Ep 111 Nicole Hainsworth on from regional wards to how to make CoCE better for students

Ep 111  (http://ibit.ly/Re5V) Nicole Hainsworth on from regional wards to how to make CoCE better for students

#PhDMidwives #research #midwifery #regional #CoCE #undergradstudents #assessment

research link t.ly/YQD0j

One of the fastest ways to improve maternity care is also the simplest: notice what doesn’t sit right, then ask a better question. We sit down with midwife and academic Nicole Haynesworth to trace how a career built across regional New South Wales, a high acuity UK hospital, and university teaching turns curiosity into real change for women, babies, and the clinicians learning the craft.

We talk about what Nicole brought back from the UK, including a different approach to post-caesarean care that keeps mother and baby together, and how asking “why are we doing it this way?” can shift practice when you involve the right stakeholders. From there, we move into midwifery education, continuity of care, and what Nicole’s PhD reveals about students learning best when they feel safe, trusted, and connected to the woman’s experience, rather than just being assessed on tasks. Along the way, we unpack practical teaching tools such as shared goal-setting, reflective practice, and making the “hidden” skills of advocacy, autonomy, and accountability explicit.

We also look ahead to program improvement in Graduate Entry midwifery, supporting clinicians returning to practice, and the research questions still driving Nicole, including synthetic oxytocin policies and induction, epidural-related fever pathways, and gestational diabetes. If you care about evidence-based midwifery, continuity of care, and better feedback loops between women and the system, you’ll get plenty to take back to your own practice. Subscribe for more conversations like this, share the episode with a colleague, and leave a review with the one question you think maternity care should be asking next.

Transcript

Meeting Nicole And Her Roles

SPEAKER_02 0:27

Thank you very much for joining me. As per usual, can you introduce yourself, please?

SPEAKER_00 0:32

Thanks, Liz. I'm Nicole Haynesworth and I've been a practicing midwife for nearly 30 years. So I've recently, or maybe not so recently, it feels completed my PhD and I'm working at the University of Newcastle in Australia. I'm the program convener for the Graduate Entry Master's Course and also the Graduate Entry, sorry, the Graduate Certificate as well, where those midwives that haven't been practicing for the last five to ten years have chosen to come back. So so that's my um scope. But I also um teach into the undergrad program as well. Yeah.

SPEAKER_02 1:20

And I think that's also somewhere that you kind of you do some clinical work on the weekends as well. Yes.

SPEAKER_00 1:25

Yeah, so I so I somehow squeeze that in. Um yeah, so I've been um yeah, practicing clinically um for a fair few years now, but I've um but I've chosen to maintain that because I just I think it's important for the currency of um practice and well, and I and I do love working with women in the birthing space, which is probably where my area is. Um yeah, so I I I'm trying to sort of trying to find the balance now to sort of work in both roles well, which is sometimes hard. So I've taken some leave and um my plan is to just go back very casually to the clinical space. Yeah.

How Mentorship Led To Midwifery

SPEAKER_02 2:07

So let's go back then. Let's talk you back. What brought you back into midwifery in the first place?

SPEAKER_00 2:14

Good question, because I because I share that with with our student. And I wasn't the person that actually was born to think that, of course, this was going to be my pathway. Um what happened was I was a registered nurse first, and then I worked in a little, well not a little hospital, but like a um regional hospital. And we sometimes got asked to um move around the ward system. And I met this fabulous midwife, Marilyn. And Marilyn was about, I don't know, she was 60 plus, let's put it that way. And Marilyn was very passionate about women and about birth. And she actually was asked to um come up to the ward and and to work in a surgical ward. So she was very uncomfortable, but she made the best of it. And and of course, we became really good um friends, and every and every chance she had, she goes, You actually need to come and work with me, not the other way around. So I enrolled in a graduate diploma and I completed my um my studies there. Yeah, so that took 18 months, and I was at the John Hunter and working still in like I think they did it like then. I think you worked the first year in the say surgical unit or ward, and then you went over to the you know, women and birth and all those spaces. Yeah, so I did that in yeah, back in the day. And um, yeah, so that was how I sort of came, sort of fell into it, and I knew when I started that this was where I needed to be. Yeah.

SPEAKER_02 3:44

So John Hunter is a regional area in New South Wales on the coast.

SPEAKER_00 3:49

Yeah, that's the tertiary centre though. Yeah. Oh yeah, so I had worked at Maitland, which was like smaller again. So Maitland's like the regional, sorry, and then John Hunter's tertiary, yeah.

SPEAKER_02 3:59

Yeah. So that's just trying to put it. So it's not a big city place, it's kind of more regional. So that's the different levels of care, but a smaller number of births. But also what we kind of keep forgetting sometimes in looking at the city is you really need to know your assessment in the regional and region um rural areas because you don't have as much of the high tech or the the uh services on call that you do have in the higher levels in the city.

