thru the pinard Podcast
a conversational podcast with @Academic_Liz with midwives & other birth professionals about their studies/ research & how it's changing our practice globally - email thruthepinard@gmail.com
thru the pinard Podcast
Ep 78 Kate Buchanan on Compassionate Care and Women-Centered Ethics framework
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Ep 78 (ibit.ly/Re5V) Kate Buchanan on Compassionate Care and Women-Centered Ethics framework
@PhDMidwives #MidTwitter #research #midwifery @EdithCowanUni @world_midwives @MidwivesRCM #phdlife #ethics @IresonDeb @Dr_Bayes @sagefemmeclare @LizNewnham
Research link - ibit.ly/mDaF1
Unlock the secrets to balancing a thriving midwifery career and academic excellence as we chat with Kate Buchanan, a midwife and researcher. Discover the pivotal moments from her teenage years, ignited by a transformative book on women's health, to her hands-on training at King Edward Memorial Hospital. Kate’s journey through the midwifery group practice and her culturally respectful work with First Nations women in Kalgoorlie provides an intimate look at the impact of compassionate care. As she transitions into academia, Kate’s passion for teaching and research shines, offering valuable lessons for anyone aiming to make a difference in this field.
Dive into the intricate path to a PhD in midwifery, where Kate shares insider tips on navigating the academic maze. From selecting the right supervisors in a niche field to balancing full-time lecturing while pursuing a PhD, Kate’s strategic advice is a treasure trove for aspiring scholars. We tackle the ethical considerations that underpin midwifery research, emphasizing the perseverance required to achieve success. Kate’s insights on applying for scholarships and the philosophical nature of some research projects will resonate with those who are equally passionate about advancing their careers and contributing to the field.
Explore the ethical landscape of midwifery through Kate’s introduction of the Women-Centered Ethics framework. Learn about the radical desires of women seeking physiological births in a culture dominated by private obstetric care and the importance of transparent information sharing between women and their healthcare providers. Kate reveals how midwives with PhDs can break free from traditional roles, engaging in both clinical and research positions that offer rewarding opportunities to impact patient care directly. This episode promises to inspire and inform anyone interested in the intersection of midwifery, ethics, and academic growth.
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From Midwifery to Academia
Speaker 1Thank you very much for joining me, as per usual. Can you introduce yourself, please?
Speaker 2Oh, hi Liz. I'm Kate Buchanan and I am a midwife and researcher.
Speaker 1So how did you become a midwife?
Speaker 2Well no it's funny because I felt like I maybe wanted to become a midwife. When I was a teenager, I read a very liberating book about women's processes I guess you could call it and I think it was really quite an emancipatory book. Because I felt at that point I wanted a home birth, when I was you know of childbearing years, and I thought, yeah, midwife would be the way to kind of be in this space. That and I think I had these inklings early on, that it was a feminist space and that I think, was yeah when the ideas first came to myself. And then, yeah, I did the usual route uni to become a nurse. Um, well, that's not the usual route for everyone of course, that was for a long time.
Speaker 2Yes, yeah, yeah. So I became a nurse in I think must be 94 and worked at freo hospital, went overseas and nursed in london and scotland and that was incredible. And then came home after my um year of travel in europe and, yeah, was the last group actually to go through as hospital-based trained at King Edward Memorial Hospital in 99, graduating I think beginning of 2000. Yeah, that's right. Yeah, so that was my midwifery journey. How I got there? And it was a year-long hospital-based training program.
Speaker 1So where did you work? Did you stay there for a while or did you, kind, of, like work, change places?
Speaker 2I worked at King Eddie's for a couple of years and ended up in the midwifery group practice, which was brilliant. So we had, um, it was called teams then. So we had, you know, a group of six of us in a new team. They formed, um, it was actually driven by myself because I asked in the graduate year whether we could um, after six months of uh, because it's a tertiary setting, we get a lot of experience, um, really quickly, and I cheekily asked could we in fact go on to the teams as graduates? Because, um, you know, we had all this new theoretical knowledge and I really wanted to consolidate normal because obviously we were dealing with a lot of abnormal. And so, um, they actually allowed us in the second half a few of us in the second half of our graduate program to jump into a team and they created a whole new graduate team.
Speaker 2So it's this young kind of rookie team called the aqua team and um, we, yeah, because we probably were a bit mermaidish and water babies and um, anyway, we, yeah, we, we did team midwifery for a while and that was incredible. So, yeah, got to consolidate all of those norms and then I moved up to Kalgoorlie actually and got a job in academia. I got a job working. There was a Kalgoorlie-based Curtin University and it was called Centre for Regional Education, I think. Back then, I mean, it doesn't exist anymore, but I was brought in to teach the final years, which included a maternity element, and that was, yeah, the beginning of my journey where I was thinking, yeah, this teaching is brilliant.
