Ep 57 Laura Biggs on finding midwifery, passion for research, and critical role midwives have in preventing maternal suicide

Ep 57 (ibit.ly/Re5V) Laura Biggs on finding midwifery, passion for research, and critical role midwives have in preventing maternal suicide

@PhDMidwives  #MidTwitter @strongerfutures @MCRI_for_kids  @sahmriAU #research #midwifery

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Join us on an inspiring journey as we chat with Melbourne-based midwife, Laura Biggs, about her fascinating path into midwifery and how her passion for research is driving practice change. Discover the intriguing findings from Laura's honors research on women's experiences of directed and non-directed pushing, and how it can shape our understanding of equity and access in healthcare.

Balancing clinical work with research can be challenging, but Laura shares her experience of navigating this delicate balance while completing her PhD. We explore the importance of having a supportive team, the power of storytelling in midwifery, and her experiences working with a mental health helpline for new mothers. Listen as Laura discusses the need for more research on motherhood and the potential for midwives to work in roles beyond service delivery, such as governance, leadership, education, and research.

Finally, we delve into the unique human experiences of suicidality during the perinatal period and the need to better understand and meet the expectations of those affected. Listen as we explore the concept of shame in motherhood, how it can be addressed in different cultural settings, and the importance of midwives utilizing their skills to make a difference in maternal health. Don't miss this engaging conversation with Laura Beats on the art and science of midwifery and the potential for research to drive meaningful change in practice.

Transcript

Speaker 1: And welcome to Through the Pinard, your conversational podcast talking to midwives around the world about the research they are doing to improve midwifery practice. These research can range from small quality improvement programs and projects to those starting part way through or just finishing their postgraduate studies, and to those that have been there, done that and got the t-shirt. So settle back and enjoy the conversation And remember you can continue the conversation on Twitter after you finish listening. Thank you very much for joining me, as per usual. Can you introduce yourself, please? 

Speaker 2: Absolutely, and thanks so much for having me, liz. So my name is Laura Biggs. I'm a midwife based here in Melbourne. I'm now working as a research fellow at Murdock Children's Research Institute. 

Speaker 1: Cool, so let's start right back at the beginning. So what got you into midwifery? 

Speaker 2: It's going to sound like I'm about to tell you my life story, but please bear with me because it's the first sentence I'm about to say is I grew up in country Victoria And that had quite a bit of sort of grounding on how it is that I found midwifery. So I grew up in quite a small, or reasonably small, kind of white farming community, had some sports injuries growing up, was really interested in osteopathy out of that That was sort of where I wanted to go with my career. So finished high school, didn't quite get the grades that I needed to do that as you do when you don't quite pay enough attention in year 12. 

Speaker 2: So enrolled in a biomedical science degree in that process moved myself to Melbourne and a whole bunch of really enormous things happened in the next 12 months that landed me in exactly where I needed to be. So I ended up living in Footscray, which is a really multicultural part of Melbourne, and so may, having grown up in that regional area, it was this enormous, just such a joy to live in this multicultural part of the world and such an eye-opener for me as a young, sort of 18, 19 year old, to have that experience. And then was going to university in the west of Melbourne as well, realised from that that osteo just was not going to work for me from my values base because it was a fee-for-service, it wasn't publicly available. I ended up with this enormous sense of the importance of equity and access around healthcare, so started to think, okay, well, what do I want to do? Just to convince the university to allow me to completely change my enrolment. And I just broke the degree a little bit and I said can I please do this environmental philosophy unit? I also want to do this politics, gender studies unit And I also want to do this Aboriginal health unit with Professor Foley, an incredible Aboriginal activist. 

Speaker 2: And it was the combination of those units, the perspective that it brought me, but also within those Aboriginal health classes. And it was incredible cohort of midwives, student midwives, and I used to watch them from across the huge lecture hall and I just thought they are my people, you know, i know it's an enormous distance. It was whilst doing all this soul searching and trying to find something that was really embedded in primary healthcare, had a huge social justice, equity focus. I knew that's what I wanted And I thought who are these people? And they're engaged. They're passionate, incredibly respectful in the way they engaged in what we were learning about And I knotted out a few weeks into semester that they were the midwives And that was it for me. I was like these are my people. 

Speaker 1: So then, when did you transfer over to mid? 

Speaker 2: End of that year. So you transferred into a Bachelor of Midwifery at Australian Catholic University and then finished my Bachelor there and did my honours the following year with my graduate program as well. 

Speaker 1: Yeah, out of curiosity, what did you do your honours in? 

Speaker 2: Yeah. So I looked at women's experiences of directed and non-directed pushing. I was really, oh lovely, yes, i was. We ended up doing it as a systematic review, qualitative systematic review, because obviously honours are needing to be quite contained pieces of work. But for me as a student midwives coming through training I always just thought how is it that we've all got such a similar way of directing what's happening within women's births at this time? and also just completely struck by the consistency of the script that people would use, even across the five, six, seven health services that I'd been in as a student And I thought, gosh, what's going on here? And have we bothered to ask women what this is like? So that's what I did for the honours. 

Speaker 1: So what did you find out? Yeah, okay, so caveat here that was more than 10 years ago, so my brain has not touched that for a while, But so What the other caveat would be that quite possibly practice hasn't changed in some areas that much Yes, which is the sad thing, especially in that area 100%. 

Speaker 2: So, from what I can remember, one of the most striking things for me was that we were first publishing about the potential negative impacts in terms of fetal oxygenation, heart rate, etc. Back in the 1960s And that, exactly as you say, the practice had been sustained And I ended up only identifying two studies that had ever looked at what it was like for women, and I'm going to paraphrase this wrong, but one of my favourite statements from a woman was something like you're all mad. You know I'm going to push him out and, yes, he'll go back a little bit the next time, but it's okay, because he'll come out that bit further the next time. Just this great sense of the people in the room were just completely at odds with what she knew she needed to do. And one of the other things that really stood out for me in that process was I went to the State Library here in Melbourne And it was a very early so-called midwifery textbook from 1904, off the top of my head So glorious. 

Speaker 2: Yes, and it came through the shoot. It was that sort of special access, you know, don't breathe on it, don't touch it, don't harm it. And that seems to be one of the first recorded sort of instructions, if you will, for clinicians to use directed pushing. Wow, and it was written by an obstetrician. 

Speaker 1: Yeah. 

