PhD or not? is it worth it?

Does this hat suite me? there is a lovely maroon gown that goes with it....is it worth up to 5 yrs of my life???? I was recently part of the academic procession at the university graduation.... and I was really inspired and enthusiastic about doing my PhD....as I watched others receive their awards... some of them looked so young...I took this picture to place on my vision board....in an attempt to see the end result.... but then when all is said and done... reality bites ....

The burning question in my busy lifestyle is whether or not to do my PhD? I am at candidate stage and have been for over a year...but have been too busy to pick it up... I need to now make a decision.... I initially was going to do something on nursing and midwifery documentation but have since changed my focus and would do something surrounding women's choices, birth, midwifery etc....I would also like to leave a legacy... something significant that changes practice for the best...but I am not sure if it is worth it....it will take three years full time or five years part-time...

I am now 53 and wonder the value of continuing along this road....Once I commence the journey I want to complete it...but something will have to give in order for me to do it... the subject matter is something I am passionate about but the financial reward is minuscule....My current workload does not permit me to pick up this study, there are just not enough hours in the day.... as for my private life.... we have seven grandchildren and still counting...whom I adore and love to spend time with as they are young for such a short time...this would mean less time for everyone.... then there is my husband, I am sure he would support anything I choose to do even if it was standing for the opposing political party to him......Working is a must... but I can reduce the number of hours I work....


I do enjoy studying and challenging myself.... the other option is not to do my PhD and continue doing what I am currently doing and get more involved in the college.... I am not sure how I will go with that...as I don't have a challenge.....
I follow Sarah Stewarts blog and she also had this decision to make..read her PhD Dropout... it is not an easy decision.... if you wish to remain in education.....I am no closer at making this decision... it will also mean I will have to change the way I study in order to complete the PhD which is usually evening study, it will take up some of my weekend if I am to complete it in the required time frame.....

What do you think? what is the answer?

Allowing women to make their own decisions......

Here is the follow up to the Empowering women - not as easy as you think scenario

....the woman is GBS positive with query ruptured membranes....she has commenced IV antibiotics, the advice given to her by the doctor is to be induced immediately 1700hrs....as the doctor feels she will not go into labour on her own...she is currently contracting 1:10 mildly. After being given all her options by the midwife....

The woman chooses not to be induced until the morning and goes against the medical advice given (this is all clearly documented).... she does choose to stay in hospital and wait until the morning.... her hope is to go into normal labour.... the outcome of this scenario is that the woman continued to walk around, eat, drink and no monitoring, until in established labour.... she progressed into normal labour and birthed at 0739hrs that morning....an assisted birth....

This was a good outcome by a woman who knew what she wanted and was willing to standby that decision despite the advice given by the doctor....she determined the risks and made her mind up with the information given... together with what she had anticipated for her birth (her birth plan was a natural normal birth) and an induction of labour was not in that plan (as it meant, restrictive movement, monitoring) however she made the best compromise she knew how..... to achieve what she wanted..... well done... congratulations......

Anger due to cuts in private obstetricans fees

This is an interesting debate the cutting of costs for rebates in private health insurance. Previously women could claim 80 per cent of out-of-pocket obstetrics fees after reaching the safety-net threshold.
It is also interesting to see that low risk women are asked to attend local hospitals as opposed to mainstream high risk hospitals where the intervention rate is much higher. This is where we would benefit from having more birth centers, or midwives working out of hospitals within the community.
The question is will this push women to seek midwifery led care in low risk cases, as opposed to paying more to see a private obstetrician and risk the cascade of intervention..... and higher costs.
The recent newspaper article Anger over cut to obstetrics rebate discusses these issues, stating that in the current boom will we run out of beds in our hospitals.

What the article fails to mention is that midwifery led care in low risk women is a more affordable option and saves the tax payer millions of dollars.....

Valentines Day.......

February 14 Valentines Day....Wikipedia defines St Valentin's day as a day of celebrating affection between lovers....often with flowers, chocolate and cards...

What does this mean...for me its a day of celebration of love...not just couple love but family love....as a romantic at heart I love Valentines Day... we do not go overboard...usually a small gift..sometimes I get flowers...or I may send Ian a noisy animal that sings to his office.... and yes we do a romantic dinner...although this year I am so busy I didn't think we would be going for dinner...but as usual Ian came through and booked us a romantic dinner....so what happens if we have an argument...several choices.. cancel dinner... go and not talk or bite the bullet and make up and enjoy the evening...sometimes when life is so busy you just have to make the time to keep your relationship going otherwise you drift apart....and that's another reason to set the dinner date for this day...any excuse... for a good time with the person you love.

"Roses are red, my love.
Violets are blue.
Sugar is sweet, my love.
But not as sweet as you."

Here is one of our favourite songs Hold me thrill me kiss me" Gloria Estefan

Happy Valentines Day everyone..........

