Ep 107 Amanda Firth on maternal inequities, forced migration and need for increased interpreters

Ep 107  (http://ibit.ly/Re5V) Amanda Firth on maternal inequities, forced migration and need for increased interpreters 

#PhDMidwives #research #midwifery #forcedmigration #maternal #inequities #interpreters #CALD #huddersfielduni

research link t.ly/a7Eol 

What if the biggest barrier to mental health support in pregnancy isn’t stigma, but language? We sit down with Amanda Firth to unpack the hidden seams of maternity care: where well-meaning screening tools miss people, where interpreters enter too late, and where equity hinges on small, repeatable habits in busy clinics.

Amanda traces a path from home births and district hospitals to a PhD on refugee and asylum-seeking women’s perinatal mental health. She reveals how identity, migration status, and access to interpreters shape outcomes, and why midwives sometimes reword screening tools just to get women the help they clearly need. We break down trauma-informed care that protects both women and clinicians, and explore the overlooked solution of training midwives and interpreters together so mental health conversations become safer, clearer, and culturally grounded.

Beyond the consult room, we tackle workforce realities: staffing ratios, burnout, and the urgency of continuity of carer. Amanda shares how to translate research beyond paywalls into practice people can use—turning dense papers into plain language and peer learning that sticks. It’s an honest, hopeful look at building fair maternity systems, starting with what you can change today while the bigger machinery catches up.

If this resonates, follow the show, share it with a colleague, and leave a quick review. Your support helps more midwives, students, and advocates find these conversations and put them to work.

Transcript

Amanda’s Path Into Midwifery

SPEAKER_02 0:53

Thank you very much for being here. As per usual, can you introduce yourself, please?

SPEAKER_01 1:00

So I am Amanda Firth and I am a midwifery lecturer at the University of Huddersfield in England. And to quote my dad, Alan Smith 2023, I am now a doctor, but not the useful kind. So yeah, I'm um a midwife academic and researcher moving towards hopefully doing more research as well as the teaching.

SPEAKER_02 1:26

Well, I really I I honestly think it depends on which um environment and context you're in to whether you're useful or not, because I think you're very useful. Okay, let's get back to the beginning. How did you get into midwifery?

SPEAKER_01 1:40

Oh god, I forgot to do the abridged version, haven't we? No, you can do the full version. No, we could be here all night if we didn't have a full version. So um midwifery is not my first rodeo. I I knew I wanted to be a midwife as a teenager. I was really uh absolute kind of biology geek. I really was obsessed with the fact that a human can grow another and a whole other human.

SPEAKER_00 2:08

Yeah, yeah, yeah.

SPEAKER_01 2:09

And an organ, a temporary organ to go with it. I've always been a complete center geek. But then got to 18 and just felt that I was too young, too inexperienced, it wasn't the right time, and kind of put it on the shelf, really, and decided I wasn't going to do it. And I did a year of primary teaching, which ironically I left because um too much reporting, too many rules, too many protocols, and irony. Uh did a few other things, and then I um had my own child, had my first child at 21 years old, just 21 years old. Uh I was a child bride, met my husband at school.

SPEAKER_02 2:48

Oh, nice.

SPEAKER_01 2:49

And became really fascinated with home birth during that time and went on to have two home births with both children, which kind of reignited that passion for midwifery once I'd had that experience and gone through it and went, yeah, yeah, that's definitely what I'm gonna do. Um, promptly signed up for a degree in counselling and psychology instead of midwifery, and it was almost like I kept getting close and then moving back away. Um, absolutely adored my degree in counselling and psychology, was really fab, super duper. Uh, but within a couple of years, kind of went, yeah, it's now or never, and still having that itch. Yeah, so went went to do it at that point when I was about early 20s, early to mid-20s, and did my um midwifery training and education then uh with very young children, and it was fab, it was super, and some of those people are messing that cohort um lifelong. No, we don't, we don't.

SPEAKER_02 3:45

It doesn't matter where you work and how far away, you just keep picking up the conversation, even if it's a few years in between, you just kind of pick it up with those type of people.

Home Births And Global Travel

SPEAKER_01 3:54

Yeah, and we live all over the world now, you know. People in my cohort live in New Zealand, they live in Australia, um, people living out in UAE practicing. So we're a pretty global brunch. Um, and then so once I qualified, I promptly took a year out. It makes it sound like I really didn't want to be a midwife, so it just keep moving away from it. Um, I promptly took a year out and we went traveling around the world, sold the house, um, decided life was short, we took the kids out of school and went travelling for a year.

SPEAKER_00 4:21

Oh grand experience with it.

SPEAKER_01 4:24

Yeah, absolutely awesome. And tried to pick up a little bit of midwifery wherever I went, not practicing, but just observing. So out in some kind of mining villages, and um even kind of getting in touch with midwives in New Zealand. So we spent a lot of time in South America and and Mexico, but then even picking up with midwifery friends in Auckland and Christchurch. So just trying to find out about midwifery around the world, came back much more inspired, and then took a job at a wonderful local district hospital, uh, which is where I did the majority of my clinical practice, which was just fine.

SPEAKER_02 4:59

What commonalities did you find in midwifery then in different countries?

SPEAKER_01 5:05

So there's that real strength about being with women, isn't there? And um, so in Mexico, the area that I was in was traditional birth attendance rather than midwifery. Yeah, and that real kind of absolutely strong advocacy for women, which doesn't always mean exactly following the rules and protocols of the government guidelines, um, such as the area of Mexico that we were in. It was women were told if they had a home birth, their children wouldn't get a birth certificate. Oh wow. It was basically illegal in that area to have a home birth because they wanted people to be uh not birthing with traditional birth attendance and that they would go out um to the hospitals and give birth. And it was very much like so. There's a I do uh I do a lecture on the history of midwifery um quite often with the first years, and one of the things we talk about is where midwifery is everywhere, and there's there's a there's a parable of midwifery in the Bible where um two midwives, shipper and poor, um basically the king says, Murder all boys, boys but boys mustn't be born, and the midwives are the ones that say, Oh, well, we're not clearly not going to do that, so we'll just make a fib. And they say, Oh, we have all these BBAs basically, all these babes are born before we get there, so we can't take these babies away. And it was a little bit like that in Mexico where I was. So the midwives, the traditional birth attendants would get to the house and go, Oh my goodness, the baby has been born. Who knew? These these these Mayan women, they're they're birthing so fast. Yeah, and I just kind of think we see that in midwifery all over the world, don't we? That we we we we work within the constraints that we can to give women the choices that they want.