Speaker 1I loved it.
Speaker 2It was you know inspiring and interesting because you got to read a whole heap as you prepared lectures and you know all of that and, of course, I was working casually as a midwife, so I was doing the two jobs. Um, that was an incredible experience working up there in Calgouli because, um, yeah, I got to work with First Nations women and I got to understand a fair bit about their traditional ways of knowing and, um, I felt really privileged to have worked up there. You know, we did incredible things like threw down a sheet outside and conducted antenatal clinic that way, you know. So we were trying to be although the term back then wasn't culturally safe, but I think we were trying our best to practice, in ways that you know, that First Nations women felt safe to come to clinic and respectful of their ways yeah, so that was.
Speaker 2That was some good years up there and um, I I did a uh so like a post-grad in adult learning and teaching or whatever it was called at the time, and um exited that after four units because I had my babies then. So I had I had um home births up there with some incredible midwives who were just you know who I worked with at the hospital and um at the time we didn't it wasn't really any formally endorsed programs or you know um, I'm not sure how midwives are practicing um privately in the city, but these guys weren't theoretically practicing privately, but for me they um came to my home for my births. So that was, yeah, incredible experiences up in and formative experiences up in Kalgoorlie. So, yeah, we were there for five years, back for a year or so to Perth and again for a couple of years. So, yeah, so I was basically teaching antenatal classes after I had my kids and, yeah, then I moved back to Perth and again was teaching antenatal classes with the community midwifery group and that's when I started thinking about going back into academia.
Speaker 2And, yeah, a friend of mine was working at Ithacown University and recommended me to jump in and start teaching actually the cultural safety unit there, because of her and I both worked in Kalgoorlie together and we had those experiences. So yeah, that's how I got into academia again in Perth and that is how I got into building my PhD. Because at the end of the day Edith Cowan Uni said if you want to be teaching, you really need your PhD. And so we both started our PhD. My friend started it a bit before me, but essentially they had created this pathway at Edith Cowan where it was called the Integrated PhD and you could get into your PhD through experience as well as you know some forms of postgraduate studies, so not your traditional pathway of either honours or masters. So it kind of you were on merit where it was decided whether, um, you would be able to get in through this integrated pathway and it was kind of a stepped approach to the phd. Had you heard about it before?
Pathways to Midwifery PhD Success
Speaker 2no, this is a new one to me so, um, yeah, I mean I hope to be describing it correctly, but my understanding is that, yeah, the what my experience of it was was that the first year, as you were preparing for confirmation of candidature, you were doing basically master's research coursework. Okay, yeah, so through that process of the year, um the unit, through those units where you were learning about research, you were also and your assignments were all about developing your confirmation of candidature proposal. So, yeah, that's the integrated pathway and it's a little stricter now. I believe you do have to have a Masters of some sort usually coursework to get into it, but at the time it was was, honestly, I probably never would have thought of a PhD if it had not been offered to me like it was. It was a really brilliant pathway, um, to go into a PhD, and so, um, yeah, for me that was perfect. It made a lot of sense and, yeah, so I had I guess my qualifications going into that were just post-grad in education.
Speaker 2I also had a grad diploma in counselling, which I had picked up through I've just recognised as part of the role of the midwife. You not only are giving a lot of information and education and you know sharing it in a way that is, um, you know, inspiratory, I guess. But also, you're spending a lot of time debriefing counseling yes, you're caring for that socio-emotional, psychological parts of a birth person. So, yeah, that for me, getting that, um, yeah, counseling call was really beneficial and, um, yeah, I think, with those two and then experience, um, I was, yeah, accepted into the integrated course. So, integrated PhD I loved it and I think it's a great way of getting midwives into PhDs and that's what we do is we need to look at the multiple pathways, not only afterwards, but also of getting people in.
Speaker 1So how did you go about choosing your supervisors then? Were they allocated to you once you'd worked out a topic, or did you find the supervisors and then work out a topic?
Speaker 2We found supervisors first, and I don't know if that's because midwifery, it's often a small pool of people who can supervise, yeah. So, um, professor bays, who at the time, yeah, she was maybe the only primary supervisor, and um, so I'm just trying to think who was on my team initially, because I had six supervisors over the course of my PhD.
Speaker 2Yep, I can appreciate that yep and honestly, just through retirement, through people leaving the uni, through all sorts of things. So, yeah, so I had, yeah, definitely Sarah to begin with, and unfortunately then she left to ACU in another state after I got confirmation of candidature and then I think, yeah, deb Ariason, she was put on board so that you know she was learning to become a primary supervisor.
