Look who I followed on Tuesday! I didn’t realise he was still doing the rounds in NSW…
Last time I think the things I have to think!
Wow, how time has flown. And yet it has also dragged past. It’s funny how fickle time is!
Anyway, this is the last blog focusing on things I’m supposed to think about. And the focus is to write a short bog reflecting on the highlights and challenges of this placement. I think I’ll just do it in dot points, under the headings of highlights and challenges. If all goes well, it’ll be useful as a plan for the final reflective essay that I hope to write sometime during these TAFE holidays.
Highlights
- Working with M, who has been a highly professional, supportive mentor during this placement. I’ve learnt lots from watching her and interacting with her. She’s introduced health promotion theory when necessary and helped connect the dots from theory to practice.
- Realising that I have well developed, transferable skills. I’m not sure why, but I often lack confidence in myself and my ability to adapt to new situations, however I feel that I’ve done well in this role. M has frequently told me that I have produced a report or some kind of written product with little fuss and bother, unlike some of the other health promotion officers in the area. I guess the years of working on my own have made me quite resilient and proficient – if I don’t do it, it doesn’t get done!
- Working with the early childhood sector from a different perspective has been enjoyable. They’ve been honest about their lack of confidence or understanding and open to learning new things. I’ve felt really proud of the way that the Room Leaders have willingly taken on board the information about breastfeeding and sought to improve their practice. I’ve been involved in the initial training of many of these Room Leaders, so to see how their professionalism has developed has been quite validating.
Challenges
- Bureaucracy, bureaucracy, bureaucracy! OMG – so much ‘excessively complicated administrative procedure’! I thought it was craziness at TAFE, but Health triumphed in this area! Whether it’s been getting clearance to start the placement (and having to resubmit the medical information about 5 times), working through the challenges of gaining ethical approval or just trying to complete placement tasks after an official in an ivory tower decided that you couldn’t have an email address if you don’t have an employee number, bureaucracy has been the bane of this placement! It has worn me out…
- Honing in on the purpose of the project was a challenge. M and I realised that we were confusing the focus when we were developing the survey for mothers who use childcare. We had to ensure our focus remained on what we (NSW Health) could do to help early childhood services better support breastfeeding mothers. It’s not a direct relationship – we’re not helping the mothers directly, but through another agency. I wonder if there is research on this? I’m not sure I’d even know how to search for it!
- The length of time I signed myself up for this project has been challenging too. I have a short attention span, and I am getting bored with this. I want it over and done with. I’ve never been a good finisher, so I imagine the next 10 weeks will be quite challenging for me, especially the first few weeks of next term when M is on holidays. BUT, the only way to improve my finishing skills is to actually finish things, so I will stick it out and manage the internal combustion engine!
Well, those are the main highlights and challenges that come to mind. I’m not sure if this will reflect my essay content or style, but it’s got the tip of the iceberg thoughts down on paper.
Thanks to Cathy and my fellow HP students who have been reading and commenting on this blog over the year. It’s been great to follow your placements and see where they’ve taken you. I think I’ve enjoyed your placements more than my own in some ways. I wish you all the best with your final assessments and then as you walk into the Health Promotion sector. Maybe we’ll meet in real life at a conference one day? That would be cool! We’ll know each other by name but not face!!
I might still blog throughout 4th term (via my TAFE calendar). I would like to share how the launch goes and I might have issues on my mind that I have to blog out before I end the placement. But this is my last official assessment-oriented blog.
Thinking the things… – Partnerships
Hey all,
It’s well and truly past weeks 5 & 6, but I’m ready to complete this activity now. I’ve been putting off this blog as I had not considered that my health promotion placement included a partnership. As far as partnership between organisations, I still believe this to be true. I did not experience or observe the Health Promotion unit partnering with another organisation in relation to the Breastfeeding project. I think I did see some glimpses of partnership for other projects that the unit was working on. M worked closely with the local council with a NSW Health initiative that encourages the local community to get active. I observed M and the council representative cooperating to gather weigh-in details to help with the evaluation of the project. As part of this relationship, M received an apple slinky machine that council had no need for (and which she was in dire need of – the apple slinky machine I’d seen M use at the Baby and Toddler Expo was losing essential parts left right and centre!).