SPEAKER_02 6:44

What surprised you the most while you were traveling with that you saw that still resonates now?

SPEAKER_01 6:53

I think probably that really big shift of wherever you are in the world, there's a huge, huge difference in outcomes according to your identity, whether you're rich or poor, whether you're educated, whether you're rural or urban, uh, whether you are Caucasian or not, whether you speak the dominant language, that just it that radiates everywhere in every country, whether it's a high income country like Australia or New Zealand, or or whether it's it's a more um developing country, or you know, Mexico's not really a developing country, but but still there are real shifts between has and has not. Yeah.

SPEAKER_02 7:34

Do you think that's that's influenced you or has um well yeah, influenced your subsequent career, that experience of that exposure?

SPEAKER_01 7:49

To some extent, probably, but I think probably what influenced me most in my probably the way my career has gone, is that so basically I'm a first gender academic, I'm the first person in my family to go to university.

SPEAKER_00 8:05

Congratulations.

Advocacy Across Cultures

SPEAKER_01 8:05

Um and it's been fab, it's opened up doors, I've seen the difference that that's made. And I've always been really, I think probably because of that, been really, really passionate about widening participation, whether that's in an education environment or whether that's out in society. And grew up in a very, very diverse neighbourhood as well, where even as a child, I couldn't have told you what white privilege was, I didn't know it, but I knew that I got away with things more than some of my other classmates did, and I couldn't put my finger on it, and I didn't know why. And it was only more as an adult that I kind of realised that actually it's just because of the body I was born in or the family I was born into that made a difference. So I think I've always kind of had my eyes open to that and kind of gone, well, what can I do to make life better or differences in anybody's life, no matter what their background is. You know, I I come from a working class background, and not many people, probably less than half of my contemporaries went to university.

unknown 9:08

Yeah.

SPEAKER_01 9:09

Now, ironically, I'm the one with the PhD, which is bizarre. Nobody if you'd have asked my sixth-form teacher, nobody would have seen that coming. I was definitely in the other sector. So um I think it's it's probably just stemmed from that, from perhaps being the underdog to championing the underdog in some respects. Underdog's not the right word, is it? But but you know, looking at who's invisible, yeah. Uh and whether in inequalities and trying to address and trying to make things fairer. Maybe I'm a little bit altruistic, but trying to make things fairer.

SPEAKER_02 9:39

No, that's I think that's well, I mean, we all want to have a purpose and a recognise a purpose where we can make a difference somewhere. And I think we all have an innate sense of justice, and it just depends on how we have been brought up and how we have been exposed to injustice, to how much that makes us want to then equalize or to change that injustice and to fight for that equality and equity in particular.

SPEAKER_01 10:10

And I think it's recognizing in midwifery, isn't it, that you can do that one family at a time. It's we all want to change systems and we all want to improve systems, but actually the big stuff takes a long, long, long time. But when you walk into a midwifery room or when you walk into a classroom, you can make a difference right there and there at that point.

SPEAKER_02 10:30

And that difference is intergenerational because you're not just affecting that person at that moment at that birth, you're affecting quite the way that they bond and attach that then kind of can help them continue what they've learned or change what they've experienced. Um, and so you have that, and their trust in the healthcare system, their trust with health professionals, their ability to these days critique information. There's so much that we do both consciously and kind of subconsciously, or a little bit more subtly, that has major effects for intergenerational health.

SPEAKER_01 11:10

So much, so much so. I completely agree.

Inequity And Identity In Outcomes

SPEAKER_02 11:14

Okay, what did you enjoy about your? You've finished, you've graduated, you've qualified, you've come back from your travelling. Um, what did you enjoy about where you were working there? You're in the community or in a healthcare facility?

From First-Gen Scholar To Lecturer

SPEAKER_01 11:31

So predominantly hospital-based. So District General Hospital at that point had about two and a half thousand births a year. So the large teaching hospital in next city had about four and a half, five thousand births. So it was a much smaller facility. Um doesn't mean to say it wasn't busy because it was staffed appropriately for that number of births. I feel like I feel like I was really lucky in that I feel like I was the last generation to have midwiferies as midwifery used to be. So when I look at the students that have come through now, they they operate and practice in a very, very different system. And I think I probably got towards the back end of that real belief. But obstetricians and uh doctors, anaesthetists, midwives in that unit all believed that physiologically women could birth babies, yeah, and that we would intervene when necessary. Some doctors intervened more than others, um, but but there was a real kind of camaraderie working together. I learned so much from the obstetricians that I worked with, and I would learn so much from the wise women midwives that I worked with, and that we midwife each other. Yeah, the being with woman was was being with colleague, and and it just worked really well. And you kind of think that's still going on in units, that must be still going on in units, but why do we keep seeing in all these national reports how difficult and how terrible it is? So clearly it's not happening all the time, but just the whole system has changed, isn't it? The whole system is so pressured, yeah. And I feel really grateful that I had my children in a different system, um, and that I got to do most of my clinical practice in that arena where they still came out of vaginas basically, and not by accident, but but but planned uh a planned safe birth, um where people felt as supported as they could be. And we had a plan B and a plan C, and not everything ended in a physiological birth, but most of the time I could go home knowing that actually we'd made a difference that day and that we'd worked together really well as a team that day. I actually didn't mean to leave clinical practice when I did. It was it was quite by accident. I um I knew I wanted to get into education eventually, and a job came up at the local university, which is where I'd had my education as well. And I kind of thought, well, if I throw my hat in the ring, and somebody had encouraged me to apply, a really wonderful woman had encouraged me to apply. And I thought, well, if I throw my hat in the ring, I can then find out what's lacking in my CV, what kind of questions they're asking, what do I need to develop? So I did, and then I got the job and I was really stunned, and I was a bit like, oh, this is five years sooner than I expected. Uh, what should I do now? And I did, and I took it so it was it was a little bit of soul searching, to be fair, because in some respects I knew I really wanted to go into academia, but I wasn't quite ready to leave clinical practice as well. It was more of a just the sounding board to see what would happen. Um, but I loved it. I absolutely loved that moving to academia. It was it was a really great opportunity. I'm really glad that I took it, and I'm really glad that somebody took a chance on me as quite a junior midwife, really. Um I'd only just started my master's at that point, so I was supposed all the way through my master's and then straight on to my PhD. Instantly, the students are finished.

