Midwives
the world over use social media for a variety of reasons. Depending upon the
part of the world a midwife lives and practices in, her use of social media
might be minimal to extensive. In the United States, most people, midwives
included, are at least somewhat computer literate. However, midwives in the US
do not seem to utilize social media to the extent that their sisters in some
other countries, such as the United Kingdom, Australia and New Zealand, do. Why
is that? In this paper, we will take a look at some of the things midwives use
social media for and some of the potential problems and what might be done
about them in doing so. We will begin by answering a fairly simple question.
What
is a midwife? Historically, midwife meant “with woman.” Traditionally, for
thousands of years before hospitals came into existence or there were doctors,
midwives were birth attendants with a reputable and respected place in society.
Today, many people in the United States have never heard of a midwife and
therefore have no idea what they do. Often people think of a hippie-type woman
wearing long skirts, sporting braids, eating a vegan diet, and who may or may
not (heavy on the may not) use deodorant.*
In
the United States, most midwives fall into one of two categories which are
certified professional midwife (CPM) and certified nurse midwife (CNM). Most
states have their own midwifery organization; in Massachusetts, it is the
Massachusetts Midwives Alliance (MMA). The MMA definition of a CPM is “an
independent practitioner who has met the national standards for certification
set by the North American Registry of Midwives (NARM) and is qualified to
provide the midwifery model of care. The NARM certification process recognizes
multiple routes of entry into midwifery and includes verification of knowledge
and skills and the successful completion of both a written examination and a
skills assessment. The CPM credential requires training in out-of-hospital
births. . .CPM credentials meet or exceed licensure requirements in over half
of the United States.” A CNM is “a midwife who has a degree in nursing prior to
entering midwifery, has graduated from an ACNM Certification Council (ACC)
accredited graduate level educational program, and has passed a certification
exam. CNMs are licensed in all states, though the scope of practice may vary
from state to state.” (Massachusetts Midwives Alliance :: What is a Midwife?.
(n.d.). Massachusetts Midwives Alliance :: HOME. Retrieved March 20, 2012, from
http://massmidwives.org/for-parents/what-is-a-midwife/) These definitions are
fairly consistent with other states, however, where and how each are allowed to
practice varies from state to state. For example, in Massachusetts, a CNM may
practice in a hospital or birth center but may not do home birth while a CPM
may do home birth but may not be the primary care giver in a hospital or birth
center.
What
is a midwife? As a young friend of mine (J. McFadden, personal communication,
March 27, 2012) said, “A midwife is a woman who guides and takes care of a
family expecting. They provide prenatals, birth and postpartum care…Midwives know
birth!!!”
How
exactly do midwives and social media fit together? Midwives, having been around
for a long time, used to be the
social media. Take, for example, Martha Ballard. Martha was born in Oxford,
Massachusetts, in 1735, married Ephraim Ballard, gave birth to nine children,
and died in Hallowell, Maine, in 1812. She also attended more than 800 births
while in Maine and kept a diary for the last twenty-five years of her life. Martha
did not just attend births. When a mill burned leaving several people injured,
she was there to nurse them. When an unmarried woman gave birth, it was her job
to find out who the father was during the process of labor. When a man killed
six of his children, his wife and then himself, Martha was there to prepare the
bodies for burial and nurse one child until she died three weeks later.
Whatever was happening around Hallowell (Augusta), it is almost a sure bet that
Martha knew about it and at least some of the details.
Thousands
of years before Martha Ballard, midwives are mentioned in the Bible. When
Rachael, the wife of Jacob, was giving birth to her second son, Benjamin, a
midwife was with her and said, “Fear not; thou shalt have this son also.” Later,
when the Israelites were in Egypt, Pharaoh instructed the Hebrew midwives to,
when performing their calling upon the Hebrew women, kill the sons. Being
Hebrew, the midwives did not like this idea and did not do as instructed. When
asked about it, they said that the Hebrew women birthed their babies before the
midwives could arrive, unlike the Egyptian women. It is interesting that
midwives are mentioned at all in these accounts as the societies they lived in
were very patriarchal and women did not account for much. Typically, women are
only mentioned if they have some direct or important bearing on the story. How
likely is it that these midwives were quiet about what they did? Being
midwives, they would have been attending births, deaths, and the whole gamut of
life between. They knew what was going on.
Today,
midwives have a fairly typical, while somewhat unusual, relationship with
social media. Midwives are human and as human beings, are usually somewhat
social; they have friends and family and like to keep in contact with them.
