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 93 Linda Sweet on a journey through birth, breastfeeding, and beyond
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Ep 93 (http://ibit.ly/Re5V) Linda Sweet on a journey through birth, breastfeeding, and beyond
@PhDMidwives #research #midwifery #education @deakin @western_health #birthingknowledge #maternalcare #obesity
research link - t.ly/Ov88k
What does it take to transform midwifery practice through research? Linda Sweet's remarkable journey provides a masterclass in connecting clinical challenges to academic solutions that genuinely improve care.
Growing up in rural Australia without knowing what a midwife was, Linda's career trajectory took her from nursing to neonatal intensive care, where her passion for supporting new mothers was ignited. Her PhD research on breastfeeding experiences for parents of very low birth weight preterm infants revolutionized how we understand maternal experiences in neonatal units. Linda's discovery of the "objectification of breast milk" – where visible storage created harmful comparison between mothers – has influenced modern practices like using brown paper bags to preserve privacy and dignity.
The conversation weaves through Linda's impressive research portfolio, from ground breaking work on pregnancy after bariatric surgery to creating visual heat maps showing obesity prevalence across Victoria. What stands out is her commitment to research that solves real problems she witnessed first hand. Linda embodies the clinician-researcher who bridges the gap between evidence and implementation.
Perhaps most significant is Linda's dedication to building research capacity in midwifery. Through innovative approaches like research internships, small grants, and mentoring early-career midwives, she's creating pathways that didn't exist when she began. Her international collaborations in Indonesia and Papua New Guinea demonstrate how midwifery research can transcend borders and improve global maternal health.
For anyone considering a research career or wondering how to balance clinical practice with academic pursuits, Linda offers invaluable insights about creating your own celebration rituals, finding supportive communities, and choosing paths aligned with your long-term goals. Her story proves that whether you're rescuing research from crashed computers or changing practice through heat maps, persistence and passion are the cornerstones of impactful midwifery research.
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Thank you very much for joining me, as per usual. Can you introduce yourself, please?
Speaker 2Yeah, Hi Liz. My name's Linda Sweet. I'm a midwife and I'm the chair of midwifery at Deakin University Western Health Partnership in Melbourne, Australia. I've been here in this role for about six years.
Speaker 1Six years already, wow, anyway, let's go back further than six years, shall we? Let's go back to how you got into midwifery in the first place.
Speaker 2Yeah. So I grew up in the country I didn't know what a midwife was. Trying to decide what career to take, I decided I'd go and do nursing because there was going to be lots of opportunity for work as a nurse. So I went and did that and then I moved to Flinders Medical Centre as a graduate and I had a fortunate opportunity to work in the neonatal, intensive care and special care nursery and then at that point that I learnt what a midwife was right, because I did my nursing in a adult only hospital. We had no maternity there.
Speaker 2Um, so then I decided I wanted to be a midwife. I did then go up to Darwin for four years and I was trying to get into my midwifery up there, kept missing out because I wasn't a Territorian local for long enough, but I did get some opportunity to work in their neonatal unit down there and their adult ICU unit as well. Oh cool, which was great. And then when I came back to Adelaide I finished off my Bachelor of Nursing because I had to do the university qualifications, yes, and then I did my midwifery as a Masters of Nursing Studies midwifery.
Speaker 1Can you remember what you needed to do for that course? How many? Because now we've got our compulsory requirements of a certain number of births, pre and post natal visits. Do you remember what you needed to do for the?
Speaker 2Masters, it was very different. It was a minimum of 10 births, accoutred births and two follow-throughs.
Speaker 1Really Only two follow-throughs, wow.
Speaker 2Yeah, so very different to what it is now.
Speaker 1So where did you go after you finished your master's?
PhD Experience and Research Focus
Speaker 2I did. I started a graduate position at the Flinders Medical Centre and then I was about three months into it and someone had seeded the idea that I could do a PhD. When I was doing my master's degree I had no idea what a PhD was. I knew nothing about scholarships or stipends or anything. But I was quite interested in my research topic, which was parents' experiences of breastfeeding very low birth weight, preterm infants. And about a couple of months into my grad year a position came up as a paid research midwife at the Women's and Children's Hospital to do research. Like to undertake either a master's or a PhD. So I applied, I was accepted, selected and I started PhD and went on that journey into academia.
Speaker 1So your master's was by coursework then, clearly. But did you have a thesis component to it?
Speaker 2I had a 9,000 word Big assignment, big assignment, big assignment. And at the time UniSA were only just starting PhDs and they were happy with my GPA and that assignment as sufficient entry criteria. But of course I wouldn't be able to get into the degrees now with that same level of entry.
Speaker 1Yep, it is an interesting way of how the format and the pathway into a PhD is that for some of them it's very clear you've got to have like an upper one or a two, so either a distinction or a high distinction equivalent to your honours, or if you're doing a master's by research, you've still got to get a really good kind of mark for that to get in. But the life experience where with some universities won't accept life experience, then they'll force you into a master's by research, so you get that training from the academic sense. Um, and I wonder if that's going to change as we're looking at more and more changes to the phd program, going from more novel approaches. Um, have you I'm not we're going to jump now because into your second head but have you found that there's been a change into the PhD format with the students you're supervising, or is it staying traditional thesis?