SPEAKER_02 14:48

It's really hard to have enough places that do both kind of the academia, the teaching and the clinical and stay in the class because there's very few, like you only need one clinical educator kind of for an area. So it's a very if somebody's there, then you can't do that to stay. And I know hard here it's hard to get even in academia to kind of you can work 0.8 or 0.6 and then kind of still keep a clinical role, but it's kind of getting hard to have those joint positions. Are they getting more to find? Because over there, well, I suppose that's the clinical academic role, which is different to you guys. But are there increasing clinical teacher roles over there, or are they still kind of staying fairly static?

SPEAKER_01 15:40

I think it really differs trust to trust and geographical region to region as well. So some of the big London hospitals and larger city teaching hospitals have more clinical academic roles, but up in the north of England a little bit less, so it's it's quite separate. Lots of people do go to academia and try and juggle both, but we all know that two part-time jobs is worth more than in hours, far more than one full-time job. Yeah, and it's not sustainable. I tried to stay clinical when I first went into academia, and as well as learning a new craft and teaching, trying to do clinical stuff as well, it was just too much.

SPEAKER_02 16:16

It's not sustainable. And the clinical academic role, and this is something that obviously I've been interested in, is not a common term internationally. So it's recognized kind of originally with medicine, and it was somebody who was doing clinic but also recognised to do some research, that's what it's recognised as in the UK, somebody who's in a clinical position but does some teaching but also does some research. Whereas here it depends on who you talk to about whether it involves research or whether it just involves teaching and there's no research involved. So it's kind of, and quite often if you're talking clinical academics, some people will go, oh, that's the same as a clinical facilitator. So that's more mostly about teaching in the clinical area. So yeah, it's a term that we need to either um standardize and recognize, or we need to come up with something that's different that can be identified.

SPEAKER_01 17:11

And I think it's very similar in the UK, and I think it definitely depends on whether that particular hospital and trust is um aligned with a very research-intensive university. If it is, you're more likely to have those relationships. But if not, you're not going to get the same opportunities in the same way. Because both need to grow.

SPEAKER_02 17:30

They do, absolutely. We need to, and that's the thing, is not everyone who does a PhD wants to go into academia. They kind of a lot of people want to stay in clinical, but they don't see the pathway, and therefore they go, well, there's no point in getting a PhD if I can't stay where I want to stay. So, what did you do your masters on?

Hospital Practice And Team Culture

SPEAKER_01 17:47

So my master's was a mixed midwifery master, so all kinds of different um modules in there. But my research interest that I really built on there was um perinatal mental health. So that kind of steps in. So my first degree was counselling and psychology. So um a lot of that is mental health and social sciences. So then my master's, I built on that with perinatal mental health as well. So my um master's thesis was all around kind of psychosocial interventions for um treating perinatal mental health conditions, whether that was peer groups, exercise, pram walking groups, meditation, that kind of thing. Um, and that was a systematic review. And then I went straight from finishing that. I knew once I'd finished my master's and all the teaching modules there that I wanted to go straight into a PhD. And I worked with the most amazing team of academics. Absolutely top-notch. Bring a bring a chair to the table, make sure that everybody's there, everybody gets an opportunity, there's a slice of the pie for everybody. I honestly couldn't wax lyrical enough about women having that other opportunity with to gain leadership skills like that. It was amazing. And my manager just said, a board Amanda is a problematic Amanda, so you should definitely go straight into your PhD. And she knew me from my undergrad days. Um, you you're definitely better for keeping busy. By all means, go straight into a PhD and and helped me to do that. She made sure that the funding was in place and after every day a week. It was absolutely fantastic, and did and made very good progress because of that.

SPEAKER_02 19:25

So your, and I've got your thesis here, got a very large title, addressing inequitable maternity services provisions in England for asylum seeking and refugee women who present with symptoms of prenatal depression, a post-colonial feminist inquiry into the experiences of asylum seeking and refugee women and the midwives who care for them. So, what made you do both sides and not just focus on the women and like the asylum seeking and refugee women? What made you do both sides of it?

Move Into Academia

SPEAKER_01 20:00

So I think that comes down to kind of that post-colonial feminist methodology of when we when we look at migration, we often look at it very problematically, and we problematize the women or the people that are there. So if you look at a lot of the refugee and asylum seeking um research that's out there, it will talk about how women DNA are their appointments, how they don't turn up, how they don't access care, they don't engage with care. And we still see that even just in wider minoritized women research. How do we get ethnically minoritized women to engage with? Almost like it's their problem that they're not doing that. So I actually wanted to look at it from an individual point of view, a midwifery clinician point of view, and their perspectives of the system that they both navigated. So um so the perspective of both women and midwives of navigating that system as well. And some really, really interesting things that came out that I wouldn't have got if I'd only spoken to women or only spoken to midwives. So I've got a paper under review at the moment, um, which hopefully, fingers crossed, will get published. And you know, some of the findings around that are I had a whole theme that of things that were really, really pertinent to and affecting women's um perinental mental health concerns being recognized and referrals being accepted, but women were absolutely oblivious to them. They didn't know, yeah, they didn't they didn't know that they were they were getting knocked back from services, they didn't know that they weren't meeting referral criteria, they didn't know that um that they couldn't access something because of their migration status or because of waiting lists, because midwives were doing the invisible brokering behind that to try and find somewhere that would. And if we'd have only spoken to women, we wouldn't have got that. Likewise, there are some things that came out in the thesis around um pockets of midwifery practice where midwives were absolutely doing the very best with the resources that they had, but not necessarily in ways that were helpful to women. What do you mean by that? So there is um an example in the thesis. So the thesis is around perinatal depression, and honestly, if I was going to do it all over again, I would just do wider perinatal mental health because actually it it's there's so much overlap between conditions, and many people are undiagnosed anyway and will have overlapping anxiety, depression, PTSD, all kinds of things, OCD. So I'd widen it to perinatal mental health. But you know, one of the biggest examples that comes out in the thesis is speaking to midwives who are getting really frustrated with perinatal depression screen tools. So we use tools, we use checklists. Yeah, and some of the sentences and some of the questions just don't make sense, even though they've been they've been transcribed into other languages and been validated for use in different languages, they're not necessarily culturally appropriate.