UK Midwifery And Culture Shock

SPEAKER_00 4:29

Yeah, and you know, we certainly get transfers in from the smaller centres, and of course, we would transfer them to the tertiary centre. So I was in the middle at um at Maitland, so I so I sort of went from a sort of a moderate sort of paced unit to the John Hunter to train train, which I which I just don't love that word, but you know, um educate. Yes, that's the word I'm after. Um yeah, so I just went there and um yeah, and then I actually came back to Maitland to work as a midwife. How long did you spend there as a midwife? At Maitland or um, yeah, well, I I'm still there, which is a bit crazy. However, what I did then, I just thought um I was sort of late 20s and I thought I'm I'm keen to travel. So I um actually went over to Reading Hospital, which is in the UK, and I and I got a job there actually, which was the probably the best thing, one of the best things I've ever done when it comes to my working life. Um, so I'd had 10 months postgrad as a midwife, and you know, I flew in there and thought I knew lots, and then um, and then I um certainly was like, oh my goodness, because you know, the the acuity of that hospital was all women um and had five and a half thousand births um a year, 14 birthing suites. Um, but the midwifery staff were amazing. Like I learned so much because I'm not sure whether it's still the same, but they, you know, they they um grade them from you know, what it was it, I I think it was either A to E. And that was around their skill set and their capabilities. Um, and we had midwives, you know, that I've just learned so much from, and then I learn a lot because there was so much going on all the time. But I suppose what I took from that was lots of things. But our mum at the time, she used a pin arts every time she was in a birthing space. So, you know, all these amazing things um stuck with me. Yeah. So um, yeah, so I I was supposed to stay for a year, and I and back in that time, my work employment, they actually gave me that space to do that. So I rang them and said, I'm gonna stay for two years, and they said, Yes, yes, that's fine. And then yeah, so I stayed for two years and just learnt a lot of things about life, women, and yeah, travel. Yeah, that was great.

SPEAKER_02 6:54

Did you experience any culture shock going over there or culture shock when you got back?

SPEAKER_00 7:00

Yeah, I think so. I mean, you know, I come from a small, you know, very Anglo-Saxon, you know, um city, you know, and I just yeah, was certainly introduced to lots of different ways of, you know, knowing and thinking and you know, and uh being, which I loved, you know. Um yeah, I I didn't realise how curious that I was till I stepped outside on my own little bubble, you know. And I suppose that sort of led into my research, to be honest, because I because was very curious about what I'd seen there. And then I was curious why actually when I came back, why of course this wasn't happening here. So yeah, so that was sort of um, yeah, I think it opened up a lot of different, you know, just sort of ways of being, you know, um, who we are, you know, um, you know, and of course how things are done, you know, or or not done, so to speak. Yeah.

SPEAKER_02 7:56

So what was it that you brought back with you? What were the kind of skills that you think you were able to develop and hone further that you were able to bring back and actually pass on?

SPEAKER_00 8:10

Yeah, I think it was just the recognition that as a midwife, you know, we're s we we've got so many different skills or capabilities, you know, and to and just to just to observe those women, just just because they're all women there, um, you know, um, just to sort of have that role and to not be handing over care all the time to different people when of course they could actually do what they needed to do in a really nice calm manner and still have those values of compassion and you know, and you know, all those things that I valued. So I think just and I think being um calm in that space, because I'm normally not always a calm person, but I certainly um certainly when I'm in that space, it just sort of it just allowed me to trust, I think. So there was no real tangible, I can now do you know, X, Y, Z. I I just became a uh a more trusting person in the birthing space because that's where I work mostly. And I suppose giving women a voice, you know, I just heard that a lot. Um and I suppose on the flip side that they there was a lot of intervention in lots of ways because this because because this unit was busy, you know. So um I suppose just learning how to advocate as well sometimes, you know, and even though I was just this, you know, new fresh type of postgraduate person, I think it just gave me the um the strength to build on things that I possibly already had. Yeah.

SPEAKER_02 9:38

So what did you find when you came back? What were the things that you found were easy to initiate or integrate? And what did you find were still challenging?

SPEAKER_00 9:50

Well, I think the main thing was when I was overseas, they kept the mothers and the babies together post-Caesarean, and I was like, wow, this is you know, this is great. Um, because where I worked when the baby was born, the baby got whisked off to the special care nursery. I mean, you know, this is given 30 years ago, but still. And then of course the mother was left by herself. And so I um came home and I and I asked the question. I said, Why are the babies going to the nursery? Well, who's going to take care of them? I said, Well, the mother and the partner or me, you know. So um, so that was huge. So then I started to ask people what they saw. And then uh Professor Henderson Smart, I think his name was, just happened to come for a visit. He was a um like a nursery, I can't remember his title, but he was, you know, he he was just doing the rounds for some reason. And I and I had a conversation with him, and I and by this stage I'd asked the mothers what they wanted. And of course, half of them didn't know that they had a choice, but half of them said, as long as the baby's fine, but half of them said, no, I just want my baby with me. And then I was really confused then because I thought, well, if half don't mind, but half do. And and of course he and of course he turned around and said to me, Look, Nicole, half of them do actually want their babies here. And and I think the other half really don't know what what cascade can happen when they're actually in the nursery, because he was very concerned that our well babies were actually going to the nursery. Yeah. I'm not sure Liz would have gone right off track there. Sorry. I don't know.

SPEAKER_02 11:30

Um that did that end up changing practice then? Yes, it did. Yeah. That's it. Woo! So it's it's the power of asking questions. Yes. Power of asking of noticing something and asking, can we do this better and how can we do this better, or why are we doing it this way? There's such power that is hidden power that people don't realise. And it's having those conversations and doing the stakeholders in which is the women, which is the midwives, which are the medical staff, the other staff, and then actually planting the seed in them. And then everyone sitting and going, Yeah, actually, why do we do this? Yes.