Speaker 2Look, all of my students are doing a PhD inclusive of publications. So I've had one completion. I had two completions last year. They both had five publications peer-reviewed publications in their thesis. I've got one that's going to graduate this year. I think she had six, including a creative output Wow. So she wrote a poem and a song and performed the song and had it audio recorded oh cool. So it was a QR code in the back of her thesis. So that was fantastic. She presented that at the College of Midwives conference last year. And then, yeah, the current students have got, you know, four to five manuscripts at least in them and if they're not accepted for publication, they go in as a submitted for peer review publication and then it's just front-ended and back-ended with a traditional thesis chapter that introduces the topic.
Speaker 1So do you think that we've lost the place for the traditional monolith thesis now?
Speaker 2Somewhat I do, and I think that's because the delay in getting the publications out there. So, for example, my PhD was, as I invariably say, six years, two pregnancies and I built a house and then I did my publications after that. So you know what could have been published and been already available. Information wasn't published until after I graduated.
Speaker 1And there is a discrepancy with universities with how many publications are required, ranging from, I think, three to 12 in what's actually required for that thesis.
Speaker 2Yeah, at Deakin University, where I currently work, there's no minimum or maximum amount. It's just a thesis inclusive of publications. So if you only get one publication, you do traditional chapters for the rest. But of course in this era of very competitive academia, it's very good to publish as you progress, for both jobs, cvs, recognition, the university's ERA, et cetera.
Speaker 1Yes, very true, very, very, very true. Do you classify presentations and posters within that publication? I know they can't be the basis of a thesis, but they're still part of that output that gets that information out there.
Speaker 2Yeah, the front end of the thesis template that we use. It asks for what output you've had, what journal articles, citations, what conference presentations and things. So people do get to explain that output, even things like if you've written for the Conversation or you've got picked up by journals sorry, not journals, newspapers and stuff like that. You can sort of front-end all of that before the examiner starts to read the thesis.
Speaker 1Yeah, now for the conversation. The lead author has to have a PhD. They don't accept any non-PhD authors, do they?
Speaker 2I haven't written in them for a while so I'm not sure of the current guidelines. Yeah, and.
Speaker 1I think it was definitely easy to have.
Speaker 2If that was the case, it would be the principal supervisor. Yeah, yeah, because certainly here you have to have a PhD to supervise a PhD student.
Speaker 1Yeah, so it's got to be at least the equivalent or a grade higher, which you can't get higher than a PhD. So that kind of doesn't help that. Okay, let's go back to your PhD then and going through so did you because it was a funded position were you able to do that full time and did you still work clinically while you were doing that and having children and building a house?
Speaker 2It was a 0.5 position, so it was half time. I tried to work at the same time but invariably the nurse unit manager would put me on night duties during the week when I couldn't do my other job and it became untenable. So I resigned from my hospital position. Yeah, and I actually got a job working as a casual for the royal flying doctor service. Oh wow, that was really um flexible and they were long shifts. They're 12-hour shifts where you're on call. So some days you didn't even get called into the office. Other days you ended up spending 15 hours because you're stuck on a plane somewhere in the middle of Australia and you're not going to get home in time.
Speaker 2So I stayed working for RFDS for the duration. For most of that PhD time I did take a year out and went and got a clinical job as a unit manager, but after 12 months I decided that wasn't the role for me and I really wanted to get back and finish the PhD. So I prioritised getting back, finishing the PhD, which is why it took six years. It really only took like four and a half, but you know some of it. The first couple of years was part-time.
Speaker 1Yes, yes, it takes a while to get your head around that kind of early starting stuff.
Speaker 2Yeah, because my contract, like it, was a three-year part-time contract and then I had to find time you know unfunded time to complete it.
Speaker 1Did you get to pick the topic that you did your PhD on, or were you given it kind of like this is what you will do.
Speaker 2No, I selected my topic and it was based on the assignment research assignment I'd done in my master's, where we had to develop a protocol and draft up what could be and justify why it's an important topic. And that's when my teacher you know the educator said you should be doing that. That's a PhD there.
Speaker 1I like how they get people kind of sitting there and go yeah, and what was your response to that?
Speaker 2I didn't even know what a PhD was. Most of my all of my academia to that point had all been off campus as distance Good old electric typewriter and posted out packs, yep. So I just didn't know what the yeah, the academic hierarchy was or what it meant. So I needed people to explain all that to me and yeah, it must be.
Speaker 1I was the same. I got offered honours when I did my conversion from my hospital train to my Bachelor of Health Science and Nursing. Got offered honours and said this is a pathway to PhD, but nobody told me what that meant. Yeah, so I didn't do honours back then because I couldn't see how it was going to help me as a clinical nurse.
Publishing Research and Career Development
Speaker 2Well, I get to talk to all of our onboarding graduates and our leaving graduates for both nursing and midwifery, where I'm at the health service I'm at now, and I always explain to them what the AQF is in Australia, so the Australian Qualifications Framework and have a nice little hierarchical chart that says master's coursework is a dead end Yep, okay, it's useful. If you want to be an intensive you know hierarchical chart that says master's coursework is a dead end Yep, okay, it's useful. If you want to be an intensive care nurse or you want to be, you know, crit care or ED, but if you want to go on and do a PhD, you have to choose a different pathway or go back and double up on doing two degrees so that you've got that entry pathway, yeah, and so many people just don't know that or don't understand it. So, because I didn't, I'm very proactive at explaining that to people that come to me for some mentoring.
