screaming the place down. It was really painful labor and I always remember we had an obstetrician called Dr TVA and R Russell. He came and he says, caroline, you're gonna have to get rid of that woman's pain. Everybody can hear that all up and down the corridor and I thought I'm really trying, but she will not take any pain relief and you know, being woman-centred, it's not my job to persuade her to. You know, immediately you get the obedience dichotomy going on here. He's saying we need to have this woman quieter, you know. And I'm saying, actually, this is our choice, right? So I went home a bit stressed and a bit upset. By the way, he was a brilliant obstetrician, you know. He did his job.
Speaker 2You can see how the picture, the picture's, multifaceted. So, um, I went home that night and I thought, oh, my goodness, that was the worst delivery of my life. Yes, torn hair, a really stressed husband. He says I cannot let her take an epidural. She's made me put my hand in the bible for my mother's death. You know that I to stop her having one. Yeah, so so forth.
Speaker 2So the night I went home and I came back in the next day and I thought I'm going to the ward to see her, yeah. So I went to the ward to see her and she threw her arms around me and she says thank you for supporting me through this. I am so proud of myself. Yeah, I delivered my baby with no pain relief can you imagine, with an OP position, although women for millions of years have been doing this. It is painful. We midwives know this. Yes, it's really painful, especially if you're a primogravity, which is what she was, and it was like wow. If I'd been spilling out a midwife's birth satisfaction score to us, I would have scored pretty low, both for me, offering her choice and control, and you know all the rest of it, but she would have scored that scale really high and I actually don't know where her partner would have sat.
Speaker 2I remember um I've got a video.
Speaker 1Oh, I think it was Billie.
Speaker 1Hunter who was doing a presentation and she said what and I tell my students this as well um, one of the most powerful things you can do is um to be with that woman when things are going wrong and then just talking to her, but that important thing of making sure they know what's happening but they have that choice in still giving that decisions in those before things go wrong. So if they want to have, can we try another hour before we kind of go, so they have that perceived choice, because then they understand that process, they feel like they've got that control. But when things do get that crazy, if somebody is there to go, look, I'm standing here with you. This is what's happening. This is why we're doing it, that instead of just suddenly losing the fact that they're a whole human and they're not just from the um, the, the umbilicus down, and everything is happening above them which can get forgotten, that that will actually help prevent a lot of the birth trauma and the ptsd, is that control, perceived control and support.
Speaker 2Jenny Patterson has written published paper about this on her PhD thesis. Yeah, she did a systematic review, published that, and then she did the findings of her study and fascinating and which is saying just exactly what Billy Hunter is saying there. And also I remember reading years ago it was when I was doing my psychology degree, actually about the social influence processes see, if somebody touches you, people will rate scare. It was done with librarians and libraries and it was. It was, you know, customers that came in and there was two groups. Obviously the librarian had to touch one group and then they gave them the scales and asked them to rate how much they liked the librarian and how good they were at their job and then the other group didn't touch them and they get higher scores on the touch, especially the poor yeah, just putting your hand on somebody is offering them some sort of connection, which is different.
Speaker 2And and maybe we say we all know, when you touch them do you release hormones. So I, I don't know so much about that, but there's another beautiful phd for somebody to do. You know all about touch and its meaning and so on, and you know, I mean midwives are touching women all the time. Oh yeah, I always. I'll tell you a funny story.
Speaker 2I was looking after a woman in labour and it was night time. I was night shift in the delivery suite at the Ayrshire Central Maternity Unit and she's a sheep. It was a summer night. I made a field of cows outside and the window was open and you could. The cows used to come in up to the window. Oh, fabulous, and they would move and then move through the window. I mean it was a lovely place to work.
Speaker 2Anyway, I had my hand on her abdomen, feeling her contractions and everything under the sheet, yeah, and she was getting a wee bit stressed and her hand was on her abdomen. So I put my hand onto her hand and clasped it For real. I said you're going to be okay, you're going to be okay and her to be okay, and her husband piped up that's not my wife's hand. We ended up in fits of laughter. Honestly, we were roaring with laughter. You know, I said you're going to put in a report about me chatting up.
Speaker 2It was just hilarious. But I tell you there's another the hormones of laughter. Oh yes, no, they are totally therapeutic. That's another thing I would like to do for my future. I would love to put out a message on some site or whatever and ask people to tell me their funny stories and put them into a book. Oh yes, hilarious midwifery stories. Yes, you know, and you know, write a. You could write a beautiful play for today. Comedy, you know, things have gone on at work and delivery suites and so on, and awards, you name it.
Speaker 1I mean, you could well just create an app and launch it at the ICM next year and then collect data that way, because that's what you want.