Speaker 2And then the third supervisor I chose once I had chosen my topic and of course choosing a topic was really hard I was just like there was so many things and, um, yeah, I don't know if other people float around in that space for a long time, but I certainly floated around in that space going what, what, what, what, what, what should I do? It's also broad and I think for me, in the end, most people funnel down to a topic, so they start broad and do come down to a tiny pinpoint, a small gap in the literature. But for me, I looked at, I guess, all the problems that I felt from my point of view, what was going on in the system, which was basically oppression of women. I then went up, so I went forward and that's where I landed with, oh, ethics, you know, actually that's guiding all of our practice. Let's, let's look at what's going on up there.
Speaker 2Yes, I, so my PhD became really philosophical, theoretical, um, you know, didn't seem practical, although maybe I can explain later how it could be. Um, but yeah, it was. I really have floundered around as well in that whole space in the background, trying to dissect the ethical theory. That was really hard too. So, anyway, but on a joy, because actually that really interests me. You know, all of that really, really interests me. So it was good learnings, yeah.
Speaker 1So how did you then structure it? With kind of working, were you able to buy out some of your time, or were you just as a lecturer, and this was done on the side, part-time as well?
Speaker 2yeah exactly.
Speaker 2I was working sessionally to begin with. I ended up working full-time as a lecturer, but to begin with I was sessional lecturer. I was doing my PhD, yeah, on my own time. I didn't ever go for a scholarship because I didn't feel I, I didn't actually want to take that money from somebody who might have meant a bit more than me and so I felt, no, I'm okay actually, um, yeah, through our time in Kalgoorlie and all the rest of it, james is in um as a geologist. So I was kind of like, yeah, I. But now in hindsight I can see actually some of the benefits. I would encourage everyone to just go for a scholarship, because there are different reasons why you might need a scholarship, not just financial. So that that was, yeah, just a choice I made at that time the dedicated time of a scholarship, of having that three-year period.
Speaker 1If you're doing it full-time is is can be an advantage for a lot of people if they need to get it done and they can still do a couple of bits of working.
Speaker 2But if you're trying to juggle that working full-time with the PhD, sometimes it it causes people to drop out yeah, yeah, so, um, so I was working sessionally and then it must have been after about a year I got a um part-time gig at University of Notre Dame in Fremantle, which was, yeah, fabulous, loved that, and then that went to full time. So I ended up doing, yeah, my PhD. It felt like both full time. It gets to a point where you're wanting to finish it and you're, yeah, you are working on it a lot.
Speaker 2And I think that's where probably a lot of your people have said that they're just getting up early, getting it done in the mornings, getting it done in the evenings yeah, the 5 am starts, and that's just one way of doing it and it does work. You know, little chunks morning and evening absolutely works. But, of course, your work as a midwifery lecturer all contributes to your thinking, to your deep thoughts. You know, as you're trying to share these, you know knowledge with midwifery students, yeah, you're actually, yeah, thinking about it in different ways and so I think it all does tie in brilliantly if you are lecturing midwifery and doing your PhD.
Speaker 1yeah, it all helps each other everything you read kind of like goes oh, I could share this and I could kind of like add that to the topic. And on the subject. So how did you kind of keep your sanity during all of those days of kind of like trying to make sense of what you're reading and then trying to do a workload and then having a family? How was your balancing? Honestly don't know, honestly don't know, it's all right.
Speaker 2There's a common answer. Don't know. You really just have to have a massive determination. That is all I can say. Determination is something that just absolutely drives you and I think you do feel like there's a higher purpose for it to be honest, and there has to be, there has to be a higher reason why you would do your PhD, and I think midwives get that.
Speaker 2I think you know, if it was a topic like you know, maths, equations or something in a totally nother field, you might flounder about and go why, or something in a totally not a field, you might flounder about and go why, you know whereas for us guys, I think, yeah, we do it for really deep reasons. You know we are wanting to. I guess it's some sort of change in the system, or for women, or for, you know, families, or for our future, or you know even more higher order, thinking about reducing violence in our world. You know it's just everything. Everything is you can't. You could almost find it all being rooted and grounded in how a person is brought into the world and how the woman was treated through that and how her partner observed that. I mean, it's so's. So. I think, yeah, determination and understanding that you. It's a small drop in a pond probably, but it could also be a butterfly effect yeah, oh yes, very much so.
Speaker 1so one of the questions that I ask is, thinking back to your phd, what is something that surprised you in the process of doing it or in the results? Gosh, that still resonates now.