Speaker 1But it's also the conversations I've had with so many people around the world is that, oh, phd, you only need that if you're going to be an academic, and I don't want to be an academic. Like there's still there and I'm currently writing about that today that misconception that you can use PhDs in assortment of other areas.
Speaker 2Yeah, so we're putting together like my position is a conjoint position at Inner Health Service but I don't do clinical work yeah, I'm doing purely just research and student supervision. But the group of professors here in Australia are getting together and we're writing a paper about the importance and need for clinician researchers Yep so that they're at the coalface, they know what the problems are, but they've got the skills to do the research and I think that's something that we need to really work hard for in the next five years to enhance within our professions Very much so To overcome that problem. But PhDs are used for lots of different reasons. You don't have to just get into teaching and academia. For example, a current student works in government Yep and she said the PhD is going to give her so much credibility and people will listen better because she's got that qualification.
Speaker 1And it is the qualifications and the experience and skills that come with doing a PhD, which is your time management, which is your critiquing skills, project management, all of those kind of skills are ones that are so transferable across so many different areas.
Speaker 2Exactly and just the. You know if you're passionate about a topic and you've got that creative. You know critical thinking, ideas and stuff like that. You know just undertaking that kind of research is fantastic and you know PhDs will get you into Category 1 grants, for example, where you can fund a research position and do research. It doesn't have to be. You know teaching.
Speaker 1No, and you get to play detective and kind of look through the evidence and come up with solutions. Did you get to choose your supervisors or were they part of the position?
Speaker 2supervision itself yeah, good question. Because there was two universities that offered PhDs at the time and I was able to choose either university, um, but because I was being appointed to the hospital under the, the nursing and midwifery research centre, um, the chair of nursing there had to be one of my supervisors, right? But I did get to choose the other one, and that was based on which university I chose to study at, and I chose a supervisor who had been a teacher, one of my educators during my Masters.
Speaker 1So I had a relationship with them, yeah, yeah. So what did you actually get into, what did you actually explore and what still resonates now about doing your PhD?
Speaker 2I looked at, as I said, parents experiences of breastfeeding, for breast expression, for very low birth weight, infants less than 1500 grams. So I played. I got 10 families, 10 couples, so husbands like mothers and fathers, and I interviewed them up to three times each over a period of six months, so at the beginning, a month later and then and then three or four months later and looked at their journeys. A lot of them had been from rural and remote areas or regional areas. So there's a lot of issues around travel and finance for housing and relocation and all those sorts of things, but then also looking at how hard it is to express for a prem baby when you've got all those other stresses in your life as well.
Speaker 2So it was a traditional thesis. It was five findings chapters. I did publish one paper during it around methodology which was about the value of telephone interviewing because of course some of my families went back to their remote locations and if I didn't get the information, the interview, from them by telephone, there was no other way to do it back then. Yeah, so I'm talking, yeah, 1999.
Speaker 1Yeah, pre-Skype, pre-Zoom.
Speaker 2Yeah, yeah, exactly Exactly. So I ended up with 45 one-hour interviews that I realised they took up about four Manila folders, but I did start out. At the beginning of my PhD, I went to a workshop on using NVivo which at the time was called Nudist and then, once I collected my data, I thought, like this is going to be more manageable. So I got into doing uh, in vivo, I coded all of my data and then my motherboard on my computer crashed no, there's no cloud back in those days no cloud and it used to take five floppy disks to do a backup.
Speaker 2Yes, yes, oh, my goodness, how many backups do you think I had not?
Speaker 1not an up-to-date one we were all still getting into the mode of doing that back then, weren't we?
Breastfeeding Research and Changing Practices
Speaker 2oh, my god, yeah so then I um, you know a couple of weeks of horrendous stress, yes, all the work that I'd lost. Um, I got in touch with the Envivo QSR help desk and I got to be best friends with a couple of people there and whilst I tried you know geeks to you to see if they could fix it for me, um, I ended up sending my motherboard over to Melbourne and the guys over there pieced it all back together and we think that we got about 98% of it back together. Wow went back through it and re-read together and we think that we got about 98 percent of it back together. Wow, went back through it and reread it and made sure that there was nothing glaring, you know missing kind of thing, and because I had so many conversations with the team over there and got to know them, they ended up asking me to be a trainer for them, so it'd be fabulous like understood the software well and truly by then.
Speaker 1Well and truly by then.
Speaker 2Yeah. So telephone interviewing the in vivo in vivo was fantastic, just for simple things, like I remember one mum had said her breast milk was her gold, and like if I had to stroll through all four manila folders full of paper transcripts whereas I could just punch in the computer, find the word gold. Which interview? That's it. I'm going to use that quote, you know, because you remember some of the great quotes during your analysis.
Speaker 2And then, as I said, at the end of the day, I had a gap year of losing faith in what I was doing as being worthwhile and that what I'm finding is not new knowledge. Everyone knows this because I've been immersed in it for four years and I just assumed everyone knew what I was finding. So I had a gap year, had a bit of a mid-PhD crisis, shall we say. Yeah, yeah, we got a full-time clinical job working 60 hours a week. I thought that's not my place, not my my space, it's not what I enjoy doing. Um, so I did opt to go back and finish that PhD. I then, at the end of it, um, from examination, we, uh, I had a examiner from New Zealand and an examiner from the UK and I had to remove one word.