At an individual / interpersonal level, I experienced partnership with M throughout the placement. This was not a partnership at an organisational level, though. Although I am the local TAFE teacher, and considered a representative of the organisation by the local early childhood community, I was not partnering with M / NSW Health in this role, but as a health promotion student with good contacts / links / relationships for the project. It is interesting to reflect on this partnership tool and consider how partnership could be developed, and whether there is a need for it between TAFE and NSW Health. I don’t really consider that this partnership is relevant for either organisation. However, I can see the benefit of partnering with the early childhood services to a greater extent within my TAFE role. I will put that thought at the back of my mind, to tick over when I’ve completed all my assessments for this semester!
With respect to the project I have been working on, partnership with early childhood services may have improved the quality of the Breastfeeding in Childcare resource kit. However, I cannot clearly envision how the early childhood educators or directors would have been able to convince their management committees / service owners that it would benefit their business / provision of care to be involved in the development of the resource. It would have needed to be sold to them as Professional Development and then those interested in becoming involved may have been released from their regular roles. This description (ie that it was PD) would have been accurate, as there would certainly have been a development of professional skills and networking from involvement on the project, but it is not an obvious relationship to PD (unlike attending a seminar / conference focused on behaviour management, for example). And I imagine it would have increased the time-frame for the development of the resource substantially.
The question asks for me to comment on the usefulness of a checklist based assessment tool such as this partnership analysis tool. I imagine it would be useful for evaluating the effectiveness of a partnership, and determining whether all parties were on the same page in regards to expectations and intentions. I hypothesise that community-based organisations would be more likely to need / want to work in partnership with other organisations to minimise the costs and share expertise than a government organisation which is extensive and can look within for such expertise. However, government organisations may not develop an understanding of the priorities of the community if it does not value or seek partnership arrangements. Hmmm, interesting!
Off my bum and into the services
Hi all
I’ve finally made it to the time in my placement when I get out of the office and take the resource around to the services. It’s taken some coordination and “Plan B” making as not all the requirements fell into place before exiting the nest!
Over the last couple of weeks I’ve been ringing around to make appointments with the room leaders of the infants/toddlers rooms and printing out the pages on “heavy stock” (ie light cardboard) so that they are robust and can be useful for as long as possible. Fortunately, one of the 100’s of changes to the hospital / health department since I started in February has resulted in the colour printer now being located in the office I spend my Wednesdays. So I didn’t have to traipse all around the hospital or impose on people I don’t know to load up the trays and hit those buttons! Yay! Unfortunately, and typical of working in a government department, the stationery order for plastic folders hadn’t arrived before I headed off on Wednesday. However, plan B folders were located from somewhere and the resource looked pretty good and a product to be proud of.
I visited 4 local southern services on Wednesday. I started with the most southerly, which happens to be a service I have not managed to build a rapport with in my TAFE role. Anyway, they didn’t realise I was the TAFE teacher as I introduced myself as a student from NSW Health Promotion. And seeing as I was arriving with free resources, it was quite a pleasant visit! The room leader of the infants’ room was really happy to talk and go over the resource, the centre allowed her time off the floor to go over it and it was actually a very positive start to the visits. I’ll let those positive feelings infuse my soul when I have to contact the service in my TAFE role next time!
The next 3 services are ones I’ve had lots of experience with, and they were lovely. Two of these room leaders had previously stated that they’d like more resources and knowledge to be able to best support breastfeeding mothers, and were very appreciative of the visit. The third educator I spoke to had used the resource with a friend who’d struggled with breastfeeding. (It was sent out last year sometime but had not been supported by a personal visit and when I rang around earlier in the project, the vast majority didn’t know it existed). So it was valuable to discover that the educators in all southern services are keen to support breastfeeding mothers, will now know the resource exists and will also consider ways it can be incorporated into their practices.