Speaker 1You want something like this oh dear Hazel, I'll happily do it with you when I finish my PhD. Hazel Cadell did an app. She created an app for her PhD for VBAC women and they were able to use the app to send her messages and kind of keep a diary, and so she's already. I don't know if the app would be useful, or you could even do it in Qualtrics. It would be easy to do something electronic and just throw up some QR codes, kind of put a poster in. Even if you just put a poster in and do a QR code or a presentation, but that would be really interesting because that would be a really interesting way of capturing, because people could do it in their own language. They could do it and then you could just translate afterwards, which would be really interesting to then get some cultural and global perspective.
Speaker 2Liz, that's brilliant. You know recruitment is an issue. I would say not for midwifery in the UK. However, could you imagine you know putting something out on the television about comedy through midwifery? Do you know what I mean? I mean the recruitment drive. I mean Call the Midwife. It was the biggest recruitment drive we ever had. Do you get Call the Midwife in Australia?
Speaker 2Yeah, yeah yeah, I mean it's such a beautiful story. I mean I do know midwives that don't like it, but I personally love it. I just think it's so engaged. It reduces in me the feelings of vocation I have surrounding my job. You know it's historic, of course. You know I told you at the beginning of this podcast I'm really interested in history and you know some of the things they did which were obviously pre modern years, but it's contextualised, yeah, and in the love stories and all the sad stories of poverty and everything. It's just amazing. But we did our own, you and I did our Aussie, uk, scottish programme about the comedy midwives.
Speaker 1You know well we'd be famous and we would also maybe do the massive recruitment drive that's required well, we could definitely do that and we well, we could put user kind of use this podcast to share some of the results, and we'll do some specials of um, share some stories, read out some stories. There's plenty of opportunities, but no, I definitely I'm going to ICM, so I'll catch you there when I retire, if I stay emeritus.
Speaker 2These are the sort of things I'd like to do, because it would never be ref returnable. Yeah, do you understand what I mean? Like every piece of research I do now, you're always considering the impact, because that's what research excellence framework surrounds is. It. Does it have impact? Does it change practice? Does it make a difference for women and their partners and families? You know so, for me, it's like to do something like this, which is comedy, applying all your skills, but it's actually valuable, but in a more artistic, yeah, you know, community way. That's what's the sorts of things I would like to do.
Speaker 1What else? Is there anything else that you've got planned that you're excited about?
Speaker 2Well, wow, I feel very excited about my team at work. When I arrived at Napier 11 years ago, there was myself, possibly the only functioning doctor in the team. Yep, now, you know, through our interviewing framework, you know where it's no longer desirable to have a phd it's actually mandatory, it's an essential requirement and more and more midwives are doing them. You know. I mean, that's the bottom line and they are extremely useful for so many reasons. I mean, first of, they teach you how to do research methods, which means we teach it better. Student midwives, you know, look at the evidence to underpin what they're doing, because we're teaching them to do that. So research methods is taught better. We have way more papers coming out.
Speaker 2You know, when I was a junior midwife, we didn't have many journals for a start and they were very different to what they are today. We are now punching in the big lane, you know, along with other. You know people are publishing all over the place. I mean it's amazing. The majority of people that ask me for the birth satisfaction scale are obstetricians. I mean, lots of midwives ask for it. Oh nice, no, but it's because they're in their jobs. They're being asked to do research as part of their programme, so they're working with midwives and they want to collect data about birth satisfaction. So they're leading projects which midwives are working in. So that is everything's moved forward.
Midwifery Innovation and Career Reflections
Speaker 2And now in my team, the majority are doctors, which means that we're a very research active unit. I'm going to add the ones that are brilliant teachers and they're great at their jobs and they're very experienced, and I'm not, you know, this is not me saying that having a PhD is everything, but it's definitely going to evidence base and push our profession forward. Yes, I mean, that's a fact, and also we're a first world countries Australia and the UK and that's what all first world countries do, and we need to keep doing that, you know, and make midwifery a really, really developed profession, you know, and gain more autonomy and more person centered care and possibly be given more rights to do more, a bigger role. Yes, yes, do you know what I mean? Because, of course, what's holding us back is we could do a lot of the mechanical jobs that obstetricians do and we need to be brave and take that over, which means we could do our own forceps, deliveries, our own ventouses, so on and so forth, but a surgeon can still do the surgery.
Speaker 1Do you know what I mean? Trained up to do the Montus because they don't have access to the doctors. So the skills, the scope of practice of what midwifery is is different in every country, even though we've got the ICM and the, the baseline kind of requirements and competencies. But you look at some of the other skills that are happening in lower resource countries because of necessity and they kind of come to Australia and they go oh, I can't do this and I can't do this and I can't do this, the same as kind of moving through because of the the unfortunately the organizational kind of governance of venues.