Speaker 1Oh, well done. That's super impressive.
Speaker 2Yeah. So I did get a small bursary from the university for a completion scholarship that was available and I did use that for editing, yeah. And then after the PhD I decided all this stuff's going to sit on the desk of the library and no one's ever going to read it if I don't get it out there and get it published. So I then turned each of those five thematic chapters into a paper each and I submitted one to the Australian Breastfeeding Association's National Award and it won Cool. It won the best breastfeeding paper. So that was great, because then that got my name known and I got to do the Around the Australia Circuit on their conference circuit. And then I went on and started working in universities.
Speaker 1And you were a lactation consultant at that time.
Speaker 2The funding that I got from the award. I used that to pay for the lactation course and my certification, yeah, so I did that with the with the award money.
Speaker 2I thought that was good use of that money rather than putting in my back pocket quite appropriate use of it and a good way to share what you had done yeah, so I stayed in IBCLC for 10 years, but because of the different roles in academia, I was at the time teaching clinical education for health professions and I wasn't having anything to do with midwifery or breastfeeding, so I did let it lapse and I'll probably never be able to get it back again now because I haven't got the clinical hours and recency.
Speaker 1Yeah, it's like a thousand hours, I think. Yeah, I'm not sure what the current current? Yeah, it is quite high to kind of do the theoretical part, but I wouldn't.
Speaker 2I wouldn't.
Speaker 1It's like 1,000 hours I think yeah, I'm not sure what it currently is.
Speaker 2It is quite high to kind of get up. I can do the theoretical part, but I wouldn't be able to get the clinical hours up without going and doing an awful lot of supernumerary work.
Speaker 1But it doesn't quite fit into your role at the moment for where you are. No, no, that's right.
Speaker 2So I'm doing research on breastfeeding, but I'm not doing any teaching or anything like that.
Speaker 1I'm not doing any clinical practice with women so you mentioned that you took some time out because of that getting that wall of why the hell am I doing this? I can't see the point in that. What else did you do to keep your sanity kind of like during that process, both before that break and after that break?
Speaker 2uh well, I had children. I think I was only second year when I had my first baby and then my second baby was born six weeks before I submitted my thesis. Okay, I was a young mum, pregnant twice, as I said, in the middle of all that building a house, so lots of to-ing and fro-ing and designing and architects and all those sorts of things.
Speaker 1How did you balance that all? How did you balance all of that?
Speaker 2I had a very, very helpful mother-in-law at the time. She would come and babysit for me so I could get on with a PhD, which I was very fortunate to have. Yeah, it was a juggle, it was just. Yeah, I don't know how, you know, you just get through it. And I remember with the, because we had to move house three times in the first couple of years and I ended up living with my mother for I don't know about six months, and that was soon after my first son was born and I bought a little electric swing you know, secondhand, like you do see it on the marketplace these days, but that didn't exist back then. So I would sit him beside me and turn the swing on and you know, just happily, or you know goo and gar at you and talk to you and you know he'll nod off and have a sleep.
Speaker 1You could be reciting your PhD and wouldn't know the difference as long as you change your tone of voice. Yeah, pretty much so. Thinking of those, if you had five distinct chapters in your PhD, what kind of still stands out now about those results?
Speaker 2The objectification was probably the best paper out of them objectification of breast milk. So you know that the things they did at the time was, you know, open bottles where you could see how much milk women were producing, and that was all in a shared fridge and it had your name on it, and women were feeling really positive if they had the most milk or really bad if they had the least amount of milk. Do you know what I mean and that stress of trying to get to a certain number all the time and whether or not they're producing enough milk to feed their baby or whether they need complementary milk as well as?
Speaker 1And that would have been breastfeeding the BFHI that was in then, or coming in afterwards it would have been.
Speaker 2It would have been breastfeeding the bfhi that was in then, or I mean it would have been would have been so I think a lot of places now, like we'll give women brown paper bags to put their milk into a brain paper bag and put it in the fridge so it's not visible in front of everyone and there's no competition.
Speaker 1You know you do what you can do and we'll be grateful that there's so much damage in that comparison and kind of not living up.
Speaker 2And we see that in social media. Yeah, the good mother, the bad mother, kind of theory.
Speaker 1If you like, and I know one of the papers that you did was looking at a Facebook support group for exclusive expressors. Did you find that attitudes had changed from when you did your PhD? Or, because this is kind of like I'm going to say, less than 10 years ago now?
Speaker 2This is very different, because this is, yeah, a peer support group in social media that are talking to each other and sharing with each other and, you know, encouraging each other.
Speaker 1That was more positive.
Speaker 2Yeah, I think so. Yeah, yeah, absolutely, whereas back then, when I did my PhD, there weren't social media groups like that and women were isolated if they weren't put into contact and hospitals didn't employ lactation consultants either, you know. So it was very different.
Speaker 1I think we're halfway through data collecting at the moment, looking at peer-to-peer milk sharing oh, fabulous using facebook as a medium to find people well, we haven't got enough milk banks to fulfill the need and in fact the one in south australia was only kind of very recent the last few years that it's been established.