Another positive from these first visits was finding that Professional Development funding can be used by the Directors to release the educators from their roles to attend a ‘launch’ we are running in October. And being out of the office gave me time to think about this launch and come up with some ideas on how to make it interactive, informative and valuable for those who attend. A win all round!
Thinking the things…. about Health Promotion Strategies
So it’s now time for me to identify 2 health promotion strategies that have been used to achieve my program’s goals and objectives. I will look at the strengths and weaknesses of each of these strategies.
Organisational Development
The description in our assessment document states that this aims to ‘shift program/service directions to accommodate health promotion activities, [including] staff education. This is the primary focus of the project I am working on. For my project, this strategy aims to educate early childhood educators of the benefits of breastfeeding and methods upon which it can be supported within the early childhood environment. The intention is to empower early childhood educators to promote the retention of breastfeeding to mothers using childcare services, and also enable the educators to more effectively support breastfed babies when they commence childcare. My project lies within the program area of “healthy weight”, so the ultimate intention is to slow down the rates of obesity within the community areas covered by Southern NSW Local Health District. It is essentially using early childhood services and educators as a secondary health promotion source. Because NSW Health has no regulative authority over the early childhood sector, the resources developed have been linked to the National Quality Standards, the framework from which early childhood services are assessed.
Strengths of this strategy:
- Slow societal change may result from increased awareness of the benefits of breastfeeding in the early childhood sector and through them into the general community.
- It may influence the parenting behaviours of early childhood educators themselves, when / if they become parents or grandparents.
- It is linked to the National Quality Standards and therefore to the criteria for assessment – enabling educators to see the benefit of the activities suggested for their service (not just for the infant / family).
- Increases slowly the normalisation of breastfeeding in the community.
- It is population focused, looking to create change in the environment in which women birth and bring up their babies.
Weakness of this strategy:
- Early childhood educators are overworked and underpaid, with many health and educational expectations already laid upon them. This is yet another requirement with no financial gain for the services or the individual workers.
- Early childhood educators do not the promotion of breastfeeding as part of their role. Many feel “live and let live” (as a student said to me on Tuesday) and will not challenge parents with this information.
- Cognitive dissonance could result for educators who did not or could not breastfeed, as in the example of the student above. Her experiences with hostile maternity nurses and dislike / discomfort with breastfeeding will restrict her from taking on board the health implications of breastfeeding.
- I believe that this strategy (nor the project itself) does not address the changes required to enhance breastfeeding rates in our area (or nation). The practices of early childhood services are not a primary reason for low rates of breastfeeding in Australia. The roots of this health concern are much broader and deeper and require a far more comprehensive approach from levels of government to address. A HiAP approach is required.
Health information
This is the way in which the organisational development is being supported. Health resources have been produced that provide information on benefits of breastfeeding and strategies for supporting retention of breastfeeding for mothers using childcare. The resources developed have been written with literacy skills in the early childhood sector in mind.
Strengths of this strategy:
- Resources are available in paper form and online.
- From next week I am taking the packs out to the early childhood services that provide care for babies and they will be walked through the resource. While the resource has been sent out in the post previously, the survey I took a couple of months ago showed that only 1 of the services could remember seeing the resource or use it. With a personal touch, this will likely improve.
- Information provided can be shared with parents or other community members by the early childhood educators.
Weaknesses of this strategy:
- As shown in the second point above, paper resources are easy to overlook or lose in busy early childhood services if not immediately required.
- The online format of the resource is REALLY hard to find! (Believe me when I say this!) The intention is for it to be placed with the other Munch and Move resources, but this has not occurred yet.
- There is high turn-over of staff in the early childhood sector. Those who receive the personal touch and become familiar with the resource will likely move on to other services or out of the sector entirely. The resources could then become another good idea, placed upon a shelf.
- Health information is easy to read, but harder to follow. There is familiarity and ease with using infant formula for busy families and busy early childhood educators.