Speaker 2Yeah, what surprised me. I mean.
Speaker 1Or what did you get a kick out of? Kind of like going yes, I'm right or no, I wasn't right.
Speaker 2I think, yes, okay. Well, what I took away from it was that women have as much embodied knowledge and understanding of all of this. You know women who are in that birth activist space. So my participants, for example, who became my community action research group, they were as knowledgeable as midwives in many ways, because they got it. They understood why change needs to happen. They could see clearly, I guess, how some of the oppression happens in the system, why it happens from a feminist perspective. You know, they were right there.
Speaker 2I didn't ever have to do any explaining around that. You know, as soon as my letter went out, which you know, in the background section, so the participant information letter, we're just explaining look, this is it. This is the topic. It's about ethics in an maternity system. Obviously, the participants that contacted me had some thinking around this and so they were right there, they were right, you know, right there in it all. So they fully got everything, all the questions I asked, and then together we did the research. You know, because it was a participatory action research, a feminist participatory action research. So, yeah, the consumers were, or the participants, or, yeah, the, the women that walked alongside me through this journey, they, they, they got it and they were fired up about it.
Speaker 1You know it was great, yeah, so what type of things fired them up?
Speaker 2I think you know they really wanted to see change happening. And, um, what fires you up is the frustration, I guess, that change of a system isn't happening very quickly. You know, all of us in the know would love to see midwifery, continuity of care for every single woman. You know, even despite this, fragmented systems that are occurring, you know it would be so easy to implement, it would be so even if other women didn't know they needed it, if it was just offered to every woman, the change that could occur. So, so, I think that fired them up and it frustrated them because I guess, in many ways, they had probably wanted to see a lot more change happen off the back of being involved in this action research.
Speaker 2But, yeah, how do you cripple a system? I don't know, how do you bring it down and then recreate it, or do you? You know, I guess, as people have said, you know, the system's working perfectly well. Actually, for some people, um, but for women and birth people who have, um, yeah, different perspective, it's not working well, or a different philosophical stance, or a different theoretical lens or a different way of seeing the world. They don't think it's working well and so, yeah, I think they would have liked to have seen more change, but realizing that change, oh well, that was one of the. Yeah, that was probably one. And action is even the transformation that happens in yourself through the process, and that's something that I certainly experienced through the process of the feminist PhD, and I know that the other women that I spoke with during you know that I journeyed with in the community action research group also had transformations through this research. So the individual can be as powerful as the collective action. Um, but yeah, if you look, at it just on face value.
Speaker 2Making change is really, really hard, um, but we had high hopes and high dreams about it.
Speaker 1But I mean your time frame of when you want and expect change is really important too, because you're going through multiple systems, but you're also going through multiple kind of people with their own priorities and unfortunately in Australia, healthcare is very much governed and controlled by the election cycle yeah yeah. So you've got election and politicians who mostly want to have success and changes within a three-year period, and we're talking at changes that are going to be longer and intergenerational.
Speaker 2Yeah, yeah, that's it, yeah. So, yeah, they were probably our challenges and, yeah, our surprises as well. Yeah, so, that's it.
Speaker 1Did anything disappoint you in doing your study and or in the results?
Reflections on Midwifery and Feminist Research
Speaker 2gosh, yeah, with the findings I it. I guess it was quite hard going through the analysis phase like that. Really, I've again kind of got had, took a while, a while to get my head around analysis and I eventually created an infograph on the different types of coding, because this is the interesting thing about qualitative research we understand thematic analysis. We understand different research, designs have different analysis. So the difference between grounded theory, phenomenology, rational research. But I ended up just getting this book on coding, just neat coding. I think that was probably one of the most helpful things to understand, just breaking it down into coding, to get to those things.
Speaker 2So, yeah, that was a tricky stage and it was, I felt, I guess, not disappointed, but jumped, I felt like I knew the answers but I couldn't know the answers. You have to just go right right, right, right back and just do it from teeny weeny increments. And then, of course, that talks into the importance of having reflexivity, because you get it that it is so, um, that your own lens is coming in in qualitative research, and especially if you're a feminist researcher, especially if you're, um, if you've got really strong and possibly radical feminist views on what's going on, and so, um, yeah, just trying to ensure, um, that reflexivity was probably, yeah, one of those, yeah, difficult areas where I, I guess I was disappointed that I couldn't just go, but this is it we need the map of how you got there yes, we need the map of how I got there.