Speaker 2So I think the stuff in breastfeeding that I've done my first postdoc little research study was looking at the legal decisions in divorce situations when mums were trying to breastfeed babies and what the judge was determining they had to do and like these were legal orders you must provide and it's like you can't do that wow, that's a very patriarchal view yeah, so that was that was really, really interesting.
Speaker 2That little study. It sort of opened my eyes up and, because I was publishing in legal journals uh, quite different to publishing in midwifery journals um, but that was a great experience. And then, yeah, since then, I've always tried to have a little bit of something about different to publishing in midwifery journals, but that was a great experience. And then, yeah, since then, I've always tried to have a little bit of something about breastfeeding on the go. I did an initial compliance trial of using a lactamo, which is a massage silicon ball for heating and for breast massage.
Speaker 2We did an audit of all of the breastfeeding outcomes for the women, uh, in 2019 at the hospital I work at, because they needed the evidence for bfhr. So we, we did that, which is great, because people don't publish that sort of stuff. Yeah, we gather it, but rarely does anyone actually put it out there and publish it, true, yeah, and then we've started to do I've got a phd student working on breastfeeding after bariatric surgery. Yes, now that's an increasing area, isn't it? Yes, so we've completed the phase one, of which is the national survey. Um, about to commence the interviews for women. Yeah, so that was one of the we. We proposed that topic to the student um and, as a midwife, she was very interested and and that's fantastic for us because that helps get the work done because you've done a couple of other publications around pregnancy and bariatric surgery as well.
Current Research and Academic Leadership
Speaker 1Yes, and we, when we see now that an increasing amount of teenage women are getting bariatric surgery, the complications and the consequences for them later on when they get pregnant, and because it is now it's been a while since I've read your paper, but it is dependent on the type of bariatric surgery that they have, whether they have the cuff versus the sleeve versus the total, because it changes then what the body does. Is that correct? The metabolism.
Speaker 2Yeah, yeah, yeah, that's right, because if you're taking away, um, the lower part of the stomach and the top end of the duodenum and you're reconnecting it, you're getting they. They do it in a way that you still get the secretions, but it's not absorbing the sugars in that early part of the of the bowel. Yeah, um, so it does change. Um, it also rapid, you know.
Speaker 2Rapid weight loss, uh will increase fertility, which is often why a lot of childbearing women will go through and have bariatric surgery, and I had a very interesting conversation with a journalist just today who's going to write a story about this in the age next weekend. Oh, cool, and use some of the work that we've done, because it is a growing, growing trend and people don't necessarily get the right information about the gap from surgery to first pregnancy, when's ideal and what you need to do, and if they go to mainstream maternity care providers who possibly don't know anything about bariatrics, if there isn't a dedicated bariatric centre, they're not going to get the right supplementation and nutritional support necessarily. You know, like you hope they do, which is why we're trying to make it more visible so that people start to learn more about it and start to question their women, because some women will say that they told the care provider that they had bariatric surgery and they never discussed it again as they went through their pregnancies.
Speaker 1I think it needs to be. It definitely needs much more of a highlight, so it's great that you've got another student who's looking into it and related to that.
Speaker 2The other body of work that we've been doing is around obesity and obesity and prevalence and obesity outcomes across 10 years of clinical data. So we've got two papers at the moment from that.
Speaker 1Really interesting when you get into the big data and to look at those trends that are happening over time, and especially when you look at what the guidelines were at the time and how they've changed. And especially when you look at what the guidelines were at the time and how they've changed, did you?
Speaker 2read the heat map paper that we put out last year about the prevalence of obesity in pregnancy.
Speaker 1My head's been in my PhD, so I'm going to say no.
Speaker 2There's a link, a URL link, to the visual heat map which is post-coded across Victoria.
Speaker 1Yes, no, I did see that. Yes, and the way that the colours changed, yes, that was fabulous and I think that goes to show we've got so I'm getting excited and getting loud. The changes in digital dissemination of research is really exciting to me, with not just, obviously, podcasts, but also the infographics and all of that kind of information, the snapshots that you get put out, that people get the message, the take-home message. But then it's like, well, if you want some more information on how to do it and how to apply it, then go to this and have a look at that. So I thought that was a fabulous way of displaying something very visually. That went, oh my goodness, yeah, it really opened your eyes up, didn't it?
Speaker 2just to see 10 years of visual change. It to see 10 years of visual change by it was a heat map. So light blue is cold and bright red is hot. So the higher the prevalence, the darker the red. You know. The map got from blues to yellows, to orange, to red.
Speaker 2And it was very much from my memory, it was very much rural and remote areas which, once again, we know have inequities in health, in nutrition, in cost, in transport there's another fabulous paper that's just come out which is why the journalist was talking to me today and it's done a heat map in victoria of all those things you've just said, looking at the prevalence of obesity in pregnancy, and food availability, fast food places, green spaces, uh, walkability, livability, all that kind of stuff.
Speaker 1So I will send that to you as well that I think they're going to lap over quite nicely, really, because that was the first thing that jumped out at me and it was just like wow yeah, that's been done on 12 metropolitan regional hospitals in Melbourne, so it doesn't cover the entire state.
Speaker 2Yeah yeah, which is hard to do, but you can add the two things together. Pretty obvious. You know, we've added a little fresh food in our rural areas and stuff like this.