SPEAKER_00 23:07

Yeah.

SPEAKER_01 23:07

And there's not a single depression screen tool out there. Someone's gonna text you now and message you and say, Yes, there is. But at the time I wrote my thesis, there wasn't another depression screen tool out there that had been validated for use with for uh women who were forced migrants that took into account potential trauma, the use of things like that. So, midwives, if they just asked the questions as they were, could not get the women to score highly enough to get referrals put in. So, um, a pocket of midwives within the study, and a third of midwives within the study were rewording the questions from a place of trying to get women help, rewording the questions to try and get the women to score highly enough. And sometimes midwives would say, I know there's something wrong, I just can't get to it. And some midwives were asking questions around women's migration experiences to try and uncover some of the things that they knew were there, but that just weren't ticking the right boxes. And if women, women, some women in the study said if they were asked about the migration experiences, they they'd answer it, they'd answer the question. You know, she must be asking me either because she wants to know whether I'm eligible for free care, yeah, or she's just interested, or she wants to know if some other reasons, so they would answer the question, but they had no idea that that was being used in an assessment of their mental health. Whereas the midwives were using that to try and help the women to trigger a high enough score to get them referred. So there's just a mismatch and a miscommunication, and at best it wasn't helpful, and at worst, for some women, it's potentially re-traumatizing to be um pulling up some of those things and then not have a mechanism where somebody can get help, but absolutely done from a place of of love and care from the midwives, not nothing intentional about harm there whatsoever. So, how do we do that? How do we make it better? How do we uh how do we improve and develop systems that are better? So things like trauma-informed care, and I feel like it's a really trendy word at the moment, but how do we actually really do it and implement it anyway and have trauma-informed systems that are psychologically safe to the midwives as well as the women that are navigating them?

SPEAKER_02 25:17

In a healthcare system that is broken and in a healthcare system that values not the person's individual experience, but how fast they can tick through checklists and get them through. How do you then bring in the trauma-informed? Because especially when you're talking about asylum seeking and refugee, they've usually had something horrendous occur to them that's made them want to move away from their home, from their land. Um, and so you've got to almost assume that everyone's had some kind of experience that would be deemed as horrendous to someone who's never had been in that situation. So, yeah, we can be very white privileged in a lot of cases of oh, we haven't had to do all that. And so, yeah. So, how do we change it? How do we bring that in?

Clinical Academic Roles Explained

SPEAKER_01 26:07

Ah, so that that brings me on to my postdoc study, which is um, so I'm doing a postdoctoral research fellowship at the moment. I've I've been really, really lucky, and I was awarded a well-being of women postdoctoral fellowship with the Royal College of Midwives and the um Bedectrus for Nursing, which is great, it's it's absolutely fantastic. So the Royal College of Midwives funded some of the activities associated with my PhD as well. I had the Mary Seacole Award, so it feels like it's been a natural progression there. But the thing I've moved towards is the migration stuff has never been more important. I don't think migrant women have ever lived in a more hostile environment across the world than they do now. Maybe that's naive of me, but in the UK, it's a very difficult time to be a forced migrant woman. Those complexities exist and it's easy to get wrapped up in those. Um, however, if we do that, we're at risk of missing some of the really fundamental things, such as language barriers. So, you know, one of the key findings in my PhD study was we've got all of these migration-related issues. However, we're not even kind of like chipping away at the edge of that because we're not addressing language barriers. So you know, the women that I spoke to, most of them had not been offered an interpreter at all. Um midwives had talked about how difficult it is to get an interpreter, that even when they tried to get them, they couldn't always get one. Or that actually they perceived that women could get by because they could ask they could answer questions such as, you know, is your baby moving? Do you have any stomach pain? Yes or no answers are quite easy. But the nuances of talking around mental health are much, much more difficult, much more complex and culturally bound as well. And if we don't address the fundamental language barriers, we can't start uncovering any of that more complex stuff that's in there. So my postdoctoral research is looking at how um midwives and interpreters can work together more effectively to discuss mental health with women. Um, and it it builds on really nicely from the PhD, but the stuff that's coming out is just really kind of insightful at the moment. So really practical things that we don't know about each other's roles as midwives and interpreters, and how we could, you know, in the in the UK we have prompts. Do you have prompt in um the US in Australia? The simulation training. Yeah, so obstetric emergency simulation training and all the reports, everything say, you know, colleagues that work together should train together.

SPEAKER_00 28:36

Absolutely.

SPEAKER_01 28:37

And we have that too. We have that with obstetricians and we have that with you know with midwives working together, but we don't have to have that with midwives and interpreters. So there's this kind of like magical thing where midwives become qualified and they should know how to use an interpreter. It's not necessarily part of the referee curriculum, it's not part of your training, it's not in any kind of mandatory updates unless you work at a very diverse trust where it might be an hour or something or half an hour. Equally, most interpreters, they're not just interpreting maternity at all. They're interpreting across all health spectrums, could be oncology, it could be geriatrics, it could be dietetics, it could be AE. Um, but also they're usually doing law and public services and social services as well. So, how do they possibly get all the kind of maternity vocabulary down? How do they understand what midwives do? They're learning it on the job, just like midwives are learning it on the job. And there is some really simple, easy things that we could be doing that that would incrementally make a big difference. I'm really passionate about what are the incremental gains that we can make in places. We need to do the big stuff, but what's the small stuff we can do whilst we're waiting to do the big stuff?

SPEAKER_02 29:49

Well, you've just um you've just added a focus into one of my undergraduate topics that's about IPE. Um I think we do it, but I'm just gonna chat to my colleague who runs it and kind of go, we need to expand on this. So thank you very much. You've just changed practice. Um before you've even finished. Yeah, no, you said you had a fabulous team for your supervisors. Did you pick them or were they assigned to you? How did you get your supervisionary panel?