Speaker 2And, um, yeah, no, that was good. And you know, one of the surprising things, um, about one of the findings was that, you know, and it really challenged my beliefs around midwifery, continuity of care and, and, of course, the majority of what the women said in all the participants was, you know, continuity of midwifery care absolutely was where we all need to go. And you know one story a woman shared that she actually switched private practitioners so unusual, and it was because her husband had felt that the midwife didn't respond quickly enough in the antenatal period, the labouring period, early labour, Sorry, that's what I was trying to say early labour, labouring period early labour sorry is what I was trying to say, early labour and you know you can as midwives, you understand how long labour is and you know you get that it's that early labour could go on for days or whatever.
Speaker 2You know you're back and forth with the woman or whatever needs to happen.
Speaker 2And that was such a break of trust for him that you know they had to switch midwives for the second child and you know it was interesting, the woman explaining the grieving process actually of having to choose another midwife. Yeah, because again, we understand that relationship and how important and deep that relationship goes. And um, in continuity, and yeah, and just how difficult it was for her to, you know, have to do that because for her family it was the better choice as a collective, as a family, and so on. So that was one of the really surprising results I got. And um, you know, and it was a lesson for us as well, I guess you know, rather than my whole PhD being pro midwifery, midwifery, midwifery, continuity, continuity.
Speaker 2It was a, it was an important result for us to understand as well that there is still a power and differential between us and the woman and we need to be responsive, attentive, you know, those little nuances we still need to be holding on to because trust is so important. Yeah, during that process. Yeah, it's not a roundabout way to answer that question. No, no, no, no that's cool.
Speaker 1No, it's valuable, but it is that, and especially when you're talking about ethics, because ethics is so broad and can can be considered into not only ethical behavior but ethical understanding, and much broader than the philosophical of ethics as well and, you could argue, is. But once again it comes under, as you said, that community or that partnership within that relationship of what was stronger for them and right for them, when you think, well, actually it should be her decision on what she kind of if she doesn't want to, but then it's like she has to live with him and that family unit.
Speaker 2So, yeah, the choices you make with that are not always easily understood yeah, that's brilliant and that's actually was my central finding in the end was um radical desires, individuals, values and context, and what essentially that means is um that the woman is the final decider on what's right for her. Yeah, which is exactly what you just said.
Speaker 1Yeah, which works, yeah, well in austral Australia, but doesn't work well with all cultures that live in Australia.
Speaker 2Yeah, that's another thing. And yeah, I didn't have any participants who were from a different culture because, of course, the majority of women also my participant group was women who had had home births and, of course, as other studies have demonstrated, because I did have to justify that during my oral exam. You know why. Why was it these, you know, highly educated, middle-income women who were Yorta participants. They all looked, you know the same, and that is the truth. They are the women who are navigating toward um, home birth and midwifery, continuity of care, endorsed midwifery, because they've had the opportunity and the privilege to read about why it might be beneficial. Um, yeah, so I I didn't have the opportunity to talk to women from other cultures. Um, yeah, so that? Yeah, that would create a whole different. Yeah, lens, wouldn't it to be a good postdoc?
Speaker 1a great postdoc to do or get another student to kind of lead on and follow on from you in the future yeah, that intersectionality is really quite interesting to explore.
Speaker 1But yeah, we look at midwifery services in Australia and supposedly everyone has access to everything. But we know reality that's not true, that there is limited access to those who can afford the home birth and that that restricts it even more until the system changes, until more people kind of get there, and then once again we're still limited by a lot of things, even though a lot of women who may have come as migrants may have experienced home birth in their own countries and it'd be like I'd like to do it again, but they physically can't access it because the MGPs are too full or it's not being offered in their area.
Speaker 2Yeah, that's right. Yeah, so that would be in a special shock, probably for New Zealand women coming across. I've had one or two speak with me about that exact thing. How can the systems be so different?
Speaker 1Yeah, one of my students were talking this week and she said she had an African lady that she was looking after who'd had five home births. And they came to Australia and A they weren't sure if they were going to make it to the hospital in time, but they had to navigate the system to actually have a hospital birth and they had no knowledge of that at all because it wasn't their normal. Their normal was a home birth.
Speaker 2Yeah, yeah, yeah, that's it.
Speaker 1So how did you celebrate finishing your PhD?
Speaker 2Yeah, so it's funny, it takes a little while to come down off it and out of it. To be honest, yeah, certainly yeah, we celebrated, I think, the biggest celebration. So if I submitted at the end like November of, it must have been 22?.
Speaker 2Oh goodness me, and I'm just trying to think how long have I had this? Yeah, end of 22. Then my oral exam was the February of 23, yeah, and then by the time you get the end of that semester, so you kind of get you know, oh no, sorry, sorry. After that you've passed your oral exam, you get a letter saying, yeah, you've finished now, yeah, and you're just like, oh, that's great. And then, yeah, it's, it's really. It doesn't feel real.