That is increasingly easy via social networking sites such as Facebook and
Twitter. Midwives also help women give birth and in this role must provide
their clients with confidentiality. Some midwives use social media to keep in contact
with their clients and to let clients and the general
social-media-utilizing-public know about various events that are taking place.
Some midwives use social media for networking. Students of midwifery use the
internet and social media to further their education. There are many schools
and programs which offer some to almost all of their coursework online.
Let
us first take a look at education. There are several programs in the United
States which offer at least part of their coursework online. Among them are
Birthwise Midwifery School, Seattle Midwifery School which is now part of
Bastyr University, and Midwives College of Utah.
Birthwise
is located in Bridgton, Maine. They offer a Campus Program and a Community
Program. The Campus Program, as one might expect, takes place mainly on campus
at first and then ends with a preceptorship with a practicing midwife. The
Community Program involves ten two-week academic sessions on campus over the
course of two years with much online work between ending, as does the Campus
Program, with a preceptorship.
Bastyr
University is located in Kenmore, Washington. They offer many different
programs one of which is the low-residency model. Three times each quarter
there are classes on campus; the rest of the work is done in an online
classroom.
Midwives
College of Utah is located in Salt Lake City, Utah. They have a distance education
program in which students work at their own pace and schedule. For each course
they are enrolled in, they are assigned an instructor and communication is via
e-mail and/or phone. Students also work with a preceptor near where they live
in order to complete the clinical portion of the program.
These
are just three examples; there are many similar programs throughout the United
States. Each utilizes the internet and social media to some degree or other.
Midwifery students in the United States are not alone in online learning.
Across the world there are similar programs.
The
University of Plymouth, located in Plymouth, Devon, UK, in 2009 explored an
alternative to on campus teaching. They used internet broadcasting which
consisted of an instructor on campus presenting information via a webpage that
students could log onto. It was well received and thought to be able to save
both money and time by students as well as universities. It appears that they
made the decision to continue with distance education as their website
indicates they are committed to blended and distance learning.
A
study conducted in Poland in 2006 indicated that for some countries, language
may be a barrier in utilizing the internet to the full extent it could be.
Also, it appeared that younger students are more likely to consider themselves
good at using the internet as a learning tool and therefore more likely to use
it. Considering that internet usage has become easier over the ensuing years,
it seems likely that the language barrier might not be as great as this study
envisaged and that older students may well be using the internet more than
previously.
Different
midwives view the internet and social media very differently. One Massachusetts
midwife, Rebecca Corliss Beck (R. Beck, personal communication, February 1,
2012) has the following to say:
“I am one who resists or maybe is
even repelled by social media--and when I say that I mean it is not a dislike
but more so it doesn't fit who I am and I just don't gravitate towards it. That
being said, I see its benefits and see that I need to be on the ball for my
children. Also when I see other midwives reaching out, I feel like I should
more. Megan [her partner] often knows what is going on with clients, gets
invited to social events, etc., because she is on Facebook. The interesting
thing about midwifery and social media is the delicate dance of it. To be hired
by today’s savvy women, one should be out there, but I think you have to be
careful not to mix in your personal life, say Facebook or even being careful
with blogs, etc., because of confidentiality. There is something wholesome and
private and off the grid that we offer that I don't think belongs in the
cyber-world, but it is our reality. One needs to use judicious use of social media
in the case of midwifery. What we can share on line as far as resources opens
up a whole new world for our clients, which is great. But I also think that we
are held in a place where we are expected to be accountable and respectful at
all times so one must be careful.”
Another,
Joyce Kimball (J. Kimball, personal communication, February 1, 2012), said
this:
“Though I don’t tweet, I utilize
my Facebook account as a type of business marketing. So many women are curious
to hear birth stories and see birth pictures from other women. I post when a
baby is born and a bit of info about the birth. It gets homebirth out there as
an option for others. It makes it feel possible. I also post articles and blogs
that interest me on Facebook.
“I have my own website (and I am
just contracting with someone to ‘do’ and maintain my website) and I put all my
contracts, referrals, etc. on there. I hope to make it more interactive with
recent birth photos, forms that are used often, etc. Folks say they like the
pictures I have on my website so pictures will stay.”