Perinatal Mental Health Focus

SPEAKER_01 30:22

So um at the University of Bradford where I did my PhD, there was one big key midwifery researcher. There were there were there were other midwifery researchers, but there was one who was really leading the way on postgraduate research and PhDs, and that's Dr. Melanie Have Cooper, and she also happens to be a reader in um migrant health as well. So I already knew that I wanted to do research in that area, so it was a really obvious alignment. Uh so I approached her and she was really supportive, and we work in a very similar way as well, so I knew it would be okay. I knew that she would hold me to account, I knew she'd hold me to deadlines, but I also knew that she would be open to things as well and and and would kind of give me the space to develop it, but also know when to bring me in as well, because I could I can get a bit excited about stuff and run away with things. Uh so then spoke with Mel about who else we could do, um, who else we could bring in for a team. So usually in the UK at that particular institution, you would have two PhD supervisors, two internal PhD supervisors. So we chose another PhD supervisor who, believe it or not, uh Dr. Andrew Hart was one of my undergraduate psychology degree lecturers who've moved institutions in that time and then met me back on the PhD. So he was there at my very first degree, you know, when I did my very first degree and had children during that time, he was there, and then he saw me like 10 years later coming back and doing a PhD. So he brought the social science and the psychology side of that and also the kind of healthcare leadership stuff, uh, which was absolutely fantastic. But then Mel had a fantastic idea around bringing in somebody from the Born in Bradford project. So Born in Bradford is a huge um longitudinal research study looking at uh health and well-being of well, what would have been babies, but who are now teenagers all the way through. So all they've routinely collected data and loads of extra stuff going on to address health inequalities. Um, and it there's there's offshoots of it all over the country now, uh, and it's absolutely fantastic. And one of the um big researchers there was um she was Dr. Josie Dickinson at that time, but she's just been promoted to professor, uh, which is wonderful, and she was absolutely amazing, and it was one of Mel's really um fantastic ideas because I didn't know Josie at that point. She was like, I've met this woman, I think she'd be really good, and she brought a really applied health research um kind of dimension to it that kind of that's really good, but what difference is that going to make in practice? How would you implement that? That real kind of knowledge mobilization stuff, how realistic is that? Or oh, do you think you've made an assumption there about that and that service because you're only looking at one service? Uh so between them, I had three really diverse PhD supervisors, which hurt the head sometimes because it came with different dynamics, but I think it absolutely definitely strengthened the PhD, without a doubt.

SPEAKER_02 33:30

And I think that's the the joy of having a multidisciplinary panel, is that whilst we keep saying midwives need to be at the table where decisions are made for healthcare because we ask different questions, we still need to remember that we need other disciplines to ask us the different questions as well.

SPEAKER_01 33:46

Absolutely, absolutely, and I think genuinely, if Josie hadn't have been on my PhD um team, it would have been a slightly different project. I think she really pushed me to make the recommendations, to make things that were that would make sense to midwives out there and that could be applied in practice rather than just ending up on a dusty shelf somewhere, another bit of knowledge that's shot out into the academic universe. And I think it was really, really helpful because I think if you are just a midwifery academic, just in that higher education arena, that you can accidentally lose touch, you can accidentally make assumptions about what you think is happening out there when you're not quite as closely aligned.

SPEAKER_02 34:32

So you said you had one day a week for your study. How did you structure your study so that you balanced it with work and family, or not even balanced it, but integrated it? Um, and how did you keep your sanity during those times where you wonder why the hell you're doing it?

Researching Refugee And Asylum-Seeking Women

SPEAKER_01 34:50

I it didn't just take one day a week, as we all know. So I worked many, many evenings and many weekends. I think I was fortunate that my children were kind of preteens and teens at the point that I was doing my PhD. So they kind of knew what was going on and they were very appreciative and gracious about it. And my husband was definitely very gracious. I'm not sure I'm the best example because I think I probably worked too hard. So I managed to do my PhD part-time in in just over five years. Nice, it was nice. I'm not if I'm really, really, really honest, if you asked my husband and children whether it was nice, I'm not sure they would say so. But they were very gracious at the time and have remained gracious about it, and I couldn't have done it if I'd had younger children or more problematic kind of family structures and things. But funnily enough, now that I'm supervising PhD students, I'm not sure I would recommend the same strategies to future people because I probably work, I probably gave it too much importance. There are probably things without a doubt that I've missed out on that that I can't get back time and things like that and experiences. I'm glad that I've done it. I really enjoyed every minute. But I also think I was really fortunate in terms of family structure and family support as well, and not everybody has that, whether that's by choice or design. Um, so I think I have to owe a lot of that PhD success to that wider support network as well. In terms of keeping me saying, Liz, you know where this is going, PhD Midwives, PhD Midwives when Twitter was a wonderful place, before it turned into a burning cesspit, yeah, um, and became ex. I was doing my PhD, and just as I hit my data collection point, the pandemic hit. Yeah, so I actually lost a whole year of data collection as well within that five years and was writing up other chapters and and couldn't do anything, just at a point where actually we were super isolated as well. So I'd just moved to a different institution, I'd only been working there for three months when the pandemic hit. So they were colleagues, not friends. They were very wonderful people, but they would they were definitely still your colleagues. And then the pandemic hit, and I'd lost everything. I'd lost my network of friends because we couldn't go out. I'd I'd left other academic friends at other institutions. I didn't really know this group well, they seemed nice, but but I didn't know them very well. And genuinely, what got me through my PhD in a really joyful way was PhD midwives. It was you, it was Anna, it was Esther, it was Belle, you know, the online chats that we'd have, which weren't even that frequent. So lots of texting, but like occasional video calls and stuff like that. They're really kind of having each other's back, digging each other up, helping each other. Yeah, how do academics show love? We share research articles, don't we? All this and thought new love heart emerging, and it's just it it genuinely is one of the most lovely things about the PhD journey is those friendships that you make along the way. And I wouldn't have got that had I not fallen into PhD midwives, yeah, because as a midwifery academic doing research, you're not with a full-time PGR student, you don't get ingratiated into that community in the same way, you're fitting it in in a full-time job. So, how do you have that identity as a PGR student when you're a full-time academic? And I wouldn't have got that at all. So I'm so so so grateful for that and for the friendships it's had. And Belle's just been over, hasn't she? So we've um we've had a great time just having fun and and being research geeks together and and staying up. I want to say really late, we're women of a certain age now, and she was jet lagged, so it wasn't that late. But we had a great time, it was super, and we really missed you.