Private Practice Midwives and Insurance

Private practice midwives / Independent Midwives, both mean the same and are used interchangeably. Just to put some issues in perspective this is a global problem and it comes down to money. Why is it we need insurance? ... this is because we live an over-litigious society.

The current situation in the UK....there is no professional indemnity insurance available to Independent Midwives, the bottom line is that they are liable for any negligence claim made against them as is the case in Australia.
The systems are similar between Australia and the UK. Hospital midwives, and Community Midwifery Pogram are covered by the hospital and in the UK by the Trusts therefore covered by vicarious liability through the employer.

Like Australia the Royal College of Midwives (RCM) provided insurance to independent midwives until Australia 2002 and UK 1994. The RCM decided to exclude those members who practised independently from the Private Indemnity Insurance cover, in order to keep RCM premiums at an affordable level. The insurance cover was half a million pounds.....to much to cover... However the UK did still have some insurers that would cover Independent midwives, despite having good outcomes the price still increase to 20,000 pounds per year for a midwife (A$45,000 per year). In 2002 the last commercial insurer withdrew from the market because it was not commercially viable due to the small numbers of independent midwives in the UK.
The UK is considering.... Independent Midwives and Contracting to NHS Trusts....its worth a thought....

Midwives have not had access to professional indemnity (PI) insurance since 2002/03, when Australia faced a medical indemnity crisis that resulted in large premium increases.

Just to add reality to the equation here is a case of negligence that resulted in a payment of $11 million dollars.....

In November 2001 the NSW Supreme Court awarded Calandre Simpson, an infant born at St Margaret's Private Hospital with cerebral palsy, fourteen million dollars (the award was reduced on appeal to eleven million dollars) for the overdose of syntocinon, which caused her birth defects. At that time the award was twice that of the next highest payout. This payout assisted in the collapse of Australia’s largest medical indemnity organisation, United Medical Protection (UMP, now Avant) and brought with it what we know as the ‘medical indemnity crisis’.

From this crisis came the key reforms was the introduction of the Policy Support Scheme (PSS), available to obstetricians, neurosurgeons and rural procedural GP’s.
and off course midwives were not included.... I think we missed the boat here.
Now this is an interesting concept that came out of this....

‘Under the PSS, if a doctor's gross medical indemnity costs exceed 7.5 percent of his or her gross private medical income, he or she will only pay 20c in the dollar for the cost of the premium beyond that threshold limit. In other words, the PSS meets 80 percent of the premium above the 7.5 percent threshold of an eligible doctor’s gross private medical income.

Justine Caines stated....Interestingly the rights of Australian women choosing private midwifery don’t have the same value as those women choosing the services of a specialist obstetrician or a procedural G.P. When I challenged the legal branch of NSW Health with this comment I was greeted with silence.

The Australian College of Midwives continues to lobby and negotiate for possible solutions to this current problem...... so watch this space....

The picture: Laura is my friend we did our Midwifery together at Hertfordshire University.. she is now an Independent Midwife......" midwives have babies too, and I can really empathise with the women I care for now"

Spitting the dummy!

We have all had to do it.... orientation, corporation day, induction day....whatever you want to call it... what does it mean? it means spending 0800hrs to 1600hrs learning all about the organisation, and why? because they care about you? think again.... it has to do with Safety & Duty of Care of the organisation to ensure its employee's have a working knowledge of the corporation's vision, mission statement and expectations of the organisation.... Why the hell do they have to be so boring? there has to be a better way! I have to remember to be politically correct even though it is very difficult when you are spitting the dummy.

The corporate day.... I think it is good for new graduates or new health professionals, however for old hands like me it is down right time consuming, (I think certain aspects can be e-learning packages, eg, manual handling, emergency procedures, waste management, human resources) especially when as a Midwife you are not acknowledged....We did 11 sessions between 1000 - 1230 all on corporate information....it was a conveyor belt of people...

I think it is a sad reflection on our health professionals that the Health Dept has issued a Operational Directive: Hand Hygiene in Western Australian Hospitals - what is the world coming to....I remember years ago the rules were simple, no wrist watches, jewelery, false nails....we didn't have lanyards...it was a name badge and every one washed their hands...except for some of the doctors... we all wore uniforms, bare arms from the elbows down and sensible closed in shoes....now a days its almost anything goes....there was something to be said for the old fashioned matron.....So now with the new hand hygiene... its back to the old days.... Best session for me was the 'infection control'.

I have myself been responsible for conducting orientation programs, first and foremost was to get to know your audience. I have always acknowledged my nursing colleagues who were often in the minority and now I understand how it must feel if they were not acknowledged. I was amazed that there was not one mention about midwives..... There was a welcome to all the nurses and what a wonderful profession nursing is... and not that I disagree with this...There was a voice from the audience.... "I am a midwife".... there was silence from the audience... and the speaker laughed and said "yes... that must be a midwife"... "I know we have one midwife in the audience do we have any more?".... and another midwife raised her hand.... nothing further was said....