Sarah
Stewart is an Australian midwife. She is a social networking goddess. She can
be reached via telephone or email. She has her own blog. She has Twitter,
Skype, Facebook, YouTube, SlideShare, LinkedIn, Wikieducator, Delicious, Flickr
and Second Life accounts. She believes in being out there. Sarah has
written many articles about midwives/midwifery and the internet and we will
return to her shortly.
We
will turn now to some of the issues involving midwifery and social media.
First, it is interesting to note that the Royal College of Midwifery (RCM) in
the United Kingdom has a policy unit which launched a Facebook group. The
purpose of this group was to “inform and influence the development of policy
that affects midwives, women and their families, working with policy-makers at
all levels throughout the UK and in the European Union.” That was in 2007.
Since
the RCM began their Facebook group, there have been several warnings to
midwives in the UK, most issued by the Nursing and Midwifery Council (NMC),
about use of social networking sites. All suggest caution to some degree from
acting responsibly to not using social media at all.
One
author suggested that midwives become aware of the four areas of law which form
pillars of accountability. Figure 1 (Griffith, R., & Tengnah, C. (2011).
District nurses’ use of social networking sites: caution required. British Journal of Community Nursing, 16
(9), 455-457.) is an adaptation of his
ideas. This could be further adapted to meet the needs of midwives in the US
where most ‘patients’ are referred to as ‘clients’ and most CPMs are
self-employed.
The
same author reiterates several suggestions offered by the NMC on the correct
use of social media. Most seem to be fairly common sense such as keeping
personal and professional lives separate, protecting privacy by adjusting the
privacy levels, not accepting or making friendship requests from/of former
clients, not posting pictures of clients online, and regarding everything
posted as public.
Most warnings are similar in bent.
They remind midwives (and nurses) of their duty to maintain the reputation of
their profession always; at all times and in all places and to remember that
anything posted on any social media site is public. Public knowledge of private
lives can have unforeseen impact on professional lives. Some even go so far as
to suggest that having a social network profile is not absolutely necessary and
therefore should be avoided in the first place. This is far different than the
attitude of Sarah Stewart. One cautionary warning encourages restraint, stating
that it is often easier to explain what
has been posted as opposed to why it
was posted.
While a little common sense would go
a long way, and even if most midwives use social media appropriately, there are
always those who must press their luck and in so doing make it difficult for
everyone. One such case was that of Timothy Hyde. Not a midwife but a
psychiatric nurse, he “was struck off in September 2010 for conducting an
inappropriate relationship with a former patient. He had met her when she
attended a screening assessment, and offered her counseling and support. He contacted
her through Facebook two weeks after she was discharged; they saw each other
regularly and developed a sexual relationship.” Because of his position as a
nurse, his conduct was deemed inappropriate. She was no longer a patient so
some would argue that there was no wrongdoing. Was there? Who can say definitively.
Some people like to take pictures of
the entire birth process. Some people even like to video record the entire
birth process. If a family decides to post a video of their child being born
and in this video is the midwife who was there, is there a problem? What if, as
some do, a family decides to internet broadcast their birth. In some places
this might be perfectly acceptable while in others, it might not. Englanders
have always had a reputation for being somewhat prudish (except in their humor)
so perhaps this is why they seem to have more of an issue with proper posting
and viewing.
Using common sense is probably the
best thing when using social media. Also, using different sites for different
purposes might be a good idea. For example, using Facebook only for friends,
Twitter for general messages for anyone, and LinkedIn for purely professional
networking.
In spite of the possibilities of
posting the wrong thing on social media sites, these sites and the internet
itself are extremely useful. It is quick and easy to access information via the
internet and it is quick and easy to share that information via social media
sites.
Two interesting possibilities for
using the internet are research and e-health. In the past, research was usually
done by conducting studies by contacting people in various manners including
telephone and mail. Now, the internet makes it much faster to get the
information to people for the gathering of information as well as getting it
back to the people analyzing the information gathered. As always, there are the
usual difficulties posed of working online such as confidentiality and
remaining anonymous. In fact, it may not be possible to be completely anonymous
online, but there are steps a person can take in order to help preserve confidentiality.
One issue that might arise from conducting research online is the availability
of internet access. Not everyone is able to access it and therefore there are
some voices that might not be heard if the internet is the only avenue used for
gathering information. However, the possibilities are almost limitless.