Speaker 2I think it felt real the September, which was the graduation ceremony.
Speaker 2Yeah, when I was walking along that um, whatever it's called stage, um, and getting that doctorate, I I honestly the photos are just hilarious because I am smiling so broadly and just I look at them and I can capture that moment because I'm just like this is nuts. So I think that was the biggest celebration. And then, yeah, the celebration with, you know colleagues at the after drinks. And then, yeah, just wandering around the city in my cape and I, just we went for a drink afterwards somewhere else. It was just so fun, it was a real celebration and I'm so glad I I did go to that graduation ceremony because, um, I was meant to be away with another girlfriend's 50th weekend away and I just had to say, look, you know, and it was my husband who said you know it, it will be worth it going, and also the kids seeing you and seeing that pomp and ceremony, because you know, half the time I don't think they ever knew what I was doing. I was locked up in my study at 5am.
Speaker 2I mean Sterling, my youngest was quite little when, like he was, I don't know 10 or 8 or something and um, he, you know, used to come in in the morning and just sit on my lap and and, yeah, just, it was nice because I could still capture that age where he was still little, as opposed to now he's 14 and, oh god, he'd never, doesn't even want to hug. But yeah, it was nice because a lot of those early times, um, and I said it, I was just reading my um acknowledgements just there now before I jumped on to this zoom meeting and I said it was funny because sterling said to me at one point, when I was getting, you know, frustrated about something or other, on on the tapping away, and he goes mom, practice your birth breathing nice nice, funny coming from.
Speaker 2So you know it's interesting how you want to instill in your kids, yeah, some ideas around, some of the ideas you have, like as in the parent paths around you know the world, and it was just great to hear that, yeah, some of it maybe does sink in, even though they don't acknowledge that it's sinking in, but, yeah, it comes out in different ways. So, um, yeah, no, that was, that was a celebration. The graduation definitely and absolutely it's worth going to your graduation, because I know some people don't, because, you know, maybe it's a little bit of a trauma response. I hate to say it.
Speaker 1For some people it is yeah.
Speaker 2You know it's a really, it is a really tough journey. I mean people used to say to me oh, how do you do it like you know, working full-time kids, phd um, you just I, you just get into a zone. You really just have to get into the weird zone and I'm sure I was probably very short-tempered with with the people around me at different times, but and then you feel really liberated when you come out the other end. You do feel so free and you know and everything. But you also feel so proud, like so proud, that you've achieved this massive um hurdle and that your findings hopefully will, yeah, transfer to something so you said earlier that you will talk later about the practical aspect of your phd.
Speaker 1So what did you mean by that?
Speaker 2Well, I came up with an ethical framework, so it was based on care ethics and it's, you know, this idea that there's more to life than bioethics. So the bioethical principles for health are set in concrete and they're great foundations, you know. It makes a lot of sense, built from you know, many hundreds of years of theory, kind of coined and put together all of these philosophies and ideas by you know two authors, and it's kind of been set in concrete from that point. And then, you know, around the early 80s there were some feminist ideas that challenged, you know, those ethical principles as being a little bit patriarchal, a little bit top-down, a little bit authoritarian.
Women-Centered Ethics
Speaker 2And so out of that was born care ethics, which was, you know, really focusing on the idea that there's more to practicing ethics and it was things like based in relationship, being more attentive, being more responsive, and that's, you know, some really important works. And so I started off in my PhD the background, giving all of that kind of ethical philosophy broadly, and then narrowed it down to care ethics and did a scoping review on what are the elements of care ethics, because that hadn't really been framed up before, and so once I had that, I kind of then did a template analysis of some initial focus groups with the community action research group and I was able to match actually well what midwifery continuity of care does, or I called it at the time midwifery led care, because that's what other authors at the time were using, but I think the term it's better to use midwifery continuity of care. Now. I was able to match that.
Speaker 2Yeah, hang on, midwives are actually practicing care ethics and then collected more data and then came up with the themes that I came up with and, as I say, it was centered around the individual. So, calling it radical desires, because it was kind of that play on words that women had these desires for a normal, for normal physiology, or just let's not call it normal, sorry, let's just call it physiology. And, um, you know, even without being, you know, really or not understanding the link between midwifery and physiology, so you, a lot of literature has said that women ideally, first time around, would have preferred normal sorry, just physiological birth.
Speaker 1Yeah, thank you.