The Question That Changed Post Op Care

SPEAKER_00 12:06

Um, yeah. And then of course, that sort of flowed on years later to we stopped, you know, scrubbing forces there in sections, and we stopped, you know, like you know, and and of course we did the skin to skin, which wasn't happening, you know. So like yeah, so I mean, it takes time, which is what I've learned. Lots of time and patients. Um, but yeah, no, so that sort of was I I think it was a bit of a catalyst because I'd always, you know, questioned, but then when I saw it differently, I I think that's was so important to step outside of my bubble and to go and see how things are done elsewhere. And that was sort of brought back. Yeah, so that was quite pivotal for me because I could see how important it was. And I spoke to people that actually were doing whether it's quality projects or research, you know, which was um something that I probably hadn't thought about previously. I just was trying to do it on my own, you know. And that doesn't always work very well when you're selling it.

SPEAKER_02 13:02

It's harder to do it by yours in that kind of context. You mentioned that part of it was that it interest brought an interest into research. So was it that area or was there another area that kind of got you into the the research pathway?

SPEAKER_00 13:17

Yeah, no, I think it was um being a CME um in at at Maitland, like post-grad, you know, like so I just got back and then I did a master's of health science teaching as well as uh I I for some reason I did two masters. I did, yeah, well, you know, just sort of sh just love learning. Um, so then I thought I I just want to, you know, share or just plant some seeds around, you know, learning. So I'd um so what did I do then? Sorry. Um, yes, so was a CME and worked in that clinical space for about 10 or 15 years.

SPEAKER_02 13:55

Let's say clinical midwifery educator.

SPEAKER_00 13:57

Yes, yes, yep, sorry. Um, and I was just, you know, I was just observing student, you know, just watching them and thinking, why can some advocate and be accountable and autonomous and actually, you know, speak up for women? Whereas why can't some of you know, what sort of stops these people, you know, women or you know, people from actually doing that? So I was a bit curious and I and I'm so passionate about lots of things, but I just thought, well, I can't, I can't teach that, I don't think, you know, I just don't know how to support that. And then the continuity of care was part of their learning. So I thought, hang on a minute, this this sort of goes together, like this is what this will teach them or you know, support them to learn. And then I thought, okay, so how do we do that? And then, of course, you know, read a lot about continuative care with um with the student space, and then you know, looked at there was no learning outcomes because I'm thinking, what does what is the pedagogical intent of this? And of course, it wasn't really there. And I and I saw that there was a few people having a look around that. So I I sort of went down that path, and that's sort of where my PhD cop topic sort of come from. It was looking at the pedagogy, or what I then went on to find that it was more like pedagogy, you know, like how how how of course we might support the students to get the best from that sort of um incredible learning, you know, time. Um, yeah, so that's sort of where that all arose from.

SPEAKER_02 15:27

Um just go back to you've got a master's at midwifery, that was your second masters.

SPEAKER_00 15:32

No, my first one was that one. Yeah.

SPEAKER_02 15:34

Oh, no, and then you have science teaching.

SPEAKER_00 15:36

Yeah.

SPEAKER_02 15:36

So did your masters have a thesis component or was it coursework? No, it was coursework. Okay.

SPEAKER_00 15:41

Yeah, so I didn't do that. Um, yeah, no, I didn't sort of go down that path then because I thought I thought that was gonna be the end of my um studies. I just thought, right. Famous last words. I know. Um, yeah, and then of course a scholarship um came up because I'd always said I'd do my PhD, but I'd sort of, you know, you know, that whole, oh, I'm just not sure when that's gonna happen. And then a scholarship was available, so I applied, and that's sort of how it all moved forward. Yeah, because I'd probably still be talking to you about maybe doing it now, you know what I mean? It sort of never seems right, does it? Who was who was the scholarship through? Through the university here. Okay, yeah. Yeah. Because I I was working um sessionally, yeah. Right. So it was so I heard of it, yeah.

Why Research Became The Next Step

SPEAKER_02 16:30

And that's that's huge to be able to get that financial support. Yes. Even though our systems in Australia are different, we don't pay for our PhDs per se. We kind of it's it's government funded, but it's more about the time it takes to do it full-time versus part-time. You've still got to pay for your bills, you've still got to pay your cost of living. Yes. And that's where a scholarship comes in because that pay is for us as tax-free at a lower rate, but it is a supposedly a livable wage.

SPEAKER_00 17:00

Well, yeah, I mean, even when I think back to it now, like I like you sort of, I mean, I I still worked one day a week teaching, and then I did one day on the weekend, you know. Um, but it was like when like I think back to it now, and it was quite a nice place to be actually, because it was not as chaotic as sometimes, you know, juggling Bible. So I just had to juggle, you know, Tuesday, you know. So it was yeah. So at the time I'm thinking, oh goodness, this is you know so much, and I'm you know, and I and I'm quite poor, but I was rich in lots of ways, you know, because I just had that flexibility of when I'd, you know, um, you know, do my studies and when I'd go for a swim and you know, when I'd go to Pilates, you know, all those things that sort of kept me grounded. Yeah.

SPEAKER_02 17:45

But did you with the scholarship, did it come attached to like designated supervisors, or were you able to find your own supervisors and then have to search out who was a match for your area?