Speaker 2: Yeah, Yeah. So that really planted the seed for my research passion. As much as my intent had always been to do research to drive practice change And that's certainly still the case I think the process of research itself is really rewarding for me. That sort of fosicking around and finding the way we understand things and the way that influences practices is quite a privilege really. 

Speaker 1: So where did you work while you were doing your honors? Because you were doing your grad year or your TPPP, whatever it's called. Yeah, so where were you working when all this was happening? 

Speaker 2: I was working at a facility in the west of Melbourne, so Western Health Yeah. 

Speaker 1: So did you find? how did you find? working and studying, because that's one of the hardest decisions that people need to make, because we need to earn money, but also trying to fit in study terms so you can do something that is of quality. 

Speaker 2: Yeah, exactly, i think for me. I enjoyed, i think, the different perspectives it could bring. I did the honors part-time and I had an absolutely awesome supervisor, jane Morrow, who was a head of program at ACU at that time, who really understood that the realities of shift work would be that if I was, i think I had like a block of six weeks of nights in my graduate year. It'd been honest. So I just kind of was like bye-bye, i'll see you on the other side, if indeed I make it. 

Speaker 2: Exactly, yeah, but I think for me it was that you know, if I got stuck in a phase of the study, i could step out and be in the clinical sphere for a while and that could recharge the battery or I might have a realization within the research space that I could then explore a little bit when I was back in the clinical space or have a think about things differently. So I think it enabled a lot of different perspective taking which kind of complemented each other. But you're exactly right that it's how many hours do we have in a day, how many hours do we have in a week, and how do we balance these realities now? 

Speaker 1: How much did it change your own practice? 

Speaker 2: That's a fantastic question And I think it would be hard for me to fully understand that, given it was so early in my own career. You know, i think, what being involved in sort of developing you know it's like when you come out of your middle of three degree, you've got this beautiful philosophy of practice Yep, and you believe in it with every cell in your body. And then that process of trying to embed and step into your own powers and be diverted into a practice that feels as if it aligns with that philosophy can be really hard. And I think researching something that was demonstrating how embedded in practice some of those barriers are. It brought insight to some of the challenges I was experiencing in developing my practice in a way that I would have liked, but it didn't necessarily bring answers to how it is that within that setting, at that time for me at least, that I could practice in the way that I felt I would have liked to have, and that's that hard. 

Speaker 1: changing practice, knowing when, but who is open to changing practice is something that can just be a magical thing that you're either in the right place or the wrong place. 

Speaker 2: Yes, yeah absolutely, and the benefit of witnessing your colleagues practice as well and how inspiring that can be when you have those opportunities and what that can enable you to have the confidence to start to maybe emulate some of those practices as well. 

Speaker 1: And it only takes a ripple to kind of like make that first movement through, and you never know how far that ripple can go. So what did you do after your honors? 

Speaker 2: So I kept working clinically. By this time I'd had and the timeline's probably a little bit fuzzy in my head but there was a particular midwife out at Western at that time who was really influential and had come from she was UK, but then had also spent time in New Zealand and then had come to practice And she developed a program called the African Women's Wellness Program which was her particular area of practice. And I think you know, given that my pathway into midwifery was really founded in those concepts around social justice and the importance of women and families being able to access the care they need proportionate to need It was really influential for me to spend time with her and to see the way she approached her practice And I did it. I was able to work within that specialist pregnancy setting a little bit, so continued to do that and work across scope of practice at that time. 

Speaker 2: But because I fell in love with that research practice you know in itself as well I actually went straight into a PhD at the end of that Honours program. So I was two years into clinical and started having a look around and, in particular, talking to my Honours supervisor about the lay of the land in the Victorian midwifery context. You know who are the fabulous supervisors, where are the great places to go. So I started having conversations with people about about that, while I continued some clinical work. 

Speaker 1: Did you already have an idea of what you wanted to explore for a PhD, or were you open to suggestions? 

Speaker 2: Great question. 

Speaker 2: So something else that had happened in the background while I was studying to become a midwife, i'd also started volunteering in a peer mental health support that peer mental health program in Melbourne. 

Speaker 2: So this was about matching people in their local communities who were experiencing often quite significant challenges to their mental health with someone who had past lived experience of difficulty with their mental health and then they would support, you know, the client or person that they'll match with. So I started in that program with that community based mental health org when I was maybe 19 or 20. And so you can imagine, as I'm then working in maternity services with a particular interest in mental health, then starting to think about PhDs, natural that my brain was starting to think in that direction. I was 23 at this stage. I had this very and I think I don't know if you're interested to hear if this resonates for you at all but you know, what brings you into a PhD is often a sense of change, like I want to drive change I want to do good Yeah sometimes the perception of what changes feasible in a three to four year PhD. 

Speaker 2: This is what one might maybe actually could, do. 

Speaker 1: That's why we have supervisors. 

Speaker 2: Except so I still have this memory of me landing in the office of the two professors who ended up being my second person, second supervisors, with this list of stuff that I just thought needed to be improved, And you know it was all sort of grounded in this sense of. You know, there's injustice in practice and the women and families that need the most care are often the ones experiencing the greatest barriers. So for me, I had this huge list of things that you know brought me passion and that I thought I could work in, And they were so lovely. They listened to me rattle off this enormous list of things that were probably completely not feasible and ridiculous, And then at the end, you know, super respectful, like that's really great. 

Speaker 2: We also have some work that is about to be beginning which also might align with these interests that you have, And so they did really well to sort of scaffold me and bring me back down to something that might have been feasible, And it ended up being a fabulous experience for me being embedded in a PhD that was part of a broader project. So right from the start I had that sense of team and momentum and sort of a purpose, a greater purpose beyond my own part of what that project was as well, which was quite cool. 

Speaker 1: How did you end up deciding on those two supervisors? 

Speaker 2: Yeah, so I'd had a few chats with different people, but I think for me it was this overwhelming sense, when I arrived in this research center, of it feeling like home. It was wow, and I think you know I knew I was stepping into a space that I could be read as not having a great deal of right to be in at my age, only having to use a clinical experience. You know often use the term whippersnapper. I was really quite mindful of that, i think, and would I be accepted and welcomed in the way that I wanted? And I was? you know I had the conversation with Helen and Della and they were fabulous. But then they took me around the center And I met these professors that I had been fighting as an undergraduate And they were lovely And I thought, oh, okay, i could see myself flourishing here actually with this amazing environment. 