Thinking the things I have to think… Part 6
Hello there! It’s been a while… I’ve had quite a few weeks away from my placement – when planning my placement, I decided to take a break from it during TAFE holidays, then I had to relieve my relief teacher as she had holidays so had a few more weeks off from placement. This week I started back with the project, although I did attend a frustrating telephone conference last week after teaching in the morning. This bureaucracy thing does my head in! There are so many cooks getting their hands into the soup, and I’m now quite confused about what I’m allowed / supposed to do with the online survey (again!).
Anyway, I’ll talk about that some other time as I need to get thinking the things I have to think now…
It seems I have to think about evaluation, specifically “Why I want to incorporate evaluation into my professional practice”.
For me, evaluation is intrinsic to my profession as an educator. I’ve been evaluating lesson plans or programs since I studied early childhood education back in the late 80’s. It’s now become a part of who I am and how I behave. I’ve never been able to just recycle lesson plans or teaching ideas from one year / semester to the next. It just strikes me as lazy, boring and incompetent. I actually thrive off getting to know who my students are and adapting my teaching style to their needs. And while there are times I wish I would / could just recycle strategies and resources as it would save time and effort, I can’t. I’d be so bored… It’s not like the topic changes much, so a change-obsessed person like me HAS to introduce improvements! And how do you determine what could be an improvement? You evaluate!
from: http://guides.library.duq.edu/informationevaluation
So, incorporating evaluation into the project has been important to me to ensure that I meet the goals of the program and also my goals of the placement. It enables me to keep on track and actually helps to motivate me, especially after the big break I’ve just had. It doesn’t have to be a big deal, my evaluation when I returned to the placement basically consisted of reading over the project plan and determining what had been achieved, what hadn’t and what seemed to be in limbo. I found some papers from another assessment I worked on a couple of years ago that looked at evaluation, and agree with the statement that ‘evaluation is… a cyclical or circular process where issues are revisited and reconsidered’ (O’Connor-Fleming et al. 2006, p. 63).
An example of this cyclical process follows. When planning the project, my supervisor and I included numerous methods of evaluation. Many of these were just identifying whether or not an outcome was achieved. For example, I aimed to gather information / feedback from parents at some stage during the project. I imagined at the beginning of the project that this would be in the form of a ‘world cafe’. I had some concerns that this might just attract an unbalanced opinion (with breastfeeding advocates likely to attend and busy formula-feeders unable or disinterested in participating) and then opportunity to participate in the Baby and Toddler Expo came up, so we created a survey for gathering information. This was vetoed because of ethical issues, so instead we created the suggestion box. This wasn’t very successful for numerous reasons (I realised this through the process of evaluation) and we have now developed a ‘survey monkey’ survey to send through to mothers via the early childhood services. BUT the ethics expert has determined that this could be deemed coercive, so we will use the survey in another form. This took so long to work out that now I forget what we are supposed to do, but I’m sure I will be reminded next week! So as you can see, evaluation and reflection, both formal and informal, have guided the progress and direction of the project.
OK – that’s it for today. Or for this blog anyway. I think there is something else I need to think, so I will switch off my evaluation brain, and switch on my HP strategies brain! See ya in a minute!!
References
O’Connor-Fleming, ML, Parker, EA, Higgins, H & Gould, T 2006, ‘A framework for evaluating health promotion programs’, Health promotion journal of Australia, vol. 17, no. 1, pp. 61-66.
Gantt Chart… Who knew?
So, with fear and trepidation I commenced this task. I noticed that Ivanka completed this a couple of weeks ago, but I stuck my head in the sand regarding it. Today I noticed Belinda had also completed her Gantt Chart also, so using this as encouragement, I gave it a go.
At this point, I’d like to add that I have minimal skills in Excel. I’ve done 2 training courses in it – I blitzed both of these – but have never used it. I’m just a good fast learner, and pick up patterns quickly. However, I have zero understanding of it, and when I open up the program and there’s that big expanse of lines, I just freak out! My supervisor talked me through an excel spreadsheet on Wednesday (as it is one of my goals / objectives for my placement), and again I picked up what she was teaching me to do quickly… After that, the big expanse of lines I saw today only freaked me out 50% as much as usual!!!
Anyways, here’s my Gantt Chart. I like how fancy schmancy Belinda’s looks with all the lines and stuff, but I have no idea how she did that. I will just be glad I’ve achieved this task and go scull a red wine or 2!!