SPEAKER_02 38:54

They had a little you had a little get together, which was kind of fun in Melbourne, and down in sorry, down in London. There was a little get-together of the PhD midwives of kind of some of the OGs and some of the early ones, and it is kind of that you create your own networks, you create your own communities, and the joyous thing that I think COVID did is that it reinforced to everyone the the advantages of the virtual world because we did have Skype before that, but it wasn't it was still utilized, but not necessarily to the same demand. Suddenly we had Zoom, and it was a normal behavior to sit and chat with people and suddenly you're meeting people in the flesh, and especially you kind of sit there and go, Oh, that's who you are. It's kind of I'm used to you in a little square box and kind of without anything else.

SPEAKER_01 39:43

Yeah, so going to ICM and seeing seeing more than just the head and trunk of somebody. That was that was like playing one of those games as a child where you've got to unwrap the whole body.

SPEAKER_02 39:53

So going thinking of your PhD now, what was something that surprised you the most that still resonates?

SPEAKER_01 40:01

I think it's really true what they say that the PhD is a training program. And it's quite a humbling training program at that, isn't it?

SPEAKER_02 40:09

It is.

Screening Tools And Unseen Barriers

SPEAKER_01 40:10

And then you get to the end and people start referring to you as an expert in something, you're an expert in this, or you're an expert in that. And having to really say to people can go, if we're going to use that really heavy word, we have to say that it's in this really niche project with X number of people at this point in time in that. And I've kind of learned that in research there's that really funny thing where you've kind of got to self promote, also remain humble, yeah, as well. And it's a really fine line. And I still don't know what that looks like. So some days I can do the self promotion bit in research, because you've got to do if you want to get out there, but it kind of sits uncomfortably. And then other bit, sometimes you meet other researchers who are in your office. field, um who invite things or help me to collaborate on things. And then you kind of go, I really knew that I only knew a little bit and now I know even less. Now I've seen how much you know.

SPEAKER_00 41:06

Yeah.

SPEAKER_01 41:06

And it and it's a very humbling experience to do that. And I kind of I kind of hope that I keep that humility because I don't want to be an Arogant researcher. I think it really worries me that you could end up being an ivory tower arrogant researcher. And I'm really lucky that I'm not surrounded by any people like that. That's and that's not who I want to be and I hope that I can kind of hold on to that because it's a bit like for some you know research when it's when it's exciting and contemporary and gets picked up it's a bit celebrity kind of inducing isn't it you see that in some circuits and that would terrify me. So I think I need to become kind of more media savvy like that. But at the same time it's not my natural bedfellow. It's not how I would like to be so I could do the social media stuff that I want to do but um it it it always worries me that the in research you have to be courageous but you have to know your stuff to be courageous. And in the research fields that I'm in around forced migration stuff there is always somebody waiting in the wings to misinterpret what you've said on recommunicate on this quote. But that doesn't mean that you don't do it. It just means that you think about what you do and and and the lens that you're doing that which is a big to quote my husband and to quote Spider-Man with great power comes great responsibility. When somebody gifts you a voice for something there's a lot of responsibility there and I still find that terrifying if I'm really honest.

SPEAKER_02 42:41

Oh no I think that's and it's I think it's actually a safer place to be but it is how do you speak out and we know that the the current world that we live in is it's so easy to be a keyboard warrior and to slash down people for daring to think something slightly different instead of taking the time and sitting and going, well let's actually talk about this why do you think this way and having that dialogue and being open to changing or more so being open to learning not necessarily changing but learning with respect and there's I think we've yeah it's too easy to see that there are so many people that don't have any intention of learning and that just out to overall and yet unfortunately especially in your area these um the political ramifications um are huge.

SPEAKER_01 43:33

And it's an exciting time to be a midwifery researcher I feel like we're on a bit of a pinnacle with midwifery. And I feel like on that precipice now we either stand up and we really really really fight for midwifery in a collegiate way that just says you know this is the evidence we know this works. We're not just shouting hot air you know these these are this is evidence based and you know we do that or we roll over and we lose midwifery.

SPEAKER_00 44:01

Yeah.

SPEAKER_01 44:01

So actually I think it's it's a real time that we have to be courageous and that's exciting and terrifying. So it's about working with the right people isn't it and that doesn't mean just midwives either it's about you know developing those relationships and there are so many good collegiate relationships and research relationships out there and we just need to get out there and we need to keep pushing it forward. So I kind of think as midwifery researchers that that's one of our goals at midwifery practitioners is to keep that autonomy in midwifery. And I hope in 10 years time that I can say that that's definitely still there. Because I feel like it's a use it or lose it time at the moment. And I desperately try to politicize my students in that way as you know this this is your career that you're going into if you want to keep that then you need to be critical you need to be evidence informed you need to be research informed you need to be able to question things that are out there but you need to know your stuff to be able to do that as well. You're going to make a difference one family at a time one trust at a time but actually societally massively we know that midwifery works and saves lives.

Trauma-Informed Care In Strained Systems

SPEAKER_02 45:03

Once again that intergenerational change and it just takes one thing to move in one place and in one hospital that then gets picked up but yeah we need to use the evidence we need to disseminate the findings because without that dissemination we could have like a dozen trusts doing the same thing but in isolation of each other. And that's where that promotion and self-promotion which it is about sharing what we're learning and being open to those communications and not going this is mine I'm going to be so protective of it I'm not telling anyone but maintaining well this is my area and this is what I think and this is what could happen and let's talk about it and sharing that. And I think that's where I think since kind of that other place has gone to um binfire um over on social media I think LinkedIn's really quite picked up on that because there's been some really nice postings and chats and conversations. There's been some contentious ones as well but I think that's really kind of starting to pick up in that professional way of communicating that I think we used to be able to do and also you can post a lot more on LinkedIn which makes it a lot easier to kind of shape too.

SPEAKER_01 46:21

LinkedIn is probably the place it no it's not probably it definitely is the place where I'm most present academically these days. I tried Blue Sky I really really wanted Blue Sky to work. It's not there yet um but but LinkedIn feels like a safe space to have those academic conversations that as you say it can still get a little bit inflammatory at times but it feels freer of the bots and the keyboard warriors in comparison to the other place as well.

SPEAKER_02 46:51

Anyway I'm so jealous of you guys in Australia because you've managed to get um postnatal ward ratios in for women and babies in Queensland yes I think Queensland got babies we've got it here in South Australia in postnatal but we didn't get the babies included but it's small steps and if one place does it one jurisdiction does it then there's your precedence it can be done and then we can use that as a fulcrum for um other enterprise bargaining and agreements.