Speaker 1Just the costing of transportation and stuff is ridiculous, especially into the further in the middle of the state, in the middle of the um the state in the north of the state northwest of the state. Okay, the fun question how did you celebrate your phd when it was fun? Did you do multiple celebrations or just one big one?
Speaker 2uh, multiple I get that. I celebrated with my family, we went out to dinner, I celebrated with my supervisors after the graduation ceremony and then I put on a party for everyone that helped us through the journey and I think we had about 40 people there at the party, which was fabulous, and the supervisors came and mingled with the family and all that sort of stuff. And then I decided I was going to go and buy myself something. So I bought myself a gold fob chain and matching earrings and a bracelet. That was a gift to me for completion. My mother-in-law said at the time I'm now divorced. She says well, why don't you say your husband gave it to you? I said because he never would have.
Speaker 1Yes, so why should I say he's done it?
Speaker 2when he wouldn't have done it. I went and did it.
Speaker 1Yeah, and let's face it, you are the person that has been there the longest and the hardest. Yeah, so I have that memory, the memorabilia.
Speaker 2Every time I wear it I know why I've got it and it means so much to me. And even when I got my current job, my professoriate job, my first full prop I bought myself a ring. Oh job, my professoriate job, my first full prop I bought myself a ring.
Speaker 1Oh nice same reason, just a gift to me for success. So do you wear that as your graduation? When you do, when you've got graduation ceremonies, you put all your graduation jewelry on and that kind of helps you. Yeah, I have been. Yep, because I know in Australia we've got graduation coming up for us here, um, in a month's time, so I say to my students, as they're what are you going to do for yourself to celebrate?
Speaker 2you know, yep, I try and at least have a lunch or dinner with all of them, you know, and go to their graduation ceremonies. But yeah, I say, this is what I did for me. I haven't got it on today and it's like, ooh, that's a good idea, yeah.
Speaker 1I think I've got a tattoo in mine that I want to get. That will be mine with me all the time. So after you got your PhD, you then started teaching, or was there another gap between completion of the PhD and teaching?
Speaker 2No, I got into academia. I was on short-term contracts. I started a nine-month contract in nursing and midwifery. I did some casual work at the other university as well, just marking and I did some of that while I was finishing the PhD as well, just to get a small income. And then I couldn't get an ongoing position in the School of Nursing and Midwifery and I applied firstly for a job as an academic developer in the staff development unit, and I worked for them for three months. I went this is not for me. It was just didn't seem to have any opportunity for succession progress. Yeah, and it was a very, very small team. Um, and you didn't have the joy of, like you were teaching other academics how to teach and support them, but you'd never got the feedback as to how successful that was, yeah, whereas if you teach a class and they pass their exams, you know you've done a reasonable job. Yes, so I just decided that wasn't really for me.
Speaker 2And then a position came up in the School of Medicine teaching the Masters of Clinical Education. So again, that was seven years of annual contracts. And then so I got to live a senior lecturer during that time, doing a number of big projects for them. Um. And then there was associate professor nursing position that came up at flinders. So I applied, um, they interviewed three of us and gave two of us those positions.
Speaker 2Yeah, so, and when I said to the boss, why are you pointing two of us? And gave two of us those positions, yep, so. And when I said to the boss, why are you appointing two of us? I thought it was only one position, he says because we want you both Nice, ali Hutton and myself at the time. And he said to me but you will do midwifery, won't you? I said, sure, if I'm allowed to, I was happy to apply for a nursing job, but hey, if you're offering mid. So I stayed there for, let me think, five, six years in that role and then I've moved across to Deakin in this role. So it's very different.
Speaker 2You know, clinical education research. I was doing educational research about how to teach better and what contents for curriculum is required. And then when I went into the midwifery team, we stuck around how can we improve the midwifery curriculum? I wasn't doing very much clinical research, I was doing educational and curriculum development research. Yeah, and then this job. I've just had to jump boots and all into clinical research.
Speaker 1Because when you were doing your educational stuff, this was and I remember seeing you in the corridor when you came back and it was just kind of like, oh my God, you're back. But you were also doing some really cool stuff with Stephen Billett.
Speaker 2at that time as well, you got an OLT grant, yeah so, stephen, I was casual teaching at Flinders with Pauline and Stephen offered Pauline an opportunity to join his associate fellowship and he had a team of like five different groups professions. Pauline put it out to the whole mid team who wants to be involved? And I just said, yeah, I'll do that. That's education, research. That's what I know and that's when we started the follow-through research. And then Stephen went on and did his full fellowship and that had 20 groups of research.
Speaker 2It was funded in 20 groups and I wasn't selected for that by the staff development team but then one of the groups pulled out and so Stephen just said I want you, you're it, come back to me, you know. And then from that you know you develop relationships and friendships with people. Amanda Henderson was the mentor on those projects. So that's how I got to do AMSAT, development and Evaluation and Psychometric Analysis and stuff working with getting to know Amanda and her getting to know me over those five or six years. Yeah, so it was an absolutely fantastic opportunity for me to develop skills and networks.
Speaker 1I think that's the key is putting your hand up but keeping your eyes open, watching what people want to do and not being afraid to kind of go look. I'm really interested in this. How can I be involved? Is there any kind of research roles that I can do, any RA roles that are possible to do?