Speaker 2: Fabulous So what did you do? My PhD was undertaken in partnership with Panda, so very natural anxiety into Western Australia. So at that time, because of where they were sort of up to in their sort of organizational timeline if you like, they were due to undertake a full review of their National Helpline Service for the Department of Federal Department of Health. So there ended up being some work focused on sort of more of the who's, contacting who's not, what's what's, that sort of quantitative profile which is not my heart space. 

Speaker 2: I'm far more of a qualitative researcher but that was awesome to generate sort of some skills and confidence in that. The heart space for me was very much around speaking to women who access the service and trying to understand what that meant for them and how that changed their trajectories within either pregnancy or early motherhood as well, and also their peer support workforce. So women who had lived experience of so called mental illness in the perinatal period who were then driven to come back and volunteer and spend time supporting people who were experiencing distress. So understanding what it is that drives people to do something that fabulous. 

Speaker 1: Absolutely. There's so much that is run by volunteers that if we truly had to pay, then like the country we broke, because you can't really pay you for that experience, for that knowledge, for that level of true understanding and passion and empathy. 

Speaker 2: Exactly, and I think you've just named part of what we ended up sort of publishing from that analysis. We use the empathy altruism hypothesis to sort of show the way or we certainly wasn't, it wasn't a theory generating activity, but that having that level of empathy for what someone else is experiencing can drive really great. That investment of time and emotional energy to sit in that space with people is a profound gift, and it was a real gift for me then to sit with those peer support volunteers and hear what brought them to that work, but what was something that actually surprised you, that you were not expecting? 

Speaker 2: Oh, that's such a good question. I think sometimes, when we sit in spaces with women and families and there are experiences of distress and whether that's around mental health, whether that's around address perinatal outcomes, if someone experiences stillbirth, or the big ticket items that we think about as a midwife and as a broader care team, i think one of the things that really struck me was and I don't mean to diminish the skills that people bring, the therapeutic skills that people bring to these environments And I'll use a story from one of the interviews that I did with a woman to. I think this was probably actually when she realised that it's fully sank into my bones. I remember she was sitting in different parts of Australia, she was sitting in her car, she was about to go into a toy store to buy a gift for one of her children, but it was boring with rain, like absolutely you could hear it in the background, and so I was very lucky to capture her then to have a chat about her experiences, and she was telling the story about her hardest day when, in her own words, the staff member on the helpline saved her life, and she was explaining what it was that this person did to enable that for her And I think the thing that surprised me was they didn't do anything, and again, not to diminish skills, it was being human that made the entire difference for her and also for her support people in the background that the service was also holding at the same time through that crisis event over a sort of a few hours, and I think that was the start for me within my own research practice and teaching practice, which I'd also started by that stage as well that it's not rocket science and that if we support people to be able to fit in that vulnerability with people in their darkest times and to connect and to bring empathy and compassion into that, that actually is the key to what drives those positive care experiences and enables them is to get what they need in those really hard times. 

Speaker 2: So don't actually have to be at university for 15 years to get that. It's a human thing that we can foster. 

Speaker 1: And I think that that goes to like being present and being in the silence, when no one's expecting you to give solutions because there are none, but just knowing there's somebody else there listening to the breathing That's exactly it. 

Speaker 2: Yes. 

Speaker 1: How did that experience change the rest of your research? when you're doing the analysis? 

Speaker 2: Yeah, I think, hopefully a deep listening for the human elements in what it is that we bring, and I think, also an understanding then about what is special amongst the peer workforce and why that empathy can drive that commitment to that deep listening and that presence that you speak of as well. It's been a long time since I was in that data to recall sort of specifics around analysis, but I think it probably was a turning point in the way that I understood the context that I was researching and also its implications for practice and education as well. 

Speaker 1: Yeah, I think that's the important thing is that, even though it has been time has gone past, that still resonates with you very deeply And that's the things that we experience that does change our view, that changes our practice, that gives us those stories. We are storytellers As humans. Our history started with telling of stories. It continues in many cultures, it continues within the profession. We have that understanding of oh many women experience this. 

Speaker 2: It's that storytelling kind of process of that is so important And I think that's part of that balancing of the arts and the science of midwifery 100% And I think that's what frustrates me in some respects with the way we are approaching, the way we support clinicians doing this work at the moment. 

Speaker 2: Actually, that tendency and I understand COVID has driven that for many reasons but that tendency now to say, great, we'll develop this online module for this, we'll be an online module for that. And it takes away the storytelling and it takes away the felt sense and that belief. When you're working with someone to expand their skills and confidence whether that's in the context of supervising a PhD student, supervising a first-year midwife on a postnatal ward, it doesn't matter If you can demonstrate that unconditional positive regard and that belief that you have in them to do the work that they have come to do. That, i think, has so much potential to transform them. Whereas when we are taking it out of the story space and putting it online and saying, can you please learn about really big ticket items like mental health and family violence in this module, i do worry that we're really not meeting anyone's needs by doing that. 

Speaker 1: And quite often in my experience in those topics I've taught those topics the students just want to script what do I say? And it's like it's not that easy. I can tell you some things not to say, but it's not that easy because you have to be individual to the situation. You have to take in a lot of context of what's happening and where you are and what support you've got and what time of day it is. But they're not happy. They just want that script that they can use and throw out regardless, so that they can then, yep, tick that off and then go on to the next thing Exactly. 

Speaker 2: Totally, and, i think, individual to the practitioner as well. We can all tell when the person that's with us is speaking from their heart as well. Yeah, very, very tricky when the students are going out there and trying to develop these skills where you know. I think the want for the script sometimes comes from the busy environment that they're then going. well, I actually don't have time to sit with this person for as long as I might like, So how do I do it? 

Speaker 1: Absolutely And globally is absolutely in crisis and it's amazing really that our students do do as well in learning the subtleties. And I don't like using the word soft skills, because I think communication, critical thinking, there are essential skills. There's nothing soft about them. They're not technical skills as in putting a catheter in. In fact, they're even more important because you actually need them to know when to put the catheter in and how to do it and get consent. So I don't like the term soft skills. That annoys me. So how did you? did you do your PhD full time or part time? then Full time, yeah, Excellent. I'm completely envious. How did you? how did you structure your study time then? Was it a job nine to five, And then you kind of balanced it out? How did you set your study period up? 

Speaker 2: It was really variable. It sort of depended a little bit on where I was up to in the study period as well And, i think, also still shift work. So what worked one week would then you know, okay, i've got a night shift this week for that, that day that I'm doing. How do I, how do I manage that? 