Speaker 1But yeah, there is so much and that's why I like the state and midwifery report and those things that come out, because it shows you what more we can do. And in Australia we've just had a couple of really interesting and brilliant work on scope of practice of midwives. That is changing and midwifery has changed so much in the last kind of like five years and it's going to change even more in the next five years. So I think that we're getting better recognition so we can just do our job, like it's about doing it instead of places changing and curtailing midwives yeah, you know.
Speaker 2Like, for example, we can solve our own problems, yeah, instead of phoning somebody in to do something mechanical that anybody could do. And we need to push through the pain barrier of thinking we won't be able to do that it's too difficult. Yeah, it's not difficult. I mean how we need to push through the pain barrier. Thinking we won't be able to do that it's too difficult. Yeah, it's not difficult. I mean how many four sets have you been present at how many of them too? So I'm not talking about surgery here, because I think that needs to be done by meds medics trained to do surgery.
Speaker 2But, you know, solving the delivery suite problems, yeah, you know, and that's what's holding us back, I think, and also our legal system. We need to. We need to look after each other really well and support each other, because medics do that. Yeah, oh yes, they're very good at that. Yeah, yeah, yeah, we need to support people who make mistakes.
Speaker 2There's being a researcher, there's sources of error and everything. Yes, and when a medivac makes a mistake, you know, we need to say that's a source of error and look at how we can prevent it happening again. Don't take away the role from them. That's pointless. If it was a medic, there'd be a source of error as well. Don't take the role away from them because one midwife had this error.
Speaker 2Do you know what I mean? Just make sure that there's policies in place. And you know we need to get brave, get our big girl pants on, and, you know, take control. And when doctors do that, don't they? They just get on with it. And now the requirements to get into university are getting coming higher and higher. You know, there's not that much difference is there really? And what you need to become a doctor and what you need to become a midwife, I mean there's a gap just now, but it's not very big, no things. So I'm not even saying it's attached to intelligence. A lot of these things that you learn about are mechanical. Yeah, they're just mechanical things. I mean, you could train a machine to do them, a robot to do them well, they are training machines to do a lot of things and they want machines.
Speaker 2I can't see them being responsive in childbirth. I would dread that day coming. But you know what I'm saying. Yeah, They've actually done some research to show that robots are kinder than humans Because they're programmed with compassion components. This is the compassionate mind training you know. They say they can give out more compassionate statements more often and more regularly than humans feel able to do.
Speaker 1Well, it was interesting. There's a paper that's just kind of come out about use of generative AI to give PhD feedback versus and so one of the leading Margaret Beerman in Australia, she's one of our leading educationalists, not a midwife, but educationalist. They looked at the AI prompts and conversations versus the supervision notes and what they found was that they were quite complementary but that the supervisors kind of were able to personalize it a little bit more than what the generation AI, and it was really interesting. There was another piece I was reading from Bill Gates and he said, yep, all the medical and education jobs a lot of them are going to be taken over by AI.
Speaker 1A lot of that kind of interviewing process, a lot of that diagnostic process and it's like, yeah, in the place it is, but midwifery it's yes, it might help with a diagnosis, it might help with looking at case notes, but it's not going to help with helping to birth a woman, because you can't get a robot to do that, you can't get a gen ai to help you with that and it doesn't matter.
Speaker 1And we've got to teach students how to use gen ai appropriately because they still need to have the core knowledge, which is why the oscars and the clinical skills are still so important, because you've got to have an understanding of what's happening here and why is this not happening as we expected it to do. So it is, yes, a very interesting future in that kind of context of how we push our boundaries to what we're allowed to do, to get other people to recognise what we can do and take the burden off the healthcare system, yes, and protect ourselves at the same time, so we don't end up with moral distress or moral injury or vicarious birth trauma because we've got too many people who are leaving because of the pressures of the healthcare system.
Speaker 2Yes, which leads me to. I've written papers about compassionate mind training for midwives. You know you are going to experience trauma. As a midwife, you are going to do it, and as a student probably more so, because you're just going into a coalface with things that you didn't know about.
Speaker 2I think we're needing to be looking after our staff on this front better.
Supporting Midwives Through Trauma
Speaker 2You know, we had some mandatory supervision in the UK and they've taken that off us and we have a sort of like ad hoc system now which is not regulated in any way whatsoever, and I do feel that we should be talking often about to students. I mean, the lecturers do it because we do reflection and practice. Yeah, so we do do it, you know, in the university, but do they do reflection and practice out in the clinical area? It's like these students qualify, go on the nmc nursing and midwifery council register in the uk and then nobody ever asked them to reflect again, as far as I'm aware, when actually there's a time to reflect, both good and bad. Yes, you get accolades for success and and you know, like yourself, getting your PhD, that'll be an accolade for success which you could reflect upon through a Gibbs model or a Jones model or whatever. And then, obviously, the times that people get very, very stressed, students get to the point that it would cause them to cut away from the profession.