SPEAKER_00 17:57

No, um, good question. No, it I could actually source out my own supervisors, and it was interesting because my supervisor, my primary supervisor, Marilyn Farrer, who is probably one of my favorite people in the world, um, she just happened to come back into my life. So what I mean by that was she I just had the pleasure of her being my lecturer when I when I did my grad dip. And that woman just inspired me, you know, like uh and and and of course she still does. So I so of course she taught me then, yeah, and then she went away and did all her things, and then then it was just very timely that she came back to Newcastle at well similar time. I I mean I could be wrong, but I just got in I mean, she was in contact with me, and then and just the way her mind thinks, you know, we just you know would talk about lots of fabulous things, and she said, come on, yes, I would love to do that with you. And then Lynn Ebert was also around at the time, yeah. And uh Eileen Dowse, she was fabulous, and then I think um, like like lots of PhD journeys, um, I think Lynn might have left first to go else, you know, elsewhere, or you know, she wasn't um, and then Eileen I think left to go and do her um some uh other things as well. And then Alison Cummings then became our head here, so she kindly stepped into that role, and Liz Newman was um came a bit later. So I I mean it sounds like it was changing a lot, but it wasn't that stressful at all because Marilyn was always there as a you know, very um guiding presence, and then I had a really nice mix of women that just were different in lots of ways, but they just supported me in the ways that I sort of needed. So, yeah, so that's how that all sort of come about.

SPEAKER_02 20:09

The group sounds like the ideal entertaining dinner party, really. Oh, we did conversations you would have with all of those, they're fabulous.

SPEAKER_00 20:15

Marilyn took me to places I'd never my brain would go. Like, think about me, the clinical person that I thought I was, ended up looking at learning theories, you know, like that is so not how I thought I would ever um that's not where I thought that would lead. But of course, it makes sense when you think of learning outcomes and assessments, you know. So anyway, yeah.

SPEAKER_02 20:39

So I so must have been transformative learning theory and um cognitive load theory are kind of a couple of my favorites that that I kind of work in and schema building. So, yes, I understand the attraction to them.

Funding And Supervisors For A PhD

SPEAKER_00 20:53

Yeah, which is interesting for me because I I suppose you learn so much about who you are. Like I I'm either sort of nerdy or I'm naughty, you know. Like there's two sort of places that I tend to sit, and I quite like them both, you know. N and then love it. Yeah, so yeah, so that's how that all came about.

SPEAKER_02 21:16

So with the I know I've spoken to lots of people, and there's advantages and disadvantages to doing full-time and part-time, but when you've got your kind of luxurious opportunity to do it full-time and to have it funded, you talked about you'd be able to go for a swim. How did you maintain that balance then so that you could do your work, you could have your family requirements and responsibilities, you could still kind of do your teaching and do your clinical work. How did you balance all that or kind of juggle it all?

Learning Theories That Reshaped Teaching

SPEAKER_00 21:49

Yeah, I think um, yeah, I suppose I've always been an organized person and I suppose I've never ever started something that I didn't finish, you know. Like that's just I'm not sure where that comes from. My my Dutch mum, you know, she's always sort of led the way, like, you know, she's always sort of um a bit of a doer, you know. So I I I didn't doubt that I wouldn't get there, I suppose, but sort of getting there was like you know, was a bit of a was just was just a roller coaster, you know. And I just say to some people, it was like climbing a mountain with thongs on, you know. There was times you know, when you're scuttling down and then you're scuttling back up. Um, yeah, so I I think it was just being very, I mean, you know, some weeks I'd work, like you know, well into the night, you know, but I suppose it was I I just didn't have a set I'm going to work from seven to three. Like my day would not I'd sort of work later in the day. So I would do a bit in the morning, have have a break, you know, do a bit later and then you spend the time with the family with dinner and stuff. And then, you know, I think I think they, you know, I think they used to be quite used to me being in the study room, you know, for hours. But, you know, I I suppose they're a bit older too, you know, so I didn't have to, you know, I think um you know my the children ran that sort of 18, you know, at the time, um 16, yeah. So it wasn't too bad. But um yeah and I I think it's just that you know just that drive to to um get to the end and just making sure I mean I don't think I did it well all the time because I'd have my family say Mom can you just stop you know like can you just step away from that computer for a bit. But yeah and of course really good friends you know just sort of being able to get out and about and and and just be naughty sometimes you know just sort of get just sort of go into that mode. And I think my husband did it quite well for all his fault sometimes you know he um he say Nick just for God's sake just sort of stop and just go and do something you know so he was sort of more helpful at times than I thought you know so um yeah just listening to people that are probably you know could see from the outside in but it's so easy to get tunnel vision when you're in the groove.

SPEAKER_02 24:01

Yes. And that's the only thing you focus on.

SPEAKER_00 24:03

Yes and then I'd get quite well worked up because I couldn't see what I needed to see. Um but I don't think I could have done it well I um don't know this but like part-time I I just probably I like to get things done and that was a real challenge with it just with the PhD because I had to sit with things for longer than I wanted to. You know how you have to sit with it. And I was Marilyn I don't want to sit with it any longer. Just sit just sit in that uncomfortable space in the car. I said oh goodness you know so um yeah so I'm I'm pleased that I had the opportunity to do it full time because I don't really know how else that would have looked but I think it I think that was right for me. Yeah. Doing it part time is tiring yeah because it just seems to go on well from what I hear it just plus I think you do well you're doing sort of three jobs aren't you really like lots of full-time stuff aren't you?

SPEAKER_02 24:56

What's what's one thing that you learnt about yourself that surprised you ah um that I can do it.