Speaker 2: But I think what I learned about myself in that period was I do better if I'm physically going into a place where I would try, and I was at the Judith Lumley Centre, which is a Latrobe University research centre. So I think one of the biggest things that kept me afloat was the cohort of other PhD students who were just phenomenal, so I'd go in and spend time there. You know it was a structure that really enabled me to feel exactly as you say a little bit like it was a job, but also that I'd get home and then my home was my home and a little bit less like there was that constant you could be at your desk, you could be reading something. Have you thought about being at your desk? 

Speaker 1: Yes, that guilty feeling of not doing something. Yeah, exactly So did that help you keep your sanity, or what else did you do to keep your sanity during that time? 

Speaker 2: Yeah, i think in the end, the sort of openness to renegotiate what the right approach looked like at those different times, you know, and it's like when you're stuck in theory, not theory. I am now doing grounded theory, which is why my brain's like yes theory generation. 

Speaker 2: So we can talk about that later. But you know, when you're in those heavy periods of data generating or analysis, what looks like a kind of sanity protective thing at that stage is quite different to the other ones. So I think I did a lot of yoga actually back then. So I sort of went to sort of three yoga classes throughout the week that would hold me accountable for stepping away at the right time to go on the train at the right time to go out there. I had really supportive housemates that would pull me up by particular points in the day. 

Speaker 2: So the same day How cool, yeah, Have you thought about eating a food? or maybe not Continuing to work two ways? Yeah, and I think the other PhD students in the centre were very, very, very supportive as well. So when things did and it's not at all commentary on my supervisors, but inevitably sometimes we'd leave supervision and we'd barely make it back to our desk before we started crying Yeah, so having the supportive team there to go, oh, that was a shit one then, wasn't it? And giving the chocolate and the tissues and just that space to hear it, because you can imagine doing that in isolation. So it's part of your brain that said, what are you doing and do you really think you can do this? They could have prevailed if I didn't have that support network around me. 

Speaker 1: And that imposter syndrome, especially when you get the chapters back and there's just corrections which you know, you know are there to help you, you know are there to make it better, you know are coming from a very genuine place, but you look at it and kind of go, why am I doing this? 

Speaker 2: Yeah, Can I keep going? Yes, i've still got a folder here actually of my first paper that I ever published every single round of feedback on that manuscript because my supervisors preferred to give handwritten feedback. 

Speaker 1: Lovely. 

Speaker 2: Yes, exactly So. I have that folder and I keep it as a reminder. Like I said, after I got published I said thank you so much. I promise I will never do that to you again. Just you know, try to get someone to be ready to publish from the ground up must have been such an ordeal for them. But just as a reminder of where we come from and how much our writing progresses over time, i do sometimes have a squeeze at that folder to remember. 

Speaker 1: Could you get a professionally bound? That is a very cool idea. We do with our thesis, yeah, but you could do. I've still got my midwifery portfolio and I keep teasing myself that one day I will get the 7000 pages that it is Wow Bound. Even I'll miss some of the comments in the corner, but it's like the blood, sweat and tears that go into that, but that means it's actually easier to read then. 

Speaker 2: That is such a good idea And if you ever do that with your portfolio, i hope you like put it out into the world so we can see it, or marvel at it. 

Speaker 1: That would be embarrassing One day. that will get bound. I've just got to find it in the boxes again. 

Speaker 2: It's such a fantastic idea And to hold that history with us as we move forward. I think you do. I don't know if you find this too is, but I think what brings us to the work, that passion and the purpose for us can really help to hold us steady exactly as things can get tough. 

Speaker 1: You said that your housemates were kind of really supported with AAC academics as well, really good humans. Yeah, you got good choice in housemates then, so have you got family that's close by. that also were a support network. 

Speaker 2: Not at that time from memory. I'm thinking of timeline here. So my mum my mum is living with and she is also a nurse, and when she was doing her PhD I think she was about 12 months in front of me, oh wow. But she was not super close to you graphically at that time And I think towards the end even she'd moved into state, so sort of more of a chosen family kind of support network at that time for me. 

Speaker 2: But certainly I made the mistake towards the start saying to mum, i'll race you. And of course she absolutely beat me. And then I made the mistake as I was gearing up to submit mine. I said oh, mum, can you send me a thesis Just so I can have a bit of a look at how you, because I did mine with publication And I said can you have a look at you through your wraparound material together? And I looked at it, realised how much better it was than mine. I was like what is that? It was this incredible health policy PhD And I was like obviously hadn't sent me that. That's really not good. 

Speaker 1: But that's actually quite human though, isn't it Exactly? 

Speaker 2: And I think to have someone around and of course I had my other folks at the centre doing their PhDs, but just that accessibility of people who could normalise those ups and downs and the freak outs and all that kind of stuff, just really helpful. 

Speaker 1: So the important question how did you celebrate then? 

Speaker 2: I had a very good friend with me as I was pressing the submit button, who she was writing her PhD. Actually, this is quite a cool story, liz. So my first placement of my third year of Midwifery, i met her at the health service where I was And she was a midwife quite senior there and we got along well, you know, and didn't see her for many years. 

Speaker 1: So it was what. 

Speaker 2: So there was three, four years later And when I was doing the tour, i think it was my first day as a PhD student. So I just, you know, done my enrollment. I was all green and terrified And I walk into the tea room at the research centre and there she is And she's doing her PhD there. And we were like I haven't seen you since the tea room at the health service. I've read a little bit, tori and what's going on. And she was. 

Speaker 2: We just fit it off three, two months ago. I would have spent that time together. So she was standing next to me when I pressed the submit button And the first thing I did was burst into tears And then just kind of got myself together and I'd already set up. I knew I'd be exhausted and potentially would be tempted to bail. So I went straight down to a lovely restaurant near the university where my other PhD buddies were there and champagne, and really just properly marked it. So that was a really I'm really glad I fit something up ahead of time because you can imagine you'd just be so tired You could flink home and get your p-dash in your hand And it's like because it's all electronic now. 

Speaker 1: Yeah, whereas I remember when I did my masters my masters was back in 2010, 2011. It was three softly bound copies printed out hard copies. Yeah, you had to take up to the desk and it was like you were just there and handed over to the kind of the staff, the professional staff there, who, thankfully, i knew Yeah. And we're going yay, and we're going yay, but now it's just like it's a button. Yes, it's a submit button on the screen. Yeah, good, i'm glad you had some ceremony around it. 