SPEAKER_01 47:23

Absolutely and we're shouting about it in the UK so we're we're definitely watching with interest because you know if you if you can see that it has an impact on your figures and your outcomes then there's no reason for it not to be adopted elsewhere.

Postdoc: Working With Interpreters

SPEAKER_02 47:36

Yeah and it's not just about the care of the the women and people who've just given birth and their babies it's also about the workload for the midwives and it's we're talking we've got a situation where we've got healthcare systems around the world that are burnt out we've got kind of dangerous staffing levels we've got mass attrition in three to five years of career for a lot of them we we we educate these fabulous new generation of midwives and then after three to five years they can't well for a lot of them it's morally they can't keep staying in the system because they can't give the level of care that they want to give because the healthcare system is so broken at the moment I think internationally and so they will leave. And so we've got this massive skills gap and we've got a lot of the the Gen X's and the baby boomers that are retiring and we know from even in 2021 with the State of the World Middle Bruce report that internationally we need a million more midwives. Yeah. And that's granted not all of them are in privileged countries like Australia we've got one of the highest um ratios but even we've got deficits and we're looking at major deficits and needing to increase the students by 20% of who we educate in Australia by Australian figures to actually match the attrition not even to kind of go above the numbers that we need.

SPEAKER_01 49:02

So yeah there's a lot we talk about the gap at the other side don't we need people to not want to leave we need to create a system that feels fair and we can flourish.

SPEAKER_02 49:12

We need to create those magnet we need to create more midwifery group practices and we're slowly getting there. We're slowly getting up and some states are doing better than others but it's still 80% of people going through the system go through a fragmented system. So it's like how do you do that? How do you increase the care and how do we decrease the induction numbers and the cesarean sexual numbers so we are acknowledging the physiological birth but also at the same time acknowledging that and this is the whole Michelle O'Donnell conversation that is quite fascinating we've got people who are getting pregnant now that without medical assistance wouldn't have and so they are coming in with comorbidities that they wouldn't have 20 years ago. So we do still need to have the experienced people to look after them and know that they may not necessarily have an easier time but it doesn't mean they can't have physiological birth if we're actually supporting and working together in kind of yep here we are we're promoting this we're working with doctors we're working with dietitians we're working with psychologists but we have that name to midwife we have that continuity of carer that we know can make so much of a difference.

SPEAKER_01 50:20

And we've got so many women globally and and you know definitely according to research in the UK women who get impregnant for the first time and they're absolutely terrified of birth. Yeah they're terrified of going into the maternity system.

SPEAKER_00 50:33

Yep.

Training Together To Bridge Language Gaps

SPEAKER_01 50:34

And what's the intergenerational consequence of that going to be the the the the fact that people are just so terrified of the system of having a poor experience in the system that actually they're just going to book the elective section and you can't blame them. When you read the reports and things that are out there but it's absolutely imperative that we change that and that we try to change that not try to change women's minds but if women are really good truly going to make an informed choice they have to have options don't they they need to have options that are open to them. How did you celebrate when you finished your PhD I absolutely crashed out so my viber was super long I had a really super long viber I think it started at about half one in the afternoon and we had a break and actually my husband took the dockers out it was kind of wintery here it was kind of winter spring um it was pouring it down with rain he took the dogs out on a seven mile walk around some reservoirs because we were still kind of working from home and um he came back and I was still at it and he could hear me chatting downstairs and at one point we stopped for a break and I messaged my supervisor who was there silently and I just said to her Mel I don't know how this is going. It's either going really well or it's going really badly and I could not call it at this point and she says I'm so glad you've said that because I feel exactly the same way. I don't know which way this is going to go and it wasn't it wasn't a combative um viber experience whatsoever but it was definitely a rigorous conversation. Yeah and so I didn't actually get out of my fiber till about 10 past five in the evening or late afternoon. So it'd been long like three and a half hours um and by the time we'd finished my husband was like yeah that's great I was like right I just need to tell my mum and my dad and the kids and the kids were like oh right because it actually done yet because PhDs have so many false endings don't they you hand in you thesis and you and then people go is it done you kind of go well yeah maybe then you have a viber then you've got amendments probably and then there's graduation so I kind of got to that point knew that I'd passed my viber with just some very minor amendments I was really fortunate and my husband was like we need to go out and celebrate I was like there is literally nothing I would rather do less but I kind of thought no this is a one off thing we've got to do that so I got dressed we went into town we went out for a meal and we sat down to eat at 8 pm by five past nine I was back home had my pajamas on on the sofa with the dog I was like I'm just so tired this is this has been really lovely. It was a very nice celebration but I just need to crash out yeah it's a that's that's a brain drain that kind of takes all your energy away yeah it it was it was so lovely I got so many kind of like messages from people that I wouldn't have expected to um and you know cards and things like that that was just really really lovely and people that say oh you know you've inspired this or I remember when you did that for me and things that little butterfly effects that you don't know that you've had because you've had your head down doing things. So that was really really lovely. But in terms of celebrating I didn't even go to my own graduation I um I just didn't want to do it. I was I was kind of done I've done I'd really enjoyed the process I didn't need the gown and the certificate I was like yeah just stick it in the post as soon as possible if you know if you can yeah but yeah that that felt like a good ending to be fair for me. And that's why it's all individual yeah I I love it when people party hard after their PhDs and I've got two colleagues who've just handed in their thesis at the moment and I am so looking forward to celebrating with them. But it wasn't what I wanted to do but I can't wait to be the ones to celebrate with them. Because you see how hard they've worked to be able to do it.

SPEAKER_02 54:31

So what did you do what have you done since then so you've you're kind of stayed in academia and you've now got this postdoc in there. But what else have you been doing?