Speaker 2And anyway. So the radical being that there's this idea in women that we might want for something that's countercultural to our society now, which is, you know, you get a private obstetrician. Well, that's what the culture is currently here in Perth I can't talk for anywhere else. And so having a private obstetrician and walking into the hospital, that's all what is considered now culturally normal. And then for anybody who wants anything outside that, having this radical desire but it's not necessarily saying that, um, they'll get that either it's just this desire that they would want this care to be relational based.
Speaker 2And then my sub themes were, yeah, having this harmonized relationship, and I actually kind of juxtaposed the two, because women couldn't talk to me about ethics or ethical care without telling what when it was unethical. So there was always this black and white of ethical and unethical. So I set it up that, um, there would be this um that women would were saying that harmonized relationships, so meaning that the woman and the midwife are in this harmony of sharing similar philosophical views about birth, or having this deep and knowing and trusting relationship. Or else the counterpart was uneasy alliance, which, again, I didn't call it relationship, because a lot of the women feel uneasy in these unknown relationships with these multiple and different health providers. So I called it alliance instead of relationship, because they had to work with the health provider, but that health provider was changing all the time, so it gave them a sense of unease.
Speaker 2And then, um, another key thing, that um or sub theme that came out was that, um, women either felt that it was ethical when there was this transparent sharing of information and I called it transparent wisdom because it was an acknowledgement again of women's ways of knowing, but also of the way midwives are just pouring information across, you know, to equalise power and then the counter of that was opaque information.
Speaker 2So it was this idea that there was a lot of information hidden from women, and the women felt that was unethical and the Community Action Research Group were really vocal about, you know, wanting to make other women aware that there's all this information out there that could make a massive difference to their pregnancy and birth journeys.
Speaker 2And then the final one was this idea around, and the sub-theme was called midwifery solidarity, which is the idea that the midwife is advocating that we have a unique set of skills that other professions don't have and and that again it's around, you know, strengthening women's capabilities through everything we do, as opposed to the flip side being I coined it saving women from themselves, and it was this idea that some health providers felt that that's exactly what they were doing saving their baby and the woman from themselves, or their ideas, or the idea of physiological birth. So yeah, so from all of those findings, I then created this framework Women-Centered Ethics and it basically steps out a way of being so, rather than applying a code of ethics top down onto midwifery, it's actually just capturing in ourselves like an embodied way of being and doing ethics, and I think most midwives I know I shouldn't generalize, I was just going to say in my opinion, most midwives are practicing in this way so yeah, so, um, and so, yeah, after I, oh, then I, yes.
Speaker 2So, in terms of the practical, I mean, how do you get that out? How do you get any research findings out to the practical world? Well, I've found another way, which is I'm doing a heap of research at the moment in my new role as postdoctoral research fellow. But, um, we're doing a lot of implementation science and that is, you know, researching while doing, and that's great because we've got um, both um, professor sarah and I have honorary positions with the fiona stanley hospital and so we can, yeah, we can do this, work that way, but at the time, yeah, and for most of us, if we're not in those positions, how do we get the findings out? And I think this is one of the big takeaways is presenting your findings at conferences I know you kind of hear this being said to you, but it really does work.
Speaker 2And networking I never even considered why networking would be important and I've only just figured that out through going to the International Confederation Midwives Conference and presenting there. Yes, it was so great and it is a bit hard for an introvert to do this networking, but anyway, it is good and it is worth it, but exhausting and um anyway. So after that presenting my findings um the mandy from the international or the icm um she's in charge of, you know um standards and codes and so on. Uh, her and I got talking and it's a long process but we're hoping that these findings will be able to.
Speaker 2And we're currently doing another research where we're asking so this was the PhD was asking women what they thought was ethical and what this next research, which I've just got ethics approval for, is asking midwives what does this? What they think is ethical, what are their ethical experiences? How do they see it? And then I'm going to present, at the end of this survey, the woman-centered ethics model and ask does this resonate you? Is this kind of how you see embodied ethics and if not, what tell me? How can we adapt it?
Speaker 1blah blah blah.
Speaker 2So then what we'd have is oh and I'm also just capturing, well, I'm just doing the analysis on midwifery students' perspective of ethics, oh, very cool. So I've triangulated all of it, hopefully by the end of the year, and this is what we can present to the ICM, because they're ready for an update, Exactly, and yeah, so that's what we're, that's how hopefully we'll get ours into the practical space.
Speaker 1So then, when the next update of the ICM International Code of Ethics comes out, the Buchanan model will be a kind of core factor within that which will be my God, I don't know if it'll be work exactly like that.
Speaker 2What I think will happen is a working group I think they call working groups you jump in, you can reference some research, but yeah, we'll, we'll figure it out together, but yeah, I don't. I don't know if I have to say it, I'm not giving a date.
Speaker 1It doesn't have to be this update, it could be a future update but then doing maybe then putting it into other countries and seeing if it translates into other countries and countries of different countries of resources, because hopefully as a philosophical statement, it should be adaptable, which is why we've now gone to the ICM and a lot of the stuff that we're going to is that global umbrella. It's not that you will do this, this and this, because that doesn't relate to different countries. So that's exciting yeah, it's.
Speaker 2It was really exciting to have those. So we've been in conversation, yeah, over these last six months and it's just a slow process, but I'm hoping that that that's how it will play out. You know, you never know.
Speaker 1I mean, as my Scottish grandfather used to say, many a slip, twix cup on the lip, which means anything can happen and I see that with a lot of your publications have been with Liz Newman as well, who is well known in this area. So kind of having some fantastic support, but also not just that support having somebody you can have some great conversations with in an area that not a lot of people are comfortable in yeah, that's so true.
Speaker 2So, yeah, she was my third supervisor, who I chose at the exact beginning and, um, she, as I said in my acknowledgements, just that, journeyed with me through the whole thing where I had then all those changes in between, who, all the supervisors were amazing but just had fragmented Yep, except Liz, and that was yeah, and the fact that she approached it, as I said in the acknowledgements, with the care, ethics, approach to life, like she really embodies it, and that was a gift because, yeah, it's just you know the kindness, the time, um, she's yeah and she's extraordinary. Her mind is extraordinary, so it is indeed.
Speaker 1So what's the? You've got lots of fingers in pies with things that are happening at the moment. Um, what is there an ultimate thing that you would like to get yourself involved in, or are you happy with all the directions that you're going at the moment?
Speaker 2yeah, I, um, yeah. So we've got these two studies on ethics and Lizzie's on the um, the international one, um, which we've got ethical approval. But I'm just trying to set up red cap. I mean, oh my goodness, that's a whole thing in itself and I've got a small grant for somebody to help me do that. But finding someone with REDCap experience is hard as well, um, anyway, so, yeah, that will be kind of my ethics research ticking along.
Speaker 2And then at Edith Cowan Uni, yeah, yeah, in this role as postdoctoral research fellow, sarah and I just work so closely together. We're in the same office so that's wonderful and we get to, yeah, bounce around great ideas and just do whatever research we so wish. But also we've got the honoree position with Fiona Stanley, so can do some great work through what they, you know, doing context analysis and understanding what they would like researched, and we help get that moving. So the debriefing space is one that we're really focused in with Fiona Stanley, yep, and we just recently published our team published a guide based on Gamble's earlier study of 2005, a midwifery student peer debriefing tool. Yep, saw that publication. Oh yeah, great.
Speaker 2So what we understood was that midwifery students are talking to each other, after difficult experiences and because of power and differentials, I guess, or they said that with academics and CFs. You know academics and cfs, you know who, all you know there's that fear about passing and you know experience, you know dropping the mask and all of that and um, and, interestingly, they didn't just want to have an ameliorating effect or getting through the process of the difficult emotions, but they also wanted to learn from it. So, yeah, we adapted through with students this tool. So, yeah, we've got that study. We're doing study two of that to role play it in class and see how we can use it in the teaching space oh, cool.
Pathways for Midwives With PhDs
Speaker 2And then, yeah, study three will be with clinical facilitators. And yeah, and then other debriefing we're looking at for midwife to midwife debriefing you know it's slightly different to what students do with each other and also, yeah, replicating in a way Gamble's original 2005 study about, yeah, the midwife's role in debriefing. So you know all of that space, because Sarah and I both have, yeah, postgrads in counselling and you know, so we've got that element to us. Yeah, so that excites me. Yeah, it's great.
Speaker 1And that's what we need. We need more of these roles where there is that clinical and that research capacity that is there. That is a pathway for midwives with phds to go into, and I think that's something that a lot of people are wanting. So if they can see it which we are getting increasingly more, um, that we will have. Once people see that and get that out there, it's like well, I don't have to stay in education, I can stay in clinical and I can still use my skills that I've got from an advanced practice point of view yeah, that's exactly right and you're right.
Speaker 2There are more research, fellow positions for midwifery coming up and are available and are around, and it's um, oh, it's a gift, it's an absolute gift to be able to do research for three years, um, and then who knows where I'll be and what I'll do after that, because it's just a three-year contract, but I'm I'm finding it. Yeah, it's wonderful excellent.
Speaker 1Thank you so much for your time. Thank you.
Speaker 2Liz and I just yeah, thank you for listening to me. I'm sorry if I've been way too radical and talked way too much no such thing.