Speaker 2: Yes, I've heard that even sometimes, when people used to submit, they'd be given like a balloon and a pen. 

Speaker 1: Yeah. 

Speaker 2: It would have been such a different experience to physically walk somewhere and hand it over like that. So I think you're right The online experience. we've lost a little bit there, really. 

Speaker 1: We need to. We need to develop something. I think it was. One of the Scandinavian countries, of course, has a brilliant tradition of, when it's being conferred, that the supervisor gives the new graduate a sword or pulls them around in a cart. There's a whole variety of different things that they seek to do, that thinking we need to build some of that stuff down here. We're not doing it the right way if we're not doing swords and carts and things like that. 

Speaker 2: I feel like we need to start something in midwifery that there's some kind of I suppose a pinard would be the appropriate thing, but a sword is very, very cool. A sword's very cool. Yeah, I think we might need to do something. A sword is very cool. 

Speaker 1: But you could do a pinard. I must admit, that was my graduation. When I finished my mid undergraduate I bought myself a wooden pinard Amazing, And that was my and eventually I'll get it engraved. And I'll kind of probably do the same with my PhD and I'll get that engraved. So there'll be this little lineup of engraved pinards because it's like yeah, what else do you do? Because it's the perfect symbol, really, isn't? 

Speaker 2: it Absolutely. 

Speaker 1: That's kind of go through all the times. So you finished your PhD, you have celebrated. Didn't quite beat your mum, but never mind. What did you do afterwards? 

Speaker 2: I had been warned by some friends who finished their's ahead of me that sometimes is that close PhD's lump. So I was kind of waiting for it to happen And interestingly it didn't for me, oh Yeah. So I was super fortunate that a couple of things sort of lined themselves up, sort of in the last months of the PhD's. I'm sort of thinking, cool, but you know, this kind of bliss coming. What happens now for that? 

Speaker 2: About 12 months before I'd submitted, i decided to step away from clinical practice And that was it really. Was that, how do I fit it in? How do I have enough time in my brain to do what I needed to do to finish the thesis? But it was also, i think, for me that challenge of can I, on one day a week, sustain and expand my clinical skills in the way that I want? I was enjoying the bits of teaching I was doing. Can you know, i think, the prospect of me trying to develop and sustain practice across research, clinical teaching, and there was a lot of grief in that for me. Yeah, exactly, it was that sense of well, can I really still be a good wife? 

Speaker 2: And you know, oh yes, yeah, and you know what it is, yeah. 

Speaker 2: And every cell in your body goes I may need life like that. I don't think there's anything, even if, for some reason, I decided not to continue with my registration. It's such a fundamental part of the way I see the world and the way that I work within it And that I thought gosh, can I? what does it mean if I'm not in practice? but it was absolutely the right choice for me, Because I think I am in the right place to operate as a new wife And that decision freed me up a little bit more to take on a little bit more teaching, which then meant, when I finished, I had a role lecturing at ACU for a time And I also took on a role within Panda as their policy and research coordinator. 

Speaker 1: Oh, well, i know the quality of your work by now, so that's kind of like an advantage They'd road tested me for a few years by that stage so I was quite shocked that they were like hey we're not sick of you, i remember a. 

Speaker 1: Twitter thread one night that kind of came out of the PhD midwives handle And it was that's how I linked onto it. I can't remember who started it, but it was about can you call yourself a midwife if you're not still clinical? And it was really. It was really quite disheartening to see how many people said no, you've got to still do clinical. 

Speaker 1: And yet when we look at the state of the world midwifery and they're kind of going well, where do we need midwives? We need, obviously, service delivery, we need it in clinical, but we also need it in governance, we need it in leadership, we need it in education, we need it in research. So, like you can, and obviously with your competence competencies in Australia at least if you're working in education or in research, if that's the area you're working in, you're competent in that area. That signs you up. There is some debate about whether they will bring in the clinical competencies that you have to do, the like 240 hours in a five year thing, which I think is a step backwards if they do. But that's, i think, similar to what's happening in the UK And I could be wrong because I haven't read it lately, but it is. 

Speaker 1: Yeah, it was really quite disheartening. So how many people kind of came in and said no, if you're not doing kind of baby physical, baby catching, then you can't call yourself a midwife anymore. And it's like but everything else I do is midwife, like everything is touched on midwife, but I well, i kept simulated babies, so that's got to count somewhere. 

Speaker 2: So much of what you said resonated around the great potential that we have in these different spaces that we fit. You know, i'm now sitting in a huge medical research institute but every single room that I'm in, whether it's with the head of government relations or you know the epidemiologist who leads our research team, who's a social historian by background, so she's quite oriented that way. She's quite awesome. But I'm still starting so many of my sentences with ah well, you know, my midwife brain is thinking this and wondering that And I, you know as much as I now, of course, bring you know lots of other skills as well. Having those voices in those rooms matters And I think it advances the profession in important ways. So I really hope that. You know it's interesting. 

Speaker 2: It's one of my great regrets in the teaching work that I did, and it was only years later that I had the big epiphany. I know it's. Of course our programs and the free programs are accredited by and make it very important that everyone's practice ready who comes out of them. But of course all of my teaching had been oriented to the sort of the assumption that people would therefore take up roles within the clinical arena. However that looked if it was, you know, home settings or tertiary or whatever. But you know we need more midwives in Parliament too. We need more midwives across all areas, and I wish that I'd had the insight at that stage to embed more of my within my framing of what the profession can be, That it wasn't quite so solely clinically oriented. I think that Yeah. 

Speaker 2: Yeah, that was a missed opportunity. 

Speaker 1: And I totally agree. When we're looking at transition to professional practice, what does that look like? Looking at we do we need a midwife at every table where a decision on women's health is made? We've got that innate skill of looking at things from a women's centred point of view, from that's our base thought. But it's really hard with students, and especially when all they can see is the only important topics, the ones that clinical. Yeah, they don't see how global health, they don't see how research, they don't see how kind of like interprofessional communication or leadership skills. It's like no, no, no, it's about unfortunately, catching numbers meeting that standard because that's the way we've got. And the clinical, but yeah, and I think that's the same, was the same in nursing, exactly the same in nursing, and it has been since even the hospital. The hospital course made it a little bit easier because you were in the in the area. But yeah, crossing that boundary between getting them to have that broader understanding is difficult on many days. 