Speaker 1That we had two third-year students. So they've only just started third year and they've already said I'm not working as a midwife, I'm finishing the course but I'm not working. I'm not going back to clinical after I finish this course, I'm going to use my degree for something else. And that's heartbreaking that they've kind of not even finished the course and they've already decided that. I mean, there are lots of other ways that you can go. So there's lots of things that they can do. They can kind of lots of other areas they can work, um, but it's just so heartbreaking that the system is in such a state that once they've finished this year, they don't want to step foot in clinical again right.
Speaker 2That is very sad and there's people that you would need to have a qualitative interview with to find out from you know what the problems were and then start looking to fix them. Go out and interview the students that don't go into clinical practice at the end of their jobs. I'm going to tell you one thing I find very interesting. See, when I was a student midwife, we all took jobs. Interesting. See, when I was a student midwife, we all took jobs. There was never the concept of not going back into midwifery. Everybody took jobs and stayed in nursing or not midwifery or went out. In Scotland, because there's a big rural area, people would triple train and they would do health visiting as well. So some would go and do that and they would have the triple training. You know, I don't know many of my peers that left midwifery get through retirement. You know, through retirement they might become practice nurses or school nurses, but but the training was really, really useful for them. It wasn't a clinical objection yeah so what has changed?
Speaker 2is it society and what it expects people, or is it you know what? Maybe our generation? Well, my generation, because I'm a lot older than you, my generation, five years, okay, well, my generation in the UK, you just got on with it. Yeah, yeah, you know, it was no, no idea. I remember saying to my dad I feel really scared about learning to drive, I feel really frightened, I don't think I'm going to do that. Anyway, don't be ridiculous. Of course you're going to learn to drive. You'll be handicapping yourself about that. And he just like books me lessons and I got my arse out of that door and into a car and I've been driving ever since. I mean, it's like you know, but but sometimes we just need that little push. Yes, so are we are, which would lead to me. You know, are we in a society giving people more choices? They say people would have three careers in their lifetime.
Speaker 1Now, well, if not more.
Speaker 2If not more um, I'm not saying there's anything wrong with that. I have probably had three careers in my lifetime, but I've done them all within my profession. Yeah, I've moved within my profession with a goal to stay in my profession, and I'm not saying that that's right for everybody. I'm not even criticizing the people that don't want to go, but we do need to find out why. Yeah, we do. We do find the absolute details and I'm talking, there's a qualitative, in-depth study there. You know IPA experiences. You know phenomenology. Find out what their experiences were that led them to make that decision and see what we can change in the system to try and save losing these people. Because it's expensive, it is, although if they used it and go and do a good job, it's something else. Maybe it's not a waste, but you know what I'm saying. You know we don't want to be leading staff and doing staff. You know short staffers. They need to look at employing more midwives and training more midwives.
Speaker 1They do, and we've got people who are leaving between like three and five years as well. So we've got that brain drain and we've got, and then we've got kind of like the other end of the oldies and looking us looking at retirement, and so it's that skill mix that we're gonna have difficulty balancing in the future the other thing is that with yourself, you know you're always a very experienced person, you know all that skill.
Speaker 2When you go, where does it go? It just you know. I mean it got. I'm not going to say it goes to waste because you've given all your life to that in my case, given all my life to it. That's why I'm saying I want to put a new spin on it. You know a bit of comedy. You know, keep my satisfaction work going because it's got impact grow, that that that's a good thing to do, etc. It's not over really, but maybe not so. A lot of my job because I'm a senior member of staff, I'm in the senior management team in my university. You know a lot of my work, stuff that you know it's just sorting out problems, yeah, planning, meeting targets, those sorts of things.
Speaker 2That side of my life will be gone you'll have so much more free time, yeah exactly so I could, even if I just did the amount of academia I'm doing now and spent that free time in my allotment yes, listening to music. I'm a music fanatic. I love um rock music and you know, poetry music, you know, and so on and so forth.
Speaker 1You look at Bob Dylan stories with songs, with stories.
Speaker 2you know, I love all that. Ed Sheeran, you know, and I like good rock, proper good rock music, so you know. And classical opera. I like everything actually, but you know, that's probably my thing. I'll be able to do a bit more of these things, you know. Yeah.
Speaker 2I don't know anyone who's retired or isn't it's impossible to get hold of because they're so busy, Because they're driven anyway. That's what got them into the jobs. You know, People like you and I were driven. I mean doing a PhD at your age, you've got to be driven.
Speaker 1Driven are insane. I'm not quite sure which day.