While there are concerns about
confidentiality when accessing social media networking sites, e-health seems to
be a going concern, at least in Australia. Basically, it is a means of providing
health care electronically. While it cannot entirely take the place of
face-to-face meetings of clients/patients and health care providers, it is a
way to provide health care for those who find it difficult to often meet with
such providers. Especially in the case of a low risk pregnancy, a woman might
be able to get all of the information she needs over the internet. If she is
able to reliably to perform urine tests (which are quite simple) and have her
blood pressure read at home, the results can be sent to her midwife
electronically and the rest of the visit can occur via Skype or instant
messaging. Add to this the fact that midwives and their clients can search the
internet for information pertinent to pregnancy and child birth, and we have
what might be considered a win-win situation.
The
internet and social media are definitely tools that can and ought to be
utilized by midwives today. They can help midwives gain knowledge through
primary and continuing education. Midwives can keep in touch with current and
former clients. The possibilities are almost limitless. So, why does it seem
that midwives in other countries, especially the UK, New Zealand and Australia,
utilize this tool more than those in the US?
In
2001, Jan Tritton, the editor of Midwifery Today, a magazine based in the US,
announced that the International Alliance of Midwives had been launched. Jan
quoted Marina Alzugaray, a midwife originally from Cuba, from the 2nd
issue of Midwifery Today (1987) as saying, “I have been interested in the idea
of networking with other midwives via modem for a while now. So far I do not
know any other midwife with a modem.” From the March 1987 issue, she quoted,
“It is also time for a midwives’ computer network. Is anyone working on this?”
and then went on to say, “In 2001, the time is ripe, isn’t it?” If the time was
ripe in 2001, it certainly is now, eleven years later.
If
the time is ripe for midwives in the United States to have a good functioning
network, and the technology has been available for many years, why has it not
happened? The answer to this is most likely to be found in the differences
between CNMs and CPMs. Many CNMs do not believe that CPMs have the training
necessary to practice midwifery. In fact, in some states, it is illegal to
practice midwifery as anything other than a Certified Nurse Midwife. The
American College of Nurse Midwives (ACNM) has its own networks in place for
CNMs and the Midwives Association of North America (MANA) has its own networks
in place for CPMs. The North American Registry of Midwives (NARM) is the licensing
agency for CPMs and has its own social networks. The ACNM is not willing to let
CPMs become members unless they are also an RN while both MANA and the NARM are
willing to let CNMs join if they are sympathetic, or at least not antagonistic,
to the home birth movement.
Midwifery
and midwives have been around as long as women have been giving birth. Whether
it is possible for midwives in the US to overcome their differences and engage
more in the world of social media remains to be seen. Real education and honest
communication is the key to overcoming these problems. How better to come by
these than by utilizing the internet and social media networks?
Notes
*
Just for fun, I often post questions on Facebook to see what sort of
information I will discover. In fact, I gathered all of my information for all
my statistics projects last spring that way. The other day, I posted the
following: “…I need to know if you’ve heard of midwives and if you have, what
you think they do.”
The
responses were quite interesting.
“hah…
I have heard of midwives;) A midwife is a woman who guides and takes care of a
family expecting. They provide prenatals, birth and postpartum care. There are
a few different types of midwives. The two I am most familiar with are Nurse
midwives and CPMs. A nurse midwife goes to nursing school and then specialized
in birth later on. A certified professional midwife does an apprenticeship
accomplishing a list of hands on skills. They do homebirths and are certified
by the state. Midwives know birth!!! Midwives strive for natural, loving,
beautiful birth♥” –Jocelyn McFadden; a fellow student of midwifery and doula
(age 18).
“they
are exhausted, and therefore somewhat mean!” –An awesome midwife who decided at
the age of 30 that it was too much.
“Midwives
squat between the legs of a mother in labor with catcher’s mitt and yell,
‘push! Breathe! Push!” –Donald Sonnefeld, a cousin and father of five who has a
sense of humor that might get him in trouble one day.
“They
typically spend more time with their patients, with a focus on education.” –A
friend, mother of four and music teacher.
“They
are wonderful helpers in the birthing process who are willing to stand up for
you against a doctor who’s being a jerk. Not biased or anything… I
swear…>_>” –Rebecca Landry, a kindred spirit and mother of one.
“Have
heard of them. They help do what comes natural to women, give birth. They coach
and encourage women during labor and delivery.” –A friend, mother of six, and
retired nurse from Boston Children’s Hospital.
“My
grandmother was a midwife. They are a great group that wants what is best for
the mom and child during the birthing process!!” –Margaret Armstrong, a friend
and mother of four plus many foster children.
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