Speaker 2: Definitely, and I think sometimes the way we teach those units that feel less clinically relevant. I remember texting my mum from within the research unit research unit, you know, inverted commas within my undergrad And I texted her and said you are mad, i cannot believe that you do this. This is so boring. 

Speaker 2: And and she's my two least favorite units of an undergrad were research and mental health. And then I grew up passions and it's, I think mum replied something to the extent of it might be about what being taught law and you might want to stick with it, But you know when it feels not clinically relevant. And when mental health is taught as a list of DSM categories? Oh, no, no, no, Exactly. It of course isn't going to align with the philosophy that those students are trying to generate. Yeah. 

Speaker 1: And that's, yeah, the teacher. The teacher makes or breaks. And there are some people who are fabulous but should never be teachers. Yeah, there are other people. They are the people who are just natural teachers but don't follow and don't get the opportunity or are very focused in the area And you've got them go take them outside that area and they're not confident And then you've kind of lost that skill of the beauty that they had when they're in there, kind of like comfort zone. 

Speaker 2: Yeah, absolutely. And those three units that I took randomly as a first year environmental philosophy, gender studies and Aboriginal health those teachers were, all three of them were just science by, and you can see that trajectory for me then of what education can be. I completely agree, it can make or break things. Yeah. 

Speaker 1: Well, i'm glad you found your passion for research and mental health, because you would not be sitting and working where you are now without it. Exactly, yes, i think we do find other spaces I don't know if I like the term getting called, but there is a pool and a. No matter which direction you go, you'll end up back. You'll kind of take this side route or deviation or detour, but you kind of end up back there again. If you allow things to just happen? 

Speaker 2: Right, definitely. And if you listen to it as well, that is this my place, staring across the lecture hall going, ah, those really passionate women, they are my people. Yes, exactly. 

Speaker 1: So what kind of things are you now into? 

Speaker 2: Yeah, sorry. I'm incredibly fortunate. I have been in the research team that I'm in now since October 2019. So, I kind of found my feet a little bit and then a pandemic happened. But yeah that's okay. 

Speaker 2: So we are called the Intergenerational Health team. If you include our PhD students, we're about sort of 45, 50 people. So we focus on understanding experiences of intergenerational trauma and social inequity and opportunities to intervene and to change those cycles And that can be across. We've got a team who are focused on Aboriginal health, a team who are focused on refugee and migrant health, also mental health and resilience and family foundations. So it's not as if we sit within those silos but the work broadly can be conceptualised across those programmes. 

Speaker 1: Yeah, And so that's I'm just looking at the webpage here with Stronger Futures, which is part of That's, our CRE. Yep, Yeah, so it's a combination with the Murdoch Children's Research Institution and SAMRI here in South Australia, the South Australian Health and Medical Research Institute, otherwise known as the Cheese Grater when you drive past it, because it's an architecturally very interesting building. 

Speaker 2: Yes, i've only been there once, but yes. 

Speaker 1: I could recall, but they do some absolutely amazing research there. So what's your favourite passion project that you're involved in now? 

Speaker 2: Great question And I hope you like the website because I built it. 

Speaker 1: I do, I love, I always love colours anyway, especially kind of the rainbow colours that go across, because that's nice and diversity. This is exactly it. And the Sunflower how can you not like a Sunflower? 

Speaker 2: Yes, and I actually grew that Sunflower that you're looking at. That's a picture of one of mine If you're on my profile page here. Actually, it's reminded me your question before about keeping sanity. I think gardening for me is an incredibly grounding thing. If I can be doing whole things, something flourish, seeing it transition across the different seasons, that's always a very sort of Yeah, something that I worked at is important. But you asked me about what I'm working on at the moment. So, yes, so my great love at the moment, which you'll find on the website, is a study called Making Sense of the Unseen. 

Speaker 2: So this was the first grant that I landed post PhD, as a sort of principal investigator, if you will. So I applied for this in partnership with Panda. It was funded by a Swiss Health Prevention Australia Innovation Grant And we secured that in late 2019. As you can imagine, i was only like 12 months post PhD. At this stage. I was like you know, i'll have a crack and I'm sure I'll have another 10 applications before I get anything. Got the phone call a few months later and almost fell over Shop. Yes, such an incredible honour. So we undertook a grounded theory study which thought to explain the evolution of suicidality in pregnancy in the following 12 months First study of its kind in Australia. We really don't have a great deal of understanding about women's experiences of suicidality at that time in their lives. 

Speaker 1: Is it still the leading cause of death in the first 12 months for? 

Speaker 2: women? Yeah, good question. So yes is the short answer. So the Australian Institute of Health and Welfare stops reporting maternal deaths at 42 days after the end of pregnancy. But for the jurisdictions that go up until 12 months so Queensland, victoria then yes, it is the leading cause AIHW, because they don't include what are the late deaths, you know, between 42 and 12 months. Usually it's sort of second or third after cardiac and sepsis and those sorts of ones. But yes, yeah, huge, huge thing. 

Speaker 2: That's just massive. Yeah. So we ended up having 139 women share their stories with us. You know, it's such an important that sensitive topic. That's amazing, yeah, and we did it in COVID. So we were like there's a lot going on in people's lives, you know. Are they going to want to talk to us on top of everything else about this? And we started our adult generation by putting out an anonymous testimonial. So quite a contained qualitative survey. So I'm going to sort of, come as you are, let us know what was important to you at that time and how you made sense of it. And my recall isn't going to be perfect here, but off the top, of my head. 

Speaker 2: We've been about 48 hours. We had 30 or 40 responses Wow. So just such a gift to have people share their experiences. But I think it also reflects how much people feel that there is go-to change and improvement Drive to share the story, to try and change Yeah. 

Speaker 1: Because there's so much pressure And you think about when you're trying to do anti-natal education and everyone's full of the joy of the birth to be, and then you've kind of got the birth and everyone's on an oxytocin high And you've got the postnatal period, where people are around But there's so much expectation on the role of being a mother and what you should do, and especially if you've got, shall we say, contentious relationships with other females in your family who give their own toughness worth and put a lot of pressure on expectation And even society. Now, with social media and that kind of support, did that make a comment as an influence and make a difference to how people were feeling? Fantastic questions. 