SPEAKER_00 25:07

I mean I'm that's very I feel a bit emotional because um I was always the child that you know wasn't oh I just had a very you know um bright um brother you know and I was always the one that had to try extra hard to do anything simple you know um so that was probably huge for me to think wow I've done this I mean of course I've just had some amazing people that have you know helped me but um and I I suppose um I'm quite proud of myself because I um you know with my speech like I sometimes haven't put myself forward even though some would laugh and say yeah yeah right Nick but um just sort of putting myself publicly on view um you know is quite is all is just always quite challenging but um but I've just learned that anything is achievable you've just got to work hard that's that that's sort of what I've you know always known but it just consolidated that for me yeah putting yourself out there in a professional way is a very vulnerable thing to do.

SPEAKER_02 26:09

Yeah it's easy to put yourself out there and to be vulnerable with people that you trust it's when it's professional though then whilst other people's opinions shouldn't make a difference we we know they do. And it's easy enough when we're going well and the imposter syndrome comes in as well.

SPEAKER_00 26:30

Yes that that's you know that's sort of been floating around for a while I mean it's sort of less now but still you know it's certainly there. Um yeah no so it's just that self-worth and you know and just knowing that it's okay to be who you are and of course you don't like you shouldn't be comparing yourself to you know all those around you either you know because we've all got something to give yeah everyone's on different pathways.

Balancing Study Work And Family

SPEAKER_02 26:54

Yeah something that still sticks in your mind now from your PhD that surprised you or still just even just strongly resonates from you about what the results that you found.

SPEAKER_00 27:10

Good question just thinking um because I'm just thinking you know like I mean I think it just consolidated what I knew about continuative care being with women was actually transformative because it gave students the safety and the freedom to learn. Like I think those key words like freedom which was really nice to hear um you know because they could um and I suppose that whole hoodogical approach is really um important for you know learners I think in that space because there's no rules well there's sort of there's just not many rules around it anyway. So of course they're taking their own path in how they do a lot of that learning. So I just think you know um I think conceptually I think that's that was sort of really important to actually give learners a bit more freedom to because what I learnt was that children have it right from the beginning. Yeah but what happens is certain school systems change exactly like change how they think and they feel and you know so I think yeah so I think um freedom to learn and I think what it's taught me is that we like as the people that are supposed to know how to teach and learn um we probably has to change the way we do things more so than sometimes our students now I get there's different ways of learning and you know students um you know how they learn and what they do but I just think yeah I I think it's more about us having a good look at how we do things.

SPEAKER_02 28:45

And that brings me that kind of is bringing up images of when we're talking about learning theories Vygotsky's zone of proximal development which is this nice and it it does come from childhood development and pagé and everything. Piaget I always get that wrong um but the zone of proximal development is there's this nice little kind of like just right zone that students or people and in in learners as well are challenged enough that they're not scared and totally anxious but they're well they that they're not bored and they're not overchallenged that they become anxious and shut down. So it's that nice zone that has to keep growing and when you're looking at systems education systems in particular it's the lowest common denominator is what needs to be addressed to try and get everyone up you don't have that personalized care that they have that freedom to do different pathways. So when we look at that from an university system how do we help the students to have that freedom to learn in the way that works for them while still having to consider classes of 30 or more and so what were the students wanting or what did you find was something that enabled that to occur?

SPEAKER_00 30:10

Yeah I think um I I think if we sort of just think about the continuity of you know care um journey for them what I think was um what was what I found was that actually actually just sort of getting them to actually set their own um goals and now I've sort of moved on with that as well and I actually asking them to sit down with the woman and to share what that is you know and actually to actually um talk about sharing what the um what they think the experience will be and what their needs are and the expectations because I think we there's a lot of assumptions around what it is. So when we got the women together you know they said well I didn't really know what what I was signing up for you know blah blah blah. So I think that share go setting I mean what I'd ideally like is actually for um when it comes to assessments and feedback and things, you know, um you know I I just wonder why it all has to be the same as well you know so and that's where it all gets tricky because it's hard because you've got you know 30 you know or more students and you're actually asking asking a system to be quite flexible. You know, it's about that flexible approach. So I think I think sort of coming back to what we're doing now is we're looking at the shared goals we're looking at regular feedback we're actually um not focusing on clinical skills we're focusing on the actual skills of advocacy autonomy and accountability you know so um so we're looking at how to you know just and we're actually making them explicit not you know not you know so it's not like this hidden sort of well what's happening here so I think it's around and of course hopefully getting them to be more re um reflexive so we do a fair bit of work with that but yeah it's certainly difficult because um I can see it in my head you know what I think should maybe help but I you know it's just made it's just sort of translating that which is hard.

Continuity Of Care As Transformative Learning

SPEAKER_02 32:16

And it's like when we talk about 30 per class that's one class but when you're looking at cohorts for courses in the different universities they range anywhere from 30 to like I think 400. Yeah got so if you're looking at assessments most of the assessments have got to be fairly uniform. So once again you've got people who are not good at writing you've got other people who are fabulous at writing you've got some people who are great at sitting and talking and reflecting and you've got other people that just can't do that under the pressure of sitting and talking to somebody. Yeah how do we how do we give the option and yet not take up too much time because none of us have got enough time. Do the kind of one of the things as I was listening to you and I don't know we don't do it and I'm not sure if anyone does do it but we've got a couple of little emails from women after their continuity journey with their students has finished. And the student the women have emailed us to say this student was fabulous, this was really good. We had this both good and bad situations and I just want to say blah blah blah fantastic wanted to pass it back. Do you or should we include formal feedback from the women as part of that reflective process for the student?

SPEAKER_00 33:33

Yes yeah I think yeah we're certainly looking at that right now Liz um so um so we asked the women to um come in with some of our students and we did a little um focus group and they were basically saying you know that to wait till the end of the journey is not ideal because they've got this baby and they sometimes may get to it may not and the student said that's not ideal because say I'm doing something all the way through that's not really supportive. So um yeah so definitely sharing and that's where this new conversation at the beginning with some shared goals and one of those little prompts is how would you like to receive feedback? So so um the student sort of um saying to the woman I would like to receive some feedback from you how would you like to be able to share that with me you know so yeah so that's so we're just implementing that right now and of course we're going to pile it and see how it goes because the students are craving it and like you know they don't always get it. And then the ticker box for the woman is sometimes not ideal. You know it's just a ticker box. And the woman also said that they would actually like more um frequent times to give that feedback um whether it's to the midwife that's you know that is supporting some of them even suggested that they'd like that of course they would love a phone call you know like you know just um which once again you know is um you just have to work how that might you know look. From the midwife or from like someone from the university could just sort of check in and say hi Liz you know blah blah blah you know um so I think I think they're thinking like um you know when when you go home from the hospital someone checks in on you. So they were wondering whether that could happen. And I thought well it would be tricky but I can't you know like it's just things to consider. So I think feedback is super important. They both would like to um have it and to give it um and of course those that don't want to give it face to face. So what we suggested was it would be like a formative dialogue. It wouldn't be to evaluate the student's capabilities it'd just be an ongoing dialogue. So that's what we're trying to work on. So hopefully I can share that with with you all in the near future how that's looking.

SPEAKER_02 35:52

And it's a really critical skill of any profession is how to ask for and how to accept feedback.

SPEAKER_00 36:03

Yes.

Building Feedback With Women And Students

SPEAKER_02 36:04

And that's you know what I didn't even sort of have that in mind when I was thinking about all this but when I put it you know down I'm thinking yes because it's so important to ask for it isn't it Elaine because you become self-aware which is the key to being a better human being I think you know what I mean um and the time is really critical too like I tell all my students and I've done it when I was a nursing clinical facilitator and I do it now with the midfield students is pick something you want to focus on for that shift and at the beginning of the shift talk to the person you're working with and say look I really would like to focus on say my time management can you um at the end of the shift would you be able to give me some feedback on how to improve it don't ask for how did I do because that's a stupid question. There's a stupid question. But if you are just like how long's a piece of string yeah if you go look at the beginning of the shift I want to focus on time management or I want to focus on my prioritization I want to focus on whatever it is give that information early and then kind of go later in the end of the shift and go, okay, can you give me some tips on how to improve and it almost goes back to also thinking about Pendleton's five um steps in giving feedback which is part of it is you've got to get rid of that emotional component first. How do you feel you went? Because a lot of us will automatically go for the negatives and you kind of go okay so what did you think you did well? Okay I agree with you there. Excellent. And it's not what did you do badly it's what would you do differently next time and then you talk and you go actually I agree with you here. Don't agree with that I think you did this here. However this could be another area you could go back and work on. So I think we as educators and as clinical facilitators and as midwives need to refresh how we give feedback but we also need to encourage our students to have the confidence once again it comes back to vulnerability in asking for feedback as well. So I think what you're doing is fabulous.

How To Ask For Better Feedback

SPEAKER_00 37:59

So I've just got to get out there and talk to the CMEs around you know embracing it as well you know la la la la but um I mean I I think we need to start somewhere because it's not sort of getting back to the students and the women you know and it's about how they've experienced the care isn't it you know like it's just not some random person that's actually looking at you doing this or that you know so yeah so hopefully we're we're on the right track there.

SPEAKER_02 38:25

So let's go back to another question that is so important. How did you celebrate completing your PhD?

SPEAKER_00 38:31

Well I know I I just planned that for a while I was so excited that I that I actually had a hat party because I just yes you um so I don't know the name of the hat that we get what what's that beautiful bonnet? That's that hat. So I just wore my hat all day all night absolutely and that's why I had a hat party because I just was scared to wear my hat. I love that and um yeah so we just hide out a um a really nice function area and yeah and of course every everybody wore a hat and we had lots of you know music and great food and um drinks and yeah so so it was really special and I had planned to buy myself a um great gift but I'm still waiting to see what that is. So I might wait till I travel in June and just get something really nice. Yeah like like some jewelry or something fabulous.

SPEAKER_02 39:28

Oh absolutely absolutely and it's about experience well so if you want something tangible or if it's about experience but it's a gift to treat yourself. Yeah.

SPEAKER_00 39:37

Yeah um oh and I think one of the highlights was that I took my bound thesis with me to the party and I and everybody signed it like in the front and you know what I still look at it and smile like even when I was going through it just this week for something I just giggle you know because there's all these really nice comments and it makes me yeah smile. Yeah so that was a really I I'm pleased and Liz you and someone said to me oh I just get it now this is what you've been doing.

SPEAKER_02 40:11

Yeah they didn't they they didn't know what I was doing basically yeah I think I was going to get them to do a painting but I actually like that signing of the thesis mind you I still might do both because it's gonna be a long process and many many celebrations for when I finally finish yeah but it's almost like the old school yearbook.

SPEAKER_00 40:29

Yes that's what it looks like. Some of the comments are a bit uh cheeky but I but I just love it. Yeah I just love it. Yeah it's really authentic and heartfelt yeah it's really cool.

SPEAKER_02 40:41

Okay so instructions to the book binders will please make sure there's some blank papers at the front blank papers at the end.

SPEAKER_00 40:48

That would have been a better instruction.

Celebrating The Finish With Rituals

SPEAKER_02 40:50

Okay so if you've got to do that ask for extra blank papers at the front and the end. Perfect yes great idea I do like the hat I do like the hat because it is it is about it is about what that Tudor bonnet symbolizes. It's more than the gown yes it is about the changing from for us in particular here in Australia the mortarboard to that bonnet and the floppy hat and the blood sweat and tears that go into that is symbolic. And I was just watching something this morning that in Finland they get given a a top hat and a sword really to do with being dignified and defending um evidence based practice and I kind of went oh I need to bring that back I kind of like that I think that's fabulous. Okay so you we've talked about but what you're kind of doing now what else have you been doing since your PhD you're working in academia what are some of the other areas that you have found a passion in yeah um I suppose I suppose like a lot of people you think when you finish your PhD that the workload sort of gets a bit less however the workload is certainly um hasn't so so just sort of trying to settle into that because I suppose prior to my PhD I I'd always worked part-time so um yeah so just working full time again was a little bit of a shock you know so um yes so just trying to settle back into that way of you know being um and working clinically like I said when I can because I do love the idea of just walking into a birthing space and just providing that I think it's calmness.

Life After The PhD In Academia

SPEAKER_00 42:35

I don't know trust all those you know things um and just probably um focusing on some publications you know things like that you know we which is always like it's a bit hard when when you've got to juggle like the research part with the teaching side you know um yeah it's um and of course you know trying to get out um to the sites you know I mean I've always been a people's person so you know trying to engage with them a little bit more around you know how we can be um in sort of partnership for our students I'm just trying to think what what else I've been doing Liz like it just seems as if um it's just a lot of work and work and work and work which is okay because I'm passionate about it but so apart from this pilot study you're gonna be doing with the continuity care of the students what else is coming up what else are you excited about? Um the future there's a Waikoto funding that we have so that's with the New Zealand you know um with the New Zealand university so um a colleague and I you know they've introduced their GEM program so the graduate you know program into their university um and they're looking at how we actually support our postgraduate students and what sort of learning well I suppose it comes back to learning theories as well you know so how do we teach how do they learn you know should we be doing it at the same pace? And of course what we found was no which of course we knew that but trying to um maybe put that into a bit of a framework around what that looks like because we're sort of all doing what we think we should. So hopefully we'll be working together and um doing some more focus groups and some more interview type style things around what is it that we do as the as the support you know um and what and what do the students sort of need from us you know and have a look at that. So that I'm really keen to continue that on, you know, because I think we've had our um GEM program, which is what we call it for about four years now. And, you know, and I and I still think, you know, we can improve that. So I think sort of that sort of way we're sort of engaging and how we're doing that with our, you know, um GEM students is something that makes me exciting.

SPEAKER_02 44:50

So four years is a really good time to start looking at because you've got to write it in the first year, you've got to run it for the second year, and then okay, so what minor tweaks? Now let's start evaluating it and then do some changes and that, and then it becomes a constant, but you need to then stop at one stage and go, let's have a big look over where we've started from, where we've come to. So that happens around that kind of like three and a half, four year process. So that's a really cool time.

Improving Graduate Entry Midwifery Programs

SPEAKER_00 45:15

Yeah, and of course, we're just up for accreditation, you know. So yeah, so I I think it's quite timely. Yeah. So that excites me, you know, about you know, um creating a new program that's even better than the one we currently have, you know. So yeah, so um, yeah, so I I think I I'm just trying to think what else we're doing because there's sort of lots going on. Um, but I can't think off the top of my my head now where else we, you know, like I mean, we've got lots, you know, smaller projects that we're running, but um, yeah, but they're sort of the main ones is to sort of get that continuity of care um process for feedback and for supporting what actually the intent is, you know, um, and then of course having a look at um our GEM students as well. And and of course the graduate search. So we've had some students that have enrolled to come back to practice, but that's an ongoing um challenge. Like we have a lot of midwifery um, you know, um people that have uh have have been out for five or ten years and they you know start in and then they might be able to finish you know, so I I think there's a I think there's some work to be done around that. Like how do we support them better and what can we do, you know, because um the uptake, which we thought would be, you know, huge because we thought, you know, like there's so many people. Um well, we need a lot more staffing, but I suppose they sort of go down a new path as well.

SPEAKER_02 46:42

One of the reasons that they left, and I know there's a few people looking at the reasons why they left. Um, and I know one of my colleagues is looking at the reasons why people uh leave after 10 years um of practice. So why did they kind of take out before retirement age? And it is why we know that with in particular in Australia, we've got around the three to five year, there is a drop-off of people that kind of tend to be. And when I talk younger, I'm not talking chronological age, I'm talking um professional age that they've been registered in the in the early career stage, they'll go and go, yeah, no, not for me. It's the healthcare system is not what I want, or I can't do the type of midwifery that I want in the healthcare system. And then you get to the other end where they've been in it for long enough and then they are leaving, and very few come back after that.

SPEAKER_00 47:35

Yeah, well, that I think that makes sense then, because you know, we've had a lot of people inquire, but that's sort of sometimes where it stops, you know. So yeah.

SPEAKER_02 47:45

And the system's changed, and especially with electronic records. That's I know that's kind of been a big thing. I know a couple of people who've kind of come back and gone, yep. And then they've gone, yeah, no, no, this is too much for me. I'm yeah, it's not gonna do it.

SPEAKER_00 48:00

Well, I'm about to embrace it next week, I think it is. So I'm I so it could be me as well. And okay, I might see that side of my career over.

Supporting Midwives Returning To Practice

SPEAKER_02 48:10

I don't know. Yeah. They had a decent system, but then again, and all the systems are different. We don't have one national system, we've got different systems in each state, and sometimes in each venue, which means it doesn't help, and you think, but then again, there's a lot of security issues as well, which we know of. Um if you had no worries about funding, yeah. What would you wish and want to explore? What area would you look into? Oh I know it's a new question for this.

SPEAKER_00 48:43

Oh la la. Um oh, there's see there's so many clinical things that really frustrate me, like when it comes to practices.

SPEAKER_01 48:52

Yep.

SPEAKER_00 48:54

Oh, I think when I, you know, there's um because you might give someone a PhD idea or a master. Well, I I I I think women getting february in labor post-insertion of an of an I can't even say that word at the minute. Epiderrill. Of an yes, of an epidural, like that really bothers me because it then it because then they go down this septic pathway, you know. Um, that bothers me, you know, time frames around labor, you know, full stop, which I think someone's doing some work around that, which I love, you know, how pick the Freeman curve. Yes, beautiful. See that um that that makes me happy, you know, because I um syntocinin actually, that's what I want someone to look at. Because that like if I had lots of money, I would be because I can't believe that there's so many intelligent people in this world and they still have these policies around syntocinin and contractions and how many should be, you know. Um, because yeah, I really think syntocinin is well evil in lots of places, and I feel like we need a lot more information around what that's doing to our birthing women, our birthing outcomes, you know. So yeah, I I I think I'd come back because I don't know whether a lot's been done around that, has it?

Big Research Gaps In Labour Care

SPEAKER_02 50:13

Like we just have this all these policies around induction and syntocinum, but we don't really have a a lot to do, I don't know of around what it's actually doing and what it's not doing, and what might be best to think now there's a couple of American midwives who um work and I can't remember, I think it's the Mum Lab, and Erin George walks works in it, and Alice Erickson, I think she runs the Mum Lab. Um where are we here? Yeah, so it's kind of M U M H Lab.com. Um, she's doing some really groovy research in her and Mum stands for Mechanisms Underpinning Maternal Health. And she was looking at some really groovy stuff, and part of it was um oxytocin as well. The relationship I'm sorry, I'm just looking at the the podcast notes from her episode. Um the conversation delves into the complex relationship between synthetic oxytocin and postpartum outcomes.

SPEAKER_00 51:28

Yeah.

SPEAKER_02 51:29

And looking at in particular how the medication affects everything from postpartum hemorrhage to breastfeeding success and altered oxytocin receptor functions. So there is people are working in that area and they're looking at it from uh both the scientific but also from the women-centered and participant view as well. So, yeah, when that stuff comes out, because obviously looking at bigger studies there, it takes a while to get those results out.

SPEAKER_00 51:55

Plus, I think Liz, too, then actually looking at how we actually care for women in labor that have actually got these drips running, I I I think that qualitative insight would be really interesting because why can I do XYZ but somebody else has a real problem with doing you know, I mean, like, you know, like some people just keep turning the thing up, you know, some people think it, you know, just all that stuff, like where does that come from? Does that come from fear? Does that come from not understanding? Does that come from years of practice? You know, so I I think I just wonder whether somebody's looked at something around practices when it comes to induction. I don't know. And one more thing that I'd like to look at is inducing women with gestational diabetes, it drives me bananas because it's like there's no good quality research. And so I so I I'd so I'd like someone to do or me to do something around that because oh, it is just really um frustrating, I think is the word.

SPEAKER_02 52:57

Yeah, especially when they're saying, Oh, we're gonna prevent a big baby in the breathing to be 40% wrong anyway.

SPEAKER_00 53:03

Yeah, well, that's another area. So many things. I don't think I'm gonna live that long to do all these wonderful things.

SPEAKER_02 53:11

But that's but that's the whole really cool thing about sustainable midway-free is not one person doing everything, it's people helping other people to do what needs to be done and supporting them. So if for you, it'll be your future postgrad students, it'll be your undergrad students, it'll be the seeds that we plant in people to understand that research is not a dirty word or a dirty S. Yes, it's got lots of long and funky words in it, like phenomenology and ground theory that make your head explode. But it is about working out better ways of doing things, and everyone can do that. You don't have to have oh, super high intelligence to do it. You don't have to have kind of it's about you have to have curiosity. Yeah.

SPEAKER_00 53:58

Yeah, that's and I think that's a beautiful way to, you know, round that up because you know, that's so true. You always need to be curious about, you know, why and how and what's happening. Yeah.

Curiosity As A Professional Practice

SPEAKER_02 54:09

Thank you very much for your time.

SPEAKER_00 54:11

Oh, thank you, Liz. It's really been really lovely to chat. Thanks for asking me, and I'll look forward to seeing you in Portugal.