It is this culture that has to change... we now have a Nurses and Midwives Board and a Nurses and Midwives Act 2006...also from July 2010 we will have the Nursing and Midwifery Board of Australia, it is time for hospital management who employ midwives to acknowledge we exist.... because there are many midwives that are not nurses, we will soon be having the Bachelor of Science (Midwifery) graduating and they need to feel part of the team, as important as nurses. Every slide in the orientation presentation referred to nursing and did not mention midwifery or midwives. Even when discussing Basic Life Support and pregnant women there was no mention of a midwife.

It is time to acknowledge we are two separate professions who complement each other.....There are some nurses who believe that midwifery is an extension of nursing and this is not the case.... You do not have to be a nurse to be a midwife.....

Needless to say I have written several letters to the appropriate organisations to try and rectify this issue...REMEMBER IF YOU WANT SOMETHING DONE FOLLOW UP WITH A LETTER put it in writing.

I am expecting that future orientations will acknowledge Midwives and Midwifery and the slides will be changed accordingly.

Empowering women - not as easy as you think

Thoughts to ponder on!

There are times it is difficult empowering women.... there is a fine line that you walk and the only way I find to walk it is to be true to yourself, let go of your ego and just state the facts and what you see.

As any midwife knows there are always two sides to a treatment and this is where the fundamental problem arises, because you can have several responses from the woman, and you as the midwife have to know which way the woman wants to go.....and often you will sense that...

Often women only get one side of the treatment, often a paternalistic point of view. Not that a doctor consciously chooses that, it is what the doctor feels is in the best interest of the woman... now how he puts across that treatment option is often to sway or dis empower the woman to his way of thinking rather than giving the woman the complete facts and allowing her to make that decision. Now why is that?

The second option of course is that the woman does get the compete treatment option from the doctor and then says "I don't know what to do, you make the decision"? now I understand this option and I can live with this option.... it is the first option I have problems with...here is an example....

A woman comes in with a query rupture of membranes...40/40 (she is due) not a convincing history of her waters breaking...she was lying in bed, knowing she wants to go to the loo.... gets up and feels a gush of fluid but she is unsure her waters have broken.... she waits several hours.. and then calls the hospital.... she is asked to put on a sanitary pad to see if any water leaks and come in to be assessed. She arrives several hours later, her pad is slightly wet so she is asked to lay down for 20 mins to see if any water is leaking (amniotic fluid)... the woman has an assessment...the fetal position is LOA, presentation-longitudinal, position-cephalic (head down) head ?3-4/5 palpable..(a high head) and a speculum examination is performed to see if there is any water pooling.... there is none...she then has a real time scan (ultrasound) which shows reduced amniotic fluid.... and on reviewing her notes it is noted that she is GBS positive... which means she needs IV antibiotics in labour... the woman is contracting irregularly 1:10..it is now 9 hours since query rupture of membranes....and early evening... the doctor recommends induction of labour (IOL)due to GBS positive, high head, and irregular contractions..... the woman is unconvinced... but her questions are dismissed by the doctor.....when the midwife attends the woman and asks what are we doing for you this evening... the woman is hesitate about the upcoming procedure... when she is asked to explain what is going to occur...she states "the doctor wants me to have the drip"...language is very important... if you are listening to women you hear the unspoken question or the resentment....the next question needs to be... "is that what you want?" she replies " what are my options, I would prefer to wait until the morning to see if I can go into normal labour", she was asked, did you discuss this with the doctor....she said yes.... but he said this is the best option, "you will not go into labour with the baby's head so high".....I would still like to wait said the woman... the midwife discussed it with the doctor and he repeated, his reasons as already stated..... now here is where the conflict lies..... how far do you push for the woman? yes I hear you say all the way.... but how many times do you do this and then the doctor walks in and speaks to the woman and she says to him ok do it......

In this instance the midwife sat and spoke to the woman asking what did she really want and why? and gave the woman the pros and cons for having the IOL now or waiting until the morning.....presenting all the evidence including information about her GBS status & ruptured membranes including the option not to accept (refuse the treatment option) the doctors treatment option and that all this information will be documented in her progress notes. The midwife left the woman to discuss her options with her family, the woman then made the decision to wait until the morning before having the drip. The doctor was notified and the information was documented in the clients progress notes. The woman had some dinner, was happy with her decision and went walking around the hospital for the next two hours.... when she returned she was contracting every 6 minutes... and they were lasting about 45 seconds... it was great......everyone was happy..... the woman went on to labour all night and birth in the morning... it was a vacuum extraction.... there was no induction....in this instance it all worked out well.... the empowering of the woman was because she was given all the information and the woman made her own choice knowing all the risks... she just wanted to wait until the morning..... it really was not a lot to ask... she was being monitored.... that is, pulse, temperature, IV antibiotics 4/24,she did not want to go home... just wait until the morning... to have her baby the way she had planned....

Sometimes I think as a midwife you need to choose the battle.... read the woman's Birth Plan, and most importantly listen to what the woman wants......

picture ref:http://mdean.tripod.com/justice.html