Speaker 2: And you've already pulled on so many of the important threads So you might be familiar that grounded theories often have a core concept. So the core concept in our theory was shame, which to understand what was or wasn't coming out in people's story and to really define what shame was. we drew on a past grounded theory from Brené Brown from 2006. And she generated that by interviewing 215 women across the lifespan, which we generated to understanding a shame as being a very painful failure, experience of being defective and unworthy of love and belonging, or being a failure and unworthy of love and belonging. And so the past work by Brown really understood shame as being questions around who women were meant to be, how they were meant to be. But you can imagine how that plays out in motherhood, about the way you're meant to be a mother and not meeting up to those expectations, But it really had a huge influence on women's questions and whether to be as well. 

Speaker 2: So it's really not just who, what and how you're meant to be. 

Speaker 1: The weather to be at well. 

Speaker 2: So those expectations and the experiences of shame are really. They are very responsive to different cultural contexts. So it might not have just been about, yes, the role of women within this context here, but it absolutely moves across those nuances, around cultural contexts, about the role of motherhood, the ways that we might expect women to continue working roles, for example, or not continue working roles, around the ways that they wanted to be both mother and self. So I suppose the other really important thing to draw out there as well is that there are a lot of commonalities in women's origins of shame. So where shame can really generate from early in life. 

Speaker 2: So often difficult early life experiences around abuse or neglect, but also birth trauma played a really important role in that as well, because if you feel as if you've failed in the process of being pregnant so, for example, hyperemesis, if you feel literally allergic to your pregnancy it's very hard to feel as if you're getting anything right right from the start. 

Speaker 2: So there was a lot of insights in there for us relevant to practice, and we're really hoping that that will enable a real broad subset of clinicians so, yes, midwives, but even GPs, dentists, anyone who's working with people around the time of pregnancy, to hopefully be able to hear for shame in people's stories, and I think the other thing that really stood out for me was how often in practice, when someone expressed a sense of failing So, for example, i just can't do this, i'm just terrible at breastfeeding How often we respond by saying things like your baby's learning a new skill, you're learning a new skill, you're doing okay. This is going to be tricky, and that's tricky for a lot of people, which I think for us sometimes like trying to come from a place of validation what sometimes we do is minimize what she's really saying Exactly. 

Speaker 1: Yeah, that's really important. 

Speaker 1: I think one of the things that I've seen when going through and looking at the tools that we use for assessment and so the Edinburgh and the kind of quality of life, is that we're now starting to bring in the question on adverse childhood experiences and the ACEs, because we're now starting to understand that those formative years do affect us physically, but also mentally, But also those relationships that we had with our family kind of a subconscious within us, And sometimes they're the patterns that people are fighting to not become when they're actually in that position of being a parent for the first time. 

Speaker 2: That is exactly it, Or certainly first time, but I think also subsequent as well. what our theory ended up explaining was the way that women move into the conclusion that their family would be better off without them. 

Speaker 2: There was a real striking commonality in the way women express that, the consistency of the words better off without me, but also the pathway to move beyond it. But that conclusion that their family's better off without them, exactly as you just mentioned comes from such a profound place of love and care and of wanting their family to be safe and to be well. And you're right sometimes when people have experienced early in life, there's really challenging experiences within contexts and relationships where they themselves should have been safe. If they feel that they're then not living up to what they want to be as a parent and we didn't speak to nonbirth parents or dads, but I suspect, based on existing literature, there may be some commonalities there. If you feel like you can't do the right thing by the baby that you love that much, of course you can absolutely say why people might come to that conclusion. 

Speaker 1: Okay. so here's the tricky question Do we have enough support services existing to help the women who need it in a timely manner? Good question. If not, how do we change it? 

Speaker 2: Such a good question. We've got an evidence brief up on the website that sits along, so this paper was published in March, late March, and then we've put an evidence brief together to try and pull out the main practice and policy implications from the work. I think, whenever we're thinking about a sense of 10x person or x group of folks who have this particular experience of this thing, can they get the support they need at the right time? I think a really important part of the puzzle is about services. So is the right amount of service available? I think, though, what complicates it is about individual differences in what people might need, what is going to be safe for them, whether that's around cultural safety, whether that's around the reality that some people will be experiencing other things at the same time, for example, family violence. So you're going to need to make sure the service is able to hold those multitudes as well. Are they going to be able to respond adequately to the perinatal context that there's going on as well? So what we often hear and I shouldn't say often, what we sometimes hear is that when women are in generalist mental health services who are not perinatal specific, those nuances are mixed. I think that's an important part of the puzzle. I think, though, also an important part of the puzzle in terms of access, the number of steps along the way that things can get amiss. And even if the service exists, if you need to be able to book in TGP to get a mental health care plan and it costs you money to get TGP, that's a profound barrier If the clinician you try to disclose to you know, even when it's like in practice, if you're aware that someone will say A, b and C is happening, and therefore I think I need care of this amplitude. You know we all drop breadcrumbs when we're trying to make a disclosure, and I'll draw on an example from the study. 

Speaker 2: There was a woman who shared her story with us. She was in a continuity of care model and deeply loved her midwife, but she was dropping breadcrumbs about not looking forward to her baby's arrival and feeling like she just wanted to run away and hide, and those feelings of escape are quite important facts for us, and I don't at all. I'm very, very sure this midwife was doing everything within her power to provide the best care possible, but for whatever reason, on that particular day those breadcrumbs weren't picked up that thick And instead a huge amount of reassurance was provided that it's not uncommon for women to feel have been trepidation and a reflection from the midwife that she was sure, once the baby arrived, the woman would feel better And for some reason, that's absolutely on point. But the running away and hiding that need for escape was what? that breadcrumb, that was what that woman offered on that day, and what then happened was, after that breadcrumb wasn't picked up, she then went under the surface and didn't try again for a long time, and you can hear that that was an attempt in pregnancy. 

Speaker 2: It wasn't for a number of months later, when things got a lot more complicated and distressing for her, that she did eventually get help. So we and then, of course, in that context, the support services that were far more able to hold a lot of risk and crisis were needed, whereas if we picked it up back here, maybe things could have looked a bit different, than trajectory could have been changed. So I think we need support services that are, yes, accessible in a literal, not having a 10 month waitlist. I think we need support services that are right from really accessible, culturally safe, flexible peer support. 

Speaker 2: That's a really important part of any model right up the way to accessible crisis support for people who might need it, that is able to be responsive to prenatal context And that's inclusive about women's very real fears about child protection services and family court, because women who do disclose and end up with a sort of mental health history on their record will then sometimes, down the track, have that used against them in family court. 