Speaker 2as there any kind of research roles that I can do, any ra roles that are possible to do as well, to kind of find that even when I started this current job, I made it a point of going around and introducing myself to key people, one of whom was the maternal fetal medicine research team. So they're, all you know, medically obstetric managed and, whilst they have a team of midwifery researchers, they're recruiting and collecting data for them. Yeah, they're not running the research themselves, they're project managing it for them, but it's still medical-led research. Anyway, in that process, one of the doctors said to me oh, we should work with you, we need you, we want to do a qualitative study as an arm of the proceed pilot trial. And I went yeah, no, worries, we can do that.
Speaker 2So vedanka and I did the uh, interviewed women and staff around the idea of a double blend, double randomized blind control trial giving corticosteroids to to women 35 to 39 weeks pregnant having sections, and we we did our 50 recruitment for that. And then joe put in for an nh and mrc clinical trials grant. So I'm an associate investigator on that and it's three and a half million and we got it excellent. So, and then there was another project where I got the opportunity to put my hand up. That was $200,000, which we've completed now, but we put in for an MRFF and we've got another $3 million to keep going.
Speaker 1And they're not easy to get Like.
International Collaboration and Mentorship
Speaker 2the competition for them is top tier and multiple rounds, but you've got to be prepared Like they're not being led by me, but I'm willing to participate and support and advise. And Deakin got the tender to do the Australian National Guidelines for Obesity, so Vedunk and I have been working on that as well and that was almost $2 million of funding and they're not quite complete yet but very close.
Speaker 1And all of that experience with research, with writing, with the project management that you get for your PhD, and also then leading trials and helping with trials, is really important to then be able to put that into that translation, into practice, which is through policy documents, which is through all those guidelines that we use that actually do change practice in hopefully less than 15 to 17 years.
Speaker 2Absolutely, and I think because we're at the cold face at the hospital as well, they ask us to do evaluations of their practice changes and stuff like that and see whether they're successful. So we've done one recently around the use of carbotocin. It's not yet published but to the best of our knowledge we were the first hospital to use carbotocin for all births, not just cesarean sections, and we've demonstrated a statistically significant improvement reduced pph, reduced bed stay length, reduced high dependency bed use, etc. So benefit costs more for the service, yep, but it's a better outcome for everyone.
Speaker 1And does that drugs need refrigeration still? Or is that one of the drugs? And that's one of the huge advantages when you're looking at global implications, Correct?
Speaker 2So it has been around for a while, but it was mostly only being used for caesarean sections, but we've been using it for all births now for about three years.
Speaker 1Oh cool. That'll be interesting when that kind of comes out. And I think that's one of the keys is people who are working and I know the common term is on the floor and that can be anywhere within hospital, birthing centres, wherever forget that they can actually talk to people like you that do the research, that if they think, why are we doing this? Is there a better way to do this? They're the conversations that you actually want to have, because they'll lead on to possibly little PDSA quality improvements that could then kind of lead on to bigger programs in different sites, but you start with one small project first and then go from there.
Speaker 2Project that we're just trying to write up now and we haven't finished crunching the numbers because it's very complex is a randomised controlled trial on childbirth education modes. So one's the hypnobirthing mode, the causal birth, and one's a traditional childbirth ed. And we're looking, we've done the survey analysis of what they thought of the classes. We're now doing the clinical outcome data about birth, pain relief, pph, et cetera.
Speaker 1What about from the midwife's point of view? Because especially with the hypnobirthing and the use of specific words and the not using those words, it is kind of semantic. But if you go in with a mindset that you're going to use surges, you're not going to use contractions, you're going to use sensation, you're not going to use pain, but then you get a midwife who doesn't go with that, how what's the uptake with midwives about that kind of process as well?
Speaker 2Yeah, good question, Liz. I don't know. I don't know the answer for that.
Speaker 1Next study. One of the other things that you've been involved in has been your work with other countries and in particular with indonesia, um colleagues and with capacity building with them from a maternal and obstetric kind of um perspective. What's one of the things that you kind of enjoyed the most about those engagements? And because you we had a group of amazing people come over to um flinders for a couple of years in a row, but then you also went over there.
Speaker 2Yeah, we had three uh dfat opportunities to bring staff over for workshops in australia, um, and then we flew back to Indonesia to support them and do some post-workshop follow-up, and so that happened three or four times, I think, with that. But one of the professors over there invited me to go for six weeks as a visiting professor and took me around a whole range of different services and conferences, and I got following back to do a couple of conferences. We met up with the Indonesian midwifery education association, and so I did research workshops for them, writing for publication workshops for them. I've done that a few times now as well on different occasions, which is fantastic. I don't have the same opportunities at the moment in my new role because I've got a, you know, very dedicated to the clinical service that I'm working at.
Speaker 2So I did get the opportunity, though, to go to Papua New Guinea last year as an Australian College of Midwives buddy. So my two buddies we got two. Each One did an education program for all of her outpost service providers and the other has put in a business case to get some haemocures, dopplers and BP machines, and we've got half of that now already for her, which is fantastic. So different kinds of things, but it was a fantastic opportunity to sort of go back and be engaged with PNG. Other things I've done in Indonesia, like we've had a couple of Indonesian PhD students that I met over there and been supporting. I've had one's midwife over there get me to help her with her publications because English is not being her first language. So you know, being able to mentor and support and help and guide and advise, all that kind of stuff has been really good.