SPEAKER_01 54:40

Because you've done a few other things as well since that time yeah I have I've been really lucky and I and I do genuinely say that because I think a lot of research is look it's not necessarily how hard you work um it depends whether your research topic is contemporary at the moment in terms of funding and things like that. It depends on who opens doors for you invites you to meetings so I'm doing my postdoc at the moment I've got about a year and a half left on that that's going touch wood really well at the moment um I got a place on the ICM leadership program. So I'm receiving research mentorship from Professor Jane Sand King's fabulous um which is wonderful it's it's really great I didn't know Jane before that whatsoever uh so that's a whole new kind of mentoring relationship um learning all kinds of things really and and all kind of networks that you need to be involved in stuff I know I want to do more research I know that that's where I want my career to go. Yeah so I'm kind of working towards being able to apply for a reader or associate professor position in the next few years. Will I ever get to professor I don't know we'll see maybe maybe not um but I want to do more it's not about the title really it's about oh it's kind of about the title yeah I want to get to associate prof. Beyond that I'm not sure um but then I know lots of midwives that don't have PhDs that are actually doing really immense research as well that just don't have a sub that that says that but actually they're probably doing research higher quality than I am. So I want to carry on doing more of that I um hope that those kind of experiences will help me work towards that in terms of making relationships with people really authentic relationships with people and get to know people.

SPEAKER_02 56:34

It is I think that's one of the things that trying to get that information out of what you've done and what your results are that yes in the kind of the formal sense we have to go through the peer reviews which are problematic in themselves the journals and the firewalls and the cost of doing open um access but it's like that will get a small percentage of people who read them it's then translating it into everyday language of this is what we did without what I call the wanky words. And it's about putting it so you can actually read it as a story or as my supervisor says my natural writing style is if I'm writing a letter to my aunt which I don't have a problem with because I think that's kind of quite easy to read absolutely in the right place, but not obviously as a PhD evidently but it's writing and that's where people will sit and talk and that's where you have them at the tea rooms and that's where you can have those conversations over morning tea and lunch and have the informal journal clubs because you're a way of of sharing that oh they did this or maybe we could do this and start that spark of even if it's a quality improvement. And yeah it is there are so many people doing such amazing research that unless they have the confidence to submit stuff to a conference either a local conference a national conference or an international one once again privilege comes in of money because you need to be able to attend like the ICM is fabulous but it costs an arm and a leg to kind of go over especially from this side of the world but we need better ways of sharing and and capacities and I also love the Vidom the Virtual International Day of the Midwife as well because that's a free thing that you can do from your home to share what quality improvement projects you're doing that people can go, oh, I really like this and then start the conversation um offline.

Supervisors, Mentors, And Method

SPEAKER_01 58:33

And it's that democratizing knowledge isn't it yeah you know it's all right your institutions say that you need to write this wonderful two, three, four star ref paper. But who's looking that up? They're only looking up if they really really need that niche bit of information. They're not finding it by accident behind the paywall I was in a a a training event a knowledge mobilization training event the other day which was really fab actually um the person leading it was somebody that I taught as a student so and she absolutely has way more knowledge than me on any of this stuff. It's really great to see somebody really flying in their career and she was fab the way that she broke it down but um somebody in that meeting gave a stat saying something like 50% of all NIHR funded research gets published but never cited.

SPEAKER_02 59:23

I mean you think about how many millions of now perhaps don't quote me on that I might have misquoted that person but basically 50% of research doesn't get cited you can think how many millions of pounds worth of public money have gone into that what's was probably an important research project but to be hidden behind a paywall somewhere or to be hidden in as you would say and I've worked so hard tonight Liz on not using bad words you know how they flow from me but you know not hidden behind the wanky words that Mecca yes it is it's and that's what pits people off is the writing style it's so hard to read a lot of the journals there's so you sit there and you kind of go this is ridiculous to kind of read you want how do I translate this paper to actually proper English that I can read it and that's the biggest turnoff. We need to have and even with students you sit there and go well here's a really interesting paper and they just look at it and it's like 15 pages and it's like okay well here's how you peek the important stuff out and they just go into the abstract and just using the abstract and you sit there and go I get the pressures I understand the pressures but you have to know how to critique the information regardless of the source of it. You've got to be able to answer the questions of well how many people what's the sample size why does that matter but yeah okay so you're doing your postdoc what is coming up next that excites you

SPEAKER_01 1:00:54

I am just starting to get involved in leading some other bits of research and co-investigating with other people in different NHS trusts and things like that, which is really exciting and really interesting. I'm learning lots from other people and learning lots about bureaucratic research governance processes, which are not my favourite, if I'm going to be really honest. That's that's the bit of research where I'm kind of having to learn. I know that these are things that are important, but why does it take six damn months to get that piece of paper signed? Um so I'm working with a few different trusts as well. I've got some potentially exciting research coming up next year that I can't talk about yet. Hopefully, that will further kind of complement the PhD stuff and the postdoc stuff that I've been doing, and that that's potentially a great opportunity. I my plan is to carry on with the research career and developing that and to try and get some buyout for some time, so like the NIR NIHR scholarships to try and get a little bit of time to dedicate to because at the moment the only way to get to a reader position is to get the research done. Yeah, but you get one day a week research if you're lucky within the university. So, how do you do that as well? So you've always got to work above. And I did promise, and I think this probably harks back to what I was saying about family. Um, I promised my children and husband that when I finish my PhD that they would have their wife, mother, friend, partner back. Uh, and it absolutely hasn't happened. It was it was the biggest, fattest lie that I never knew I was going to tell. And every month I say it will get better to the point where they just go, really? But the only way that will happen is by getting buyout. Yeah, I realize to to kind of make that time. So I'm going to try and do that. And it will either work or it won't. But actually, I still really enjoy my day job as well. So I could doing the bits of research, but I really love being with the students.

SPEAKER_00 1:02:54

Yeah.

Surviving A PhD In A Pandemic

SPEAKER_01 1:02:54

I can't imagine never, I can't imagine a position where I'm never in the classroom at all with the students. So I think I'll always do some of that. But yeah, just building those I've I've made so many good relationships through the postdoc already of people that I kind of think, how did I not know this person existed? You've been really gracious and really wonderful as well. I'm just a very odd person that you come across that you maybe held on a little bit of a pedestal, yeah, and then realize that they're a little bit frostier in real life. Yeah. And that's been a little bit humbling, but very rare, thank goodness. Um but I try to surround myself by with similar people, to be fair. And I think that that's how we kind of build momentum, isn't it? So my basically, my aim is to keep building those networks of really wonderful midwifery researchers, and that together we'll do great things, is the plan. And I sound like a fairy tale, I know I do, but if you do you've got to dream it to believe it, haven't you?

SPEAKER_02 1:03:59

You've got to you've got to absolutely thank you so much for your time.

SPEAKER_01 1:04:05

It's been super fun.