Speaker 1: And there is a very, very fine line between that minimizing, supporting, but validating what they're feeling is true, because otherwise there is that risk of it's all in my head. I'm imagining this. It's not real And they don't want to listen, so I'm not going to talk about it. Yeah, i'm kind of delaying that seeking of help, Exactly, or sharing. 

Speaker 2: Yes, or I'm not sick enough to warrant not not people, i'm not not What is happening for me is not profound enough to warrant attention And that they're not that bad, or that it's just so shameful. You know this thing that can reinforce the shame, of course, if you're already feeling as if you're not a good enough mother, this sheer fact that you are not enjoying this thing that you're meant to enjoy and that you're finding it challenging, then feeds back into it, because here's the evidence that you're not good enough because it's not enjoyable. 

Speaker 1: Did you find that there was any crossover or any commonality with superior psychosis, because we know that happens within usually that first two weeks it's kind of a much more onset. Was there women that experienced that, that didn't go into actioning because they were picked up, or is it kind of a different, very different experience? Great question. 

Speaker 2: So you know grounded theories, all about generating theory from the data up and all that sort of stuff. So in that process I did code. if someone said I have been given X diagnosis, i had X experience. I did all of that And I coded across, you know, whether that was therefore an experience in pregnancy, a past experience, you know, all those huge matrix, kind of coding stuff. It didn't appear to make any difference. And we had people with experiences of psychosis inside and outside the perimetal period, experiences of, you know, being given labels like an abortal and personality, bipolar depression, anxiety, everything. And there was this striking for human experience within it that suggests what is special about the way sort of fidelity evolves at this time is actually the perinatal bit. Right, because it is, it makes perfect sense. But if it's occurring in the context of pregnancy or a young baby, that would look different to it occurring at a different life stage. 

Speaker 1: So much that we still need to know. There's so much that we need to do better with expectations, but sitting and talking and listening, and not expecting everything from anyone, but also knowing that everyone experiences something very different. Their journey is very different, totally. 

Speaker 2: And I think the thing, if you'd asked me before I got into, you know, doing that analysis, and we implemented a lot of things to help keep the study team well, particularly given we actually we never came together face to face This incredible group of people who did this study. we've still never been in the same room together. Melbourne lockdown has got in the way of that. But you are the world world. 

Speaker 2: Yes, not just at boarding grounds and things, apparently, but we implemented a lot of things around our mental health And I'd sort of done some anticipation of what I thought was going to be difficult in being the person leading that analysis and being in that data for so long. But there was profound hope in it And very similar to the conversation that I had with that woman years ago when she was sitting in a car in the rain and about that particular helpline staff member that changed her life. There were so many stories amongst people who spoke about how they made sense of their experiences And then what made that difference, and I coded those moments where they said this was where it was changed And when I often use when I'm presenting at conferences or sharing with health professionals just to demonstrate that it isn't. It is not as complicated as we think. 

Speaker 2: One woman reflected that she had met a particular lactation consultant while she was in a hospital, was then back at that facility because she needed some quite urgent mental health support, and the lactation consultant saw her and stopped and said ah, so sorry, i just I love it to see you. 

Speaker 2: How is your baby going, are you doing? I haven't seen you for a couple of weeks And the woman recalled that this moment of this lactation consultant remembering her, stopping, validating her worth as a human by stopping to probably just a couple of minutes, but that in that time for her was the proof that she was worth something And that this person believed that she could be a mum who was more than good enough for this baby And, in her pathway beyond that, feeling that her family would be better off without her. That was that moment of change And I think it reminds us. I hope, i hope anyone listening to this thinks there's actually a lot that they can do within their practice that can demonstrate and hopefully start to build the evidence that women are so important and they do have worth as people and they are worthy of our time and our care. 

Speaker 1: So, with all that you've learned so far in these studies, what's kind of one take-home message that you want to leave listeners with? Oh it could be lots, yeah, there could be lots, and they can come and contact you, they can get involved, they can connect with you on Twitter, read your papers and start a conversation that way. What's one thing that you really want to get across to people? 

Speaker 2: I think it's probably that midwives have really profound potential to change these trajectories and that they already have everything that they need to be incredible in their hearts and in their hands. Actually, i see the second part of this is that I think to enable midwives to do this work, one of my other great loves, and if anyone can be bothered reading the paper, it's within there as well. We sort of say as much as dehumanising or experiences of care were unfortunately common and they did act as evidence for women that they were worthless, because if they were being treated as if they were worthless, of course, unfortunately, that can then reinforce that, and experiences of compassion and rehumanising care, just as that lactation consultant demonstrated, can make a huge difference. But we think systems that are stress underfunded are really pushing clinicians mental health and capacity to even give themselves compassion much less anyone else. It is unfair to continue to say to them you need to do more with less, more quickly, and for the narrative around their practice to be not good enough, not quick enough. Hurry up, and did you know you made an error over here. 

Speaker 2: So what I would want to say is you know, coming from that unconditional quality of regard, midwives are phenomenal and you can do so much to change these trajectories, and I know midwives do want to fix exactly as we were talking about before, to listen with their whole hearts and to be really present. But please also know that there is. You are deserving also, as those clinicians, of a space that would enable you to practice in the way that you want and to bring all of your skills into that practice. So I think they're the two things that we need to hold as we go forward, trying to work out what the response to this is. 

Speaker 2: Because I'm not sure if you're familiar with that, liz, but as an example, there's a Melbourne research, alizabeth McClendon, who's done some work looking at female practitioners, lived experiences of family violence at a particular Melbourne health service and female domino workforce. They have far greater lived experience of gender-based violence than general population. So we've got a workforce who has a lot of lived experience themselves to bring to their practice around things like mental health and family violence. So that's actually a great driver of empathy and the research also suggests that those clinicians are more confident and feel more able to respond to families that they're caring for within those contexts. But I really believe midwives are the answer, but I believe it's properly enabled midwives, midwives that are showing the love that they need to do that work. 

Speaker 1: And there lies the big issue in the current health care system. Yes, thank you so much for your time. 

Speaker 2: Such a pleasure. Thank you for dealing with my rambling. I hope it's resonated for you and for people who might be listening. 

Speaker 1: Definitely. Thank you for joining us today. You'll find all the links on Twitter, instagram and on the podcast website. If you are a midwife and you would like to share your research, your postgraduate studies or even the quality improvement projects you are doing now, then email me through thepinard at gmailcom, send me a tweet or send me a DM.