Speaker 1I think that's a if I, if I was financially of stuff has been really good, and I think that's a if I was financially independent and had free time. I think one of the things that I would love to help facilitate is an English writing kind of service for people where English is a second language, because there's so much research being done that isn't published in English that is of equal value, because there is no kind of we don't get to hear about it from a lot of countries because they don't publish it in English, because English is the default kind of like research language.
Speaker 2I was reading an article yesterday that was written by some people in Iran and clearly it hadn't been English edited. There's so much grammar and wrong word choice and you know talked about drowning in their data and all that kind of stuff which you wouldn't normally see in an academic paper. But it was the way it was written. It was just like, oh, but anyway it's published and they got it out there.
Speaker 2It'd be nice to be able to help do something to do to get more papers out, because a lot of them get turned down very early on One of my other roles which I've been doing now for a very long time since 2007 I think is being on the Editorial Board for Women and Birth, and I've been Deputy Editor now for about eight years and in that role as an Associate Editor or Deputy Editor I have helped a few people improve their papers, like giving really constructive grammar feedback. There was one in particular that stood out to me was written by some midwives in Africa and they were talking. They'd done a small qualitative study where they interviewed women following euclaptic seizures oh wow, that had survived, yep. Where they interviewed women following euclaptic seizures oh wow, that had survived, yep. And I thought this is novel because very few women in our context get to the point of seizure, let alone, you know, surviving to be able to have that insight about what it was like to be there.
Speaker 2So we ended up with four or five rounds, but I was honest with them saying look, I think this is a really important article to have published, very unique. I don't know that's probably not very well cited, but you know I wanted to support them. So I gave them a lot of editorial writing guides to get their paper up to standard for publication in the journal the best thing really for anyone who's looking at doing writing for publication is get someone else a friend, a colleague to read it before you submit it and make sure it makes sense. Make sure it's someone who's prepared to be a critical friend. Yes, and not just oh, that's lovely, dear. Yes.
Speaker 1What does this make sense? Kind of like, this doesn't make sense because you've left a third of it in your brain instead of writing it on the paper. What's next? So you're kind of well established now within your joint position. It's exciting the fact that nationally we've now got that clinical professors community of practice. That's going to be helping. Drive that, because once again, if you see it, you can be it, and so the fact that it's going to increase visibility drive that, because once again, if you see it, you can be it, and so the fact that it's going to increase visibility is like yep, there's another role that people can go into post PhDs. But what exciting things, what things are you excited for that are coming next.
Building Research Capacity in Midwifery
Speaker 2Um, well, I think there's a couple of big grants that we've got and then setting myself up to be able to apply for one myself, you know, because you've got to sort of be on some before you get one. That's the potential. But yeah, no, I absolutely love the job I've got. At the moment, I still continue to work on NMAC, doing accreditations around the country and sit for NMBA appeals, as well as the journal work, which is fabulous.
Speaker 1How do you fit it all in?
Speaker 2Just do. I have a wonderful full-time research fellow, vedanka, who works with me. We complement each other really, really well and, yeah, we just hit the ground running and keep going. I've, in my current role, I've also employed a clinical midwife a day a week to help us and she's been phenomenal just getting ethics applications and stuff and she's got the direct contacts of who to talk to. That's been fantastic and I've had for last year and this year.
Speaker 2I've got support from my hospital boss to get a six-month grad intern coming and doing some research work with us, so one day a week. So my grad intern for this year should start in a few weeks' time and she'll do one day a week with us just getting involved in research, getting to understand it, doing a literature review, doing some ethics applications, possibly help with writing up publications and doing some analysis, that kind of stuff. So it really depends on what we've got on the go at the time as to what we can offer them to learn. However, my service does offer an annual research grant of $15,000 for a midwife to do a study, and so every year I mentor the successful person through that and this year the person that won it was my grad intern from last year. During her grad intern she developed her proposal and wrote up a protocol document and started her ethics, and so now we've got the funding for her to actually do the study and be paid to do it.
Speaker 1So is she going to turn that into a PhD?
Speaker 2An honours.
Speaker 1An honours, oh wow. But that's kind of a good first step because you get to do the whole process, you get to have that supportive environment and if it's funded it's even better.
Speaker 2So that's the pipeline. That's what we need to get our midwives engaged and excited about research early in their careers and not wait 10 years and then don't know how to get into it.
Speaker 1And that's a really interesting discussion that is happening internationally is how soon is it too soon to go into the higher research pathway? Because there's still people who say you have to have clinical experience. You have to have three to five years of clinical experience. Other people are saying you need a decade of clinical experience. Other people are saying well, no other disciplines. You get your clinical experience while you're doing the undergrad. You get an idea. There's no reason why you can't then do an honours and then go straight into a PhD. So what's your thinking along that pathway?
Speaker 2No, it depends what you want to be. At the end of the day, where do you want to be in 10 years time? Yep you, I think. If you're wanting to teach clinical midwifery, you do need some clinical experience, yes, but if you want to be a midwifery researcher, it's different.
Speaker 1Yeah, we're just going to have those clear pathways so they can see where they can tread into afterwards. Yeah, exactly, thank you so much my pleasure.
Speaker 2It's been a lovely chat, liz.