Some of these tasks have been changed in response to feedback from M’s big boss, so this is a synthesis of the original project plan and recent changes.
Back to the story of placement…
So last week M had a fun workshop to go to, which she invited me to, but I felt it would be best to complete my telephone surveys with the children’s services staff. I was really nervous before ringing them, and took about an hour to steel my back and do it. I was going to start by ringing my favourite service, but had a good stern talking to myself and just started with the service that was at the top of the contact list that E had collated last year. Fortunately, the room leader of the infants room was in a good mood, and really happy to talk to me. She laughed at me being nervous (she was one of my students a few years ago), and made me feel quite comfortable. After speaking to her, I breathed a sigh of relief and knew I had this interviewing thing in the bag. It was intense, and my ears felt like they were ringing by the end of the day from concentrating so hard, but I gathered lots of valuable data.
The thing that stood out to me most of all was that all of the educators were supportive of the rights of women to breastfeed or provide expressed breastmilk for their babies. There were a couple who have not been mothers themselves who were a little less confident, but they still had a positive attitude and were keen to learn more. I’m so proud of them! The other big thing was that the original “Breastfeeding in Childcare” resource kit that had been mailed out to the services mid last year was unknown to all but 2 of the educators I spoke to. Mailing resources doesn’t work. It’s cheaper financially than a face-to-face visit, but mail just gets filed somewhere safe, and rarely ends up in a place suitable for use.
This week, M and I spoke to her boss K and big boss L (I forget their titles, ones probably a relieving coordinator and one a manager? I should get my head around this soon!) via teleconference on Wednesday. I hadn’t interacted with K before as she is replacing the person who conceived and introduced the Breastfeeding in Childcare project in 2015. She left to have a baby after my first week of placement. Anyway, K and L decided that it would be appropriate for me to survey mothers, as long as the questions are based on improving the role of early childhood educators to support breastfeeding mothers’ needs. I will just adapt the questions in the original survey to ensure they don’t cross over this boundary in any way, then adapt them to use on survey monkey. I’ll need to send this out to the children’s services in the next few weeks or so.
When I was talking to L and K, I was quite cheeky and suggested that it would be a good idea for them to give me a job at the end of this placement. L said you just never know what’s coming up… Well, I didn’t expect that reply! (And I realise it’s not a promise, but it gives me a little bit of hope for a happy ending). I think both L and M are impressed with the work I’m doing and feel that they are getting a lot of value for little outlay from my project. I’m enjoying it, especially now that I’ve managed to get on top of the bulk of my marking for work and feel like I have some breathing space – leaving room for learning!
Placement goals and catch-up
Goals and objectives
One of my goals for this placement was to:
Develop confidence and competence in developing, implementing and evaluating a project plan.
Three objectives related to this goal were:
- Plan, implement and evaluate at least one health promotion project, including:
- Identifying realistic goals and
- Identifying realistic time-frames and
- Evaluating throughout and at conclusion of the project.
Catch-up
I’ve had a couple of quiet Wednesdays on my project. I spent most of the day last week working on a literature review that focuses on barriers and enablers for working mothers in regards to breastfeeding. Being me, I keep reading more and more and more papers, so it’s kinda getting out of control! I’m going to finish up summarising the papers I printed out at work and stop gathering information. At this stage I’m just identifying the relevant points from each of the papers I’ve read, and next I’ll categorise into similar points. Today I spent a short period of time on this, but most of my hours was on analysing and reporting on the findings from the suggestion box at the Baby and Toddler Expo.
I spent nearly 4 hours at the Expo on Saturday. It was a glorious day, and I forgot sunscreen, so was a bit anxious about being fried, however I came away untarnished! There were a lot of people moving through the Expo and it had a lovely vibe to it. In my networking, I discovered a personal trainer who runs outdoor group classes in my little suburb, which is fab to know. I’m actually going to head out to it tonight to assess their skills at adapting to my dodgy physical needs!
The Suggestion Box gathered a few ideas on how