Making a sacred space for birth

What a lovely tender blog, a blog full of practice messages that gesture to something that dwells both within and beyond the experience of being in and around birth. A sacred quality that touches us as well as we touch it. These ‘guidelines’ speak of sheltering something holy that needs safeguarding so it can continue to be in all the places we provide maternity care.
Best wishes to all families and midwives and medical staff who are so privileged to be touched by this sacred quality.
Susan

@JennyTheM©️

This blog is inspired by the women I have cared for as a Midwife and also the wonderful Spirituality and Childbirth book book by & Dr Susan Crowther and Dr Jenny Hall . The women I have met and cared for in my midwifery career have helped me to invent new ways of working for and with them.This experience has shown me that in order to achieve a special birth experience we must be connected with the woman . The value of approaching each woman with a different perspective but the same professional compassionate values regardless of their mode of birth is the core of individualised care .

It’s taken me all my midwifery career to reach this point and I am still evolving.

Making a sacred space for women and birth is something that we should all consider as midwives. How many times do we enter a room of…

View original post 687 more words

New Zealand midwifery model of continuity of carer must be safeguarded

I have been worried by the social media and media coverage of the New Zealand maternity system lately. Some of the dear David’ comments/responses have been uninformed and sensational, yet many are heart rendering pleas from Midwives wanting financial recognition for the work they do. Rightly so! The NZCOM have asked for solidarity and action. Although I now live in Aberdeen Scotland I know the value and preciousness of the model of care in New Zealand – I also remain very much a New Zealand midwife. So pen to paper I wrote the following email to David Clark (health minister) and Jacinda Ardern (prime minister) at the New Zealand government, and Karen Guilliland the CE of the new Zealand College of midwives (NZCOM).

Dear Colleagues in New Zealand,

I applaud the NZCOM rapid response to the social media discussions concerning New Zealand’s excellent midwifery services. Having worked in various countries and regions globally, including 10 years as an LMC rural/remote rural midwife in Northland, and a 15 years in the UK system, I wholly support the midwifery led continuity of carer model in New Zealand. It is by far the most progressive model of delivering midwifery care I have witnessed and experienced anywhere. Working in New Zealand as a rural LMC midwife was the best days of my entire midwifery practice. The relationships I was able to build with women, their families and communities provided much joy to my own practice.

The evidence on optimal maternal satisfaction, safety and positive outcomes with continuity of carer are clear to everyone globally. Many of us working in midwifery practice development, education and research around the world now look to New Zealand for ways to make the system of continuity of carer sustainable, both for the midwife and the communities in which they work. Empirical evidence clearly shows that sustainable LMC ways of working are possible if the payment and support structures are in place. My own New Zealand study (completed in 2015) clearly showed how NZ rural midwives enjoyed what they do yet felt under pressure to work in unacceptable ways – they just need sufficient paid locum support, back up, and funding pathways that do not penalise them; they need to feel supported by an infrastructure that appreciates the valuable work they do in rural communities. The model is not the problem it is the payment structures. Recent evidence shows that LMCs do very well emotionally and enjoy what they do when supported. To consider changing the maternity model of care in New Zealand would be a travesty.

I am now working as a professor of midwifery in Scotland that has had a recent review of all maternity services (Best Start, Scottish Government, 2017). I gave evidence to the policy working group in Scotland on continuity of carer models of midwifery care provision and used the NZ experience as an exemplar. The number one recommendation out of 76 in Scotland’s maternity care reform is: ‘Every woman will have continuity of carer from a primary midwife who will provide the majority of their antenatal, intrapartum and postnatal care…..’. The same recommendation then recommends ‘midwives will normally have a caseload of approximately 35 at any one time’. This recommendation was developed from the evidence and wide consultation with women, families, midwives, obstetricians, neonatologists, managers, researchers and educators from across Scotland. Likewise, a similar review of maternity services from England ‘Better Births’ (2016) recommended continuity of carer for all women based on the evidence and women’s wishes for their care. Currently I am supervising a group of postgraduate research students exploring midwifery continuity of carer implementation in North East Scotland. Many of our senior undergraduate midwives in Scotland are eager to work in continuity of carer practices. In Scotland we are finding and working towards a change that would ensure continuity of carer for all women – something that you in NZ already have.

I hope that the NZ ministry of Health takes heed to the international evidence, women’s wishes and policy direction for maternity services. Currently NZ is shining a light on the journey ahead for many global regions – let them not turn that light off.

Kind regards

Susan

Dr Susan Crowther, Professor of Midwifery

Robert Gordon University | Garthdee Road|Aberdeen | AB10 7AQ

T: +44(0)1224 263291    ORCID ID:  0000-0002-4133-2189

Twitter: https://twitter.com/SusanCrowtherMW     Blog: DrSusanCrowther.com

New book: https://www.amazon.co.uk/Spirituality-Childbirth-Meaning-Care-Start/dp/1138229415

My message to those that read this – make comments, take action get writing, get lobbying today.

Caseload – verloskunde is duurzame verloskunde: een persoonlijk relaas

A blog a wrote in May 2016 about my personal experience in sustainable caseloading in midwifery has been translated by a colleague, Tine Oudshoorn, into Dutch.

Er is veel gesproken op sociale media en diverse internationale fora over caseload – verloskunde en werken met persoonlijke continuïteit van zorg (gehele proces) die het model nastreeft. Er bestaat nogal wat opwinding over; veel mythes, misvattingen en ongegronde bezorgdheid gaan rond. Ik had het genoegen in verschillende geboortezorg systemen te werken in het Verenigd Koninkrijk en erbuiten. In het Verenigd Koninkrijk werkte ik in een groepspraktijk met standaard verloskundige zorg en als zelfstandige verloskundige. De standaard verloskundige zorg, waarbij de 1e- en 2e-lijnszorg gescheiden zijn appelleerde eenvoudigweg niet aan mijn behoeften.

De groepspraktijk regelingen in de praktijk van het Chelsea en Westminster ziekenhuis, waar ik werkte in de jaren ’90, hoewel leuk in het begin, waren ook frustrerend en putte mij uit. Zelfstandig werken in het Verenigd Koninkrijk was geweldig, maar wel erg stressvol, doordat het niet volledig geïntegreerd is in het zorgsysteem en de noodzaak bestaat om betaling te vragen voor je diensten.

In Nieuw-Zeeland waar ik werkte, is de vrijgevestigde verloskundige volledig geïntegreerd in het zorgsysteem, waarbij vrouwen een verloskundige rechtstreeks boeken, zonder betaling als ingezetene of burger van Nieuw-Zeeland. Ik heb het Nieuw-Zeelandse verloskunde systeem al eerder elders beschreven.

Ik ga hier niet opnieuw de onderbouwing van caseload – verloskunde opsommen, die vindt je elders. Wat ik hier eerst ga beschrijven is wat persoonlijke continuïteit van zorg voor mij is. Het is ‘het meest’ ter zake doende en meest belangrijke in de contacten tussen de vrouw en de verloskundige tijdens de zwangerschap, de bevalling en het kraambed. Zorg wordt alleen overgedragen aan anderen, als ik op vakantie ben, een weekend vrij heb, bij ziekte of studiedagen en als er twee vrouwen tegelijk gaan bevallen! De zorg die ik verstrek doorkruist risico’s en de gekozen plaats bevalling. Ik volg vrouwen naar de haar geprefereerde plaats bevalling. De regeling is flexibel. Er wordt doorlopend op gelijkwaardige wijze (in partnership) tussen vrouw en verloskundige overeengekomen wat de volgende stap is.

Om te werken als caseload – verloskundige had ik nodig:
• Een uitstekende ondersteunende structuur (netwerk) met collega ‘s.
• Gelijkgestemde collega’s die qua filosofie en visie op dezelfde lijn zitten.
• Eerlijke vergoeding voor het werk dat ik deed, afgestemd op- en overeenkomend met het niveau van mijn vaardigheid. De betaling georganiseerd door het ministerie van volksgezondheid en gratis voor vrouwen.
• Regelmatige verlofregeling in overleg met een vaste praktijkpartner.
• Zelfregelend en autonoom werken, zoals het zelf bepalen wanneer prenatale zorg en postnatale zorg gedaan worden. Zelf het aantal volledige begeleidingen per jaar bepalen en de jaarlijkse rustperiode en vrije weekenden in overleg met de vaste praktijkpartner regelen.
• Eén volledige maand onafgebroken vrijaf zijn per jaar, plus een week vrijaf in overleg met de vaste praktijkpartner.
• Werken in partnerschip met vrouwen, dat wederkerig sensitief was en tegemoet kwam aan beider behoeften.
• Gelegenheid en tijd om ‘geen dienst te hebben’ als dat dringend nodig is.
• Genereuze open sfeer en goede communicatie tussen collega’s.
• Uitstekende werkrelaties met ziekenhuiscollega’s (verloskundigen en artsen).
• Regelmatige ondersteuning en begeleiding van de Midwifery Councel en College of Midwives (organisatie van verloskundigen).
• Begripvolle familie die ondersteunend is aan mijn manier van werken.
• Goede verstandhouding met iedereen (de gemeenschap) in de vestigingsplaats waar ik werkte.
• Betrouwbare auto en telefoon!

Achtergrond
De caseload was 4 – 6 bevallingen per maand. Dat genereerde redelijke inkomsten, iets meer dan collega’s die in ploegendiensten in het ziekenhuis werken. De betaling van caseload – verloskundigen in Nieuw Zeeland zet momenteel aan tot nadenken. Aanpassing is nodig om te voldoen aan inflatie en de mate van de verantwoordelijkheid. Op het moment dat ik dit schrijf staan 4 – 6 bevallingen per maand voor een adequate beloning, maar dit is nog niet verhoogd met de inflatie en daarmee een actuele uitdaging.
Ik werkte samen met 8 andere caseload – verloskundigen, opgesplitst in partnerschips van twee collega’s die elkaars partner zijn en waarnemer bij vrije weekends, vakantie- en studiedagen of ziekte. De tweede verloskundige is ook beschikbaar voor primi para bevallingen, of hulp bij langdurige bevallingen of als twee vrouwen tegelijk gaan bevallen! Spreekuur tijden, huisbezoeken en kraamvisites bepaal ikzelf in overleg met de vrouwen. Ik verzet afspraken in overleg met de vrouwen als dat nodig is. Flexibiliteit is de sleutel.

Sommige caseload – verloskundigen prefereren het om alle prenatale zorg op één bepaalde dag te plannen en bij voorbeeld nieuwe aanmeldingen, kennismaking en volledige intake, op een andere dag te doen.

Partnerschap is van essentieel belang tussen de vrouwen en mezelf, mijn praktijkpartner/waarneemster, de groepspraktijk waar we deel van uitmaken en de bijbehorende ondersteunende diensten, zoals de huisartsen, de geboortehuis staf en de plaatselijke ziekenhuiscollega’s.

Hoe ziet een maand werken als caseload – verloskundige eruit? Was ik overwerkt na die maand? Was de doorlopende aanwezigheidsdienst een constante verstoring van- of druk op mijn privé leven? Maakten vrouwen misbruik van mijn constante aanwezigheid en belden ze mij voortdurend?
Hieronder één maand van activiteiten uit het dagboek van mijn praktijk. Alle namen en plaatsen zijn verwijderd. Iedere maand was anders, maar dit voorbeeld geeft je een momentopname.

Daar gaan we …

Week één

• Maandag, dienst. Prenatale zorg in de praktijk 8.00 – 12.00 uur (8 dames). Drie kraamvisites en 1 nieuwe aanmelding, kennismaking en intake aan huis van de vrouw (2 uur). Thuis om 16.30 uur. Geen telefoontjes of oproepen.

• Dinsdag, dienst. Vier kraamvisites in de ochtend. Praktijk administratie bijgewerkt in de middag. Geen telefoontjes of oproepen.

• Woensdag, dienst. Drie kraamvisites in de ochtend. ‘S middags vrij. Geen telefoontjes of oproepen.

• Donderdag, dienst. Prenatale zorg in de praktijk (8 vrouwen). Twee kraamvisites. Praktijk vergadering geannuleerd omdat iedereen bezig was. Om 15.00 uur thuis en om 22.00 uur gebeld voor een bevalling. De volgende ochtend (vrijdag) om 08.00 uur thuisgekomen.

• Vrijdag, dienst. Ochtend vrij om te slapen. In de middag 4 kraamvisites. Thuis om 17.00 uur. Mijn praktijkpartner neemt de dienst over van 18.00 – 23.00 uur, zodat ik buiten mijn werkgebied naar een afspraak kan.

• Zaterdag, dienst. Eén kraamvisite. Geen telefoon of oproepen.

• Zondag, dienst. Eén kraamvisite. Geen telefoon of oproepen.

Totaal aantal uren weg van huis en aan het werk = ca 36 uur.

Buiten de werkdagen, maandag tot vrijdag, – één maal gebeld.

Week twee

• Maandag, dienst. Prenatale zorg in de praktijk 08.00 -12.00 uur. Vier kraamvisites. Thuis om 16.00 uur.

• Dinsdag, dienst. Nieuwe aanmelding, kennismaking en intake 09.00 – 11.00 uur. Drie kraamvisites. Thuis om 14.00 uur. Geen telefoontjes of oproepen.

• Woensdag, dienst. Geen telefoontjes of oproepen. Geen pre- of postnatale zorg. Administratie bijwerken (2 uur).

• Donderdag, dienst. Prenatale zorg in de praktijk 08.00 -12.00 uur. Praktijk vergadering tijdens de lunch. Vier kraamvisites. Thuis om 16.00 uur. Neem waar voor mijn praktijkpartner, zodat zij een avond vrij is.

• Vrijdag geroepen voor een bevalling om 07.00 uur. Thuis om 13.00 uur. Nieuwe aanmelding, kennismaking en intake 15.00 – 17.00 uur. Gebeld om als 2e verloskundige bij een bevalling aanwezig te zijn 19.00 – 23.00 uur.

• Zaterdag, dienst voor mijzelf en mijn praktijkpartner. Haar vrije weekend. Geen telefoontjes of oproepen. Eén kraamvisite.

• Zondag, dienst. Twee kraamvisites. Klaar tegen lunchtijd. Gebeld om 17 uur voor een borstvoeding probleem.

Totaal aantal uren weg van huis en aan het werk = ca 35 uur met 1 – 2 uur telefonische contacten en de administratie bijwerken.
Buiten de werkdagen, maandag tot vrijdag, – tweemaal gebeld.

Week drie

• Maandag, dienst. Prenatale zorg in de praktijk 08.00 -12.00 uur. Vier kraamvisites en één nieuwe aanmelding, kennismaking en intake. Thuis op 17.00 uur.

• Dinsdag, dienst. Twee kraamvisites. Niets te doen vanaf 11.00 uur. Geen telefoontjes of oproepen.

• Woensdag, dienst. Gebeld om een inleiding te begeleiden (over tijd) om 11.00 uur. Thuis om 23.30 uur.

• Donderdag, dienst. Prenatale zorg in de praktijk 08.00 -11.00 uur. Drie kraamvisites. Praktijk vergadering tijdens de lunch. Thuis om 15.00 uur. Geen telefoontjes of oproepen.

• Vrijdag, dienst. Vier kraamvisites. Nieuwe aanmelding, kennismaking en intake 13.00 – 15.00 uur. Overdracht aan praktijkpartner om 18.00 uur. Vrij weekend.

• Zaterdag en zondag, geen dienst.

Totaal aantal uren weg van huis en aan het werk = ca 38 uur met 1- 2 uur telefonische contacten en de administratie bijwerken.
Buiten de werkdagen, maandag tot vrijdag, – eenmaal gebeld.

Week vier

• Maandag vanaf 08.00 uur dienst. Prenatale zorg in de praktijk 08.00 -12.00 uur. Vier kraamvisites. Gebeld voor bevalling om 16.00 uur. Thuis om 21.00 uur.

• Dinsdag, dienst. Gebeld voor ondersteuning van praktijkpartner bij een thuisbevalling, van 07.00 – 11.00 uur. Drie kraamvisites. Nieuwe aanmelding, kennismaking en intake 15.00- 17.00 uur. Geen andere telefoontjes of oproepen.

• Woensdag, dienst. Geen werkzaamheden of gesprekken. De administratie in 2 uur bijgewerkt. Geen enkel telefoontje of oproep.

• Donderdag, dienst. Prenatale zorg in de praktijk 08.00 -12.00 uur. Praktijk vergadering tijdens de lunch 12.00 – 14.00 uur. Daarna twee kraamvisites.

• Vrijdag, dienst. Drie kraamvisites. Nieuwe aanmelding, kennismaling en intake (2 uur). Perinatale sterfte vergadering in plaatselijk ziekenhuis 13.00 – 15.00 uur.

Dienst vanaf 18 uur voor praktijkpartner, haar vrije weekend.

• Zaterdag, dienst. Om 6.00 uur gebeld voor assistentie van een collega (lid van de groepspraktijk die we samen voeren). Thuis om 16.00 uur.

• Zondag, dienst. Eén kraamvisite. Geen andere telefoontjes of oproepen.

Totaal aantal uren weg van huis en aan het werk = ca 35 uur met 1 – 2 uur telefonische contacten en de administratie bijwerken.

Buiten de werkdagen, maandag tot vrijdag, – tweemaal gebeld.

Ik hield ervan en floreerde met deze manier van werken. De voldoening die ik had van het relationele model van zorg resoneren nog altijd door in mijn perspectieven op de verloskunde. De relaties gaven mij energie en inspireerde me. Ja, soms was ik moe en wilde niets anders dan mijn telefoon afzetten. Maar dat werd steeds opnieuw goedgemaakt bij de volgende geboorte, het volgende imponerende moment; dat wij als verloskundigen het privilege hebben geïnviteerd te worden een bevalling te begeleiden.

Laat de caseload – verloskunde en persoonlijke continuïteit van zorg je geen zorg geven of bang maken. Het was een prachtig deel van mijn werk als verloskundige, dat ik vaak mis, nu ik ben ingebed in de academische wereld. Het plezier van zo te werken, overtrof altijd de momenten van kwetsbaarheid of twijfel. Zorgen voor vrouwen en hen adviseren en uit de eerste hand zien en horen hoe het werkt of niet werkt voor hen, geeft vorm aan praktijk besluitvorming. Het steeds opnieuw vrouwen ontmoeten die gezinnen vormen is een genot.

Ik moet zeggen dat caseload – verloskunde echt de kunst en de magie van de verloskunde door vroedvrouwen benadrukt, die mij altijd na aan het hart zal liggen. Wees niet bang voor caseload – verloskunde, het is duurzaam, aangenaam en goed uitvoerbaar met de juiste ondersteuning en flexibiliteit. Ik ken collega’s die na 20 jaar zo werken, het nog altijd even boeiend en inspirerend vinden. Net als collega’s met kinderen, collega’s die net afgestudeerd zijn en collega’s die nooit zo hebben gewerkt in een vrije praktijk. De belemmeringen om op deze wijze te werken worden overwonnen met steun- en de wens- en inspiratie te willen slagen.

Wat anderen ervan denken? Zou deze aanpak werken in het Verenigd Koninkrijk? Zou deze aanpak werken als nationale aanpak in bijvoorbeeld Schotland (of Nederland)? Heb je er ervaring mee?
Go well ……

Dr. Susan Crowther is hoogleraar verloskunde aan de Universiteit van Aberdeen, UK.

Vertaling Tine Oudshoorn, verloskundige, n.p. MA.

UK Hermeneutic Phenomenology course & symposium

Course and symposium bookings now open. The 2018 April event is in Aberdeen, Scotland hosted at Robert Gordon University. As at the 2017 event Dr Gill Thomson from UCLAN co-facilitates with me! The 2017 event in Preston was fantastic and we are both looking forward to the 2018 one…. see you there. Information on how and where to book a place for the course/symposium is on the attached posters.

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Ecology of Birth

Last week I spent a day at the University of Humanistic Studies, Utrecht, The Netherlands  attending a symposium:

“Concerning maternity: ethical and existential questions at the beginning of life” hosted by Dr. Inge van Nistelrooij & Dr. Joanna Wojtkowiak.

Every human is brought into the world through the woman’s body, however, there is surprisingly little research conducted on mothers’ perspectives on good care at the beginning of life. The symposium focused on existential concerns at the beginning of life from the perspectives of those closely involved in the care of new life: mothers, fathers and professional caregivers. This symposium was the first part of a two-piece expert-meeting of a new program of research. This 1st symposium posed the question

‘What are existential concerns at the beginning of life?’I was invited to share some of my insights about spirituality, childbirth and existential experience. Needless to say i resonated with this theme! Part of the key note I gave explored the following taken from my chapter  ‘Birth as a Sacred Celebration’,  In (Crowther, S & Hall, J. 2017 Eds.) Childbirth and Spirituality: meaning and practice at the start of life. pp. 15-16. I want to share this excerpt from the chapter and presentation in the hope it will generate some dialogue.

Ecology of birth

There is a wholeness about childbirth which I to refer to as an ‘ecology of childbirth’ which unfolds at each birth (Crowther 2016, Crowther 2014). Yet we need to be cautious of naming something. The notion of an ‘ecology of childbirth’ (see figure 1) and its implications for how childbirth occurs within contemporary maternity systems is used here as a point of departure in our explorations and is not intended to be taken as a fixed and inflexible notion.

An ecology of birth

According to Haeckel (1986) ecology is the science of relationship of living things/beings and their environments. What is key in this definition of ecology is the significance of relationships. I would contend that ecology in relation to childbirth is concerned with multiple relationships. It is an interrelated phenomenon comprising an embodied quality [i], a spatial quality that includes felt-space and physical places of birth, a quality of relationality or being with others, a quality of temporality that incorporates Kairos time (explored later in chapter), a dynamic quality of social-political and cultural context e.g. changing policies and practices informing childbirth. Simultaneously every birth includes a mysterious unspoken quality unfolding in and around the occasion. This ‘ecology of birth’ incorporates ALL types of birth in ALL circumstances.

An ecology of birth is a notion built upon the enigmatic description of Heidegger’s fourfold [ii] (Heidegger 1971/2001), Smythe et al’s (2016) interpretation of the ‘good birth’ and my own research in relation to the existential qualities of lived-experiences of being at the time of birth (Crowther 2014). Reawakening our collective cognisance of an ecology of birth can bring remembrance of how each birth is potentially a joyful celebration of life and our shared natality. I infer a ‘reawakening’ as I fear we have forgotten or covered up our original knowing. In this chapter I adopt a phenomenological and philosophical hermeneutic lens informed by the works of Heidegger (1927/1962), Gadamer (2008/1967), Arendt,(1958) Dilthey, (2002) and O’Byrne, (2010) to present a philosophical interpretation of birth as spiritually meaningful.

[i] Embodied experiences refers to how the body is the medium of our perceptions (Merleau-Ponty 1962/2002). Experience and bodily sensorial sensations are thus inseparable. For example a joyful experience is both our material body, such as tears of joy, as well as the lived experiencing of the joy. As Heidegger (2001) contends we body our experiences, that is to say we embody them.

[ii] Heidegger’s philosophical notion of the fourfold is a central aspect of how we dwell as human beings in all situations we find ourselves. The fourfold has four components: earth and sky, divinities and mortals which are an inseparable unity that cannot be divided into separated components. Each component is interconnected and in the interiority of the other. Heidegger claims that human beings are not only a being in the world, but are always part of this fourfold. For further description read Heidegger’s (2001) Poetry, Language, Thought

(full references given at end of chapter).

Finishing First Year Midwifery

This is such a lovely blog from a 2nd year student midwife at RGU – I just felt compelled to share! Emma, midwifery is privileged to have you join the profession!

RGU Student Blog

This September I finished the first full year of my midwifery course, and so much has happened in that time. I sat an exam, I failed essays and passed essays, I moved into a new flat with 3 fantastic girls, I’ve worked in 3 different hospitals during 4 clinical placements, I set up my own Netflix account and I have delivered 10 beautiful babies.

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Spirituality and Childbirth: meaning and care at the start of life

It is now published! Available on Amazon – that was quite a journey. Made wonderful by a team of amazing chapter authors and my lovely friend and colleague Dr Jenny Hall as Co-editor. The official launch will be at the Normal labour and Birth research conference early October at Grange over Sands, UK. We hope it brings this conversation to the table or at least begin a conversation. To find oneself, in whatever capacity, in and around childbirth, is to be moved and transformed by an event in human life that is significant on so many individual and societal levels. Enjoy the read and let me know your thoughts.

A four-day Hermeneutic Phenomenology Methodology Course (3-6th April, 2017)

School of Nursing and Midwifery Blog

A four-day Hermeneutic Phenomenology Methodology Course (3-6th April, 2017)

The University of Central Lancashire and Robert Gordon University are delighted to invite you to attend the following:

A four-day Hermeneutic Phenomenology Methodology Course (3-6th April, 2017) aimed at postgraduate research students, researchers and academics working within health and social care areas who are new/novices in this theoretical and methodological approach.  During the course, participants will receive an introduction to, and beginning experience in, designing hermeneutic phenomenology studies, collecting and analysing data, and reporting themes, qualities and patterns.  (Please note this event includes a three-day methodology course and attendance at the one-day symposium detailed below)

A one-day Hermeneutic Phenomenology Symposium (6th April, 2017) aimed at postgraduate research students, researchers and academics working within health and social care. This is an exciting opportunity to listen to experienced researchers who have used a hermeneutic phenomenological approach to a) highlight some of the challenges…

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Hermeneutic Phenomenology Symposium April 2017

Hi all. Dr Gill Thomson and I have finalised the program for the 4th day of a hermeneutic Phenomenology methodology course (see previous blog). The 4th day is an exciting and inspiring symposium open to all. So even if you cannot join us for the week come along for the symposium. Attached is information to wet your interpretive appetites. A great line up of hermeneutic phenomenological scholars. See you there for a day of dialogue! Looking forward to a feast of thinking!

Compassion in midwifery, maternity and childbirth

Last week I had the wonderful opportunity to be part of an interactive event in Dundee. It was the 2nd Scottish Improvement Science Collaborating Centre (SISCC). A wonderful liberating and inspiring day. I just want to share some insights that came during the day which focused on care and compassion.
I was confronted by a series of questions that arose both within myself and in communication with others: 

  • What is compassion? 
  • Where does it come from? 
  • Does it dwell within us or outside of us? 
  • Can compassion be taught and learnt? 
  • Is compassion an innate human quality?
  • How can compassionate care be spread to places where it may not yet be realised?

My personal life experience is that compassion is a quality and energy that manifests, and awakens between us within relationship. Such relationship is born of communications both silent and spoken. It is in the richness of a reciprocal dialogue that the possibility of empathy and compassion awakens. For me it is a way of being in the world and being with others. 

Following last week I am left wondering how do institutions and organisations in which we work enable and disable the potential for compassion to be revealed? Do our organisations ensure relationships can flourish? I am thinking of organisational structures that resonate at a particular tone or mood of fear and control that may not value human connection in which compassion can thrive. 

What does the organisation you work for value most? I’m not speaking of written policy, guidelines and organisational rhetoric but coalface interactions between and through all layers of an organisation. Does the context you work for allow the magic between people to unfold and energise compassion? Are the the conversations we have with colleagues and users of services based on a democratic dialogue, that is to say, does our use of language create a level playing field between us? 

For compassion to thrive and inform our connections with others a particular mood is required. A mood of congeniality, openness, transparency, care and tenderness. If we understand that we have to be in one mood or another and that we cannot be without a mood then the mood of a places and persons are significant. If a mood permeating your place of work is largely fear based then that is how that environment comes to be understood and how all interactions in that environment become interpreted. I would contend that in that mood a maternity (or any health environment) unfolds into a risk orientated experience. That can feel threatening and stressful.

I remember transferring a women into a hospital from community. I was happy to see an old colleague on duty in the hospital yet the communication between us was uneasy. I was confused and disoriented. I was met by a host of questions about the care I had provided prior to admission. This was all necessary yet it was the tone of the communication that left me feeling uneasy. The obstetrician then entered and the mood drifted into antagonism which translated into a barrage of risk discourse that awakened anxiety both for me and the family I was working with. I remember becoming overly judgemental of my own decision making, second guessing myself and feeling defensive. I was on guard and felt no sense of connection between the staff and myself. I went quiet. 

My relationship with the mother and partner became challenging as they too were being pulled into this new mood since being admitted. Suddenly everything became dangerous and risky. We transferred in for slow progress of labour and maternal request for analgesia. It felt we had arrived just in time to stop a terrible outcome! I felt that no one was having a good day in that environment. 

On the other hand I have admitted from a homebirth with a woman having a retained placenta and been met with congeniality, respect and a listening ear. The admitting midwife made me a coffee whilst I admitted the woman and spoke to the doctor. The admitting doctor was friendly and professional. The mood on both occasions was startlingly different. Although the outcomes both times were positive for mother and baby in terms of physical needs there was a tangible felt difference postnatal in my relationships with the mothers. In the first story I went home exhausted, questioning my abilities and feeling frustrated. The postnatal care did not flow easily in the way I had hoped. In the second story I felt connected to my colleagues and went home feeling part of a team and that I had done a good job. The compassion in the second story left me sustained and nourished my relationship with the mother throughout the postnatal period.

Compassion is a quality awaiting a fertile ground to awaken and grow. Once compassion and care takes root it can nurture the possibility of compassionate connections in each moment. So for me compassion requires the right ground, a freeing type of resonance. Once the mood of an organisation shifts from one that narrows potential, for example when fearful, to one that opens to possibility something enlightening between us awakens. A spark of compassion, once a spark of a potential flame awakens it can be fanned into a roaring fire warming and bringing brightness to all our encounters.

Let us think about how our leadership is attuned? Our colleagues? Our policy makers? Our researches? Our educators? Our new graduates? 

Maternity and midwifery have been shown repeatedly to be based on relationships. Indeed it is the relationships that keep care safe. Midwives are the ambassadors of maternity care and have a responsibility to safeguard what is precious in childbirth and ensure its continuance is holistically orientated. Facilitating and turning to moods that enable compassion to flourish between us is therefore worthy of our efforts. We may or may not have innate compassion, in a certain sense that does not matter. However we can be accountable to the moods which we contribute to and choose to awaken and we can also decide the moods we choose to turn away from. We just need to be aware of moods and take notice of the affects certain moods have on ourselves and others.

For me the good news is that compassion awaits us all. It is not dependent on whether you or your colleague next to you has a good amount of innate compassion! The notion of compassion being inside or outside creates a kind of false objective -subjective dichotomy that is antithetical to compassion. Compassion wants to gift us all those wonderful experiences that come from giving and yielding to each other. Compassion is thus realised and expressed in our relational encounters. Compassion for me is thus unfolding moments between us in the reciprocal play of our interactions. Without the play between us compassion finds no ground to take root and grow. Compassion only asks for a fertile ground to grow and come forth. The delight of feeling compassion once awakened between us reminds us of our shared human needs of wanting to be understood to feel loved and to feel safe.

It may only take a kindly moment of eye contact, perhaps a smile and some gentle verbal acknowledgement of the others you meet and work with. Such moments can be the fan that ignites the flame of compassion between us.

taken from collective notes board at SISCC in Dundee 2016:Sept

New book early 2017 “Spirituality and Childbirth: meaning and care at the start of life”

kali-squatting
Co-editors – Susan Crowther and Jenny Hall.
Publishers: Routledge: Taylor & Frances Group.

The book will draw attention to the beginning of life; a poignant human journey that holds meaning and significance within and beyond current maternity care systems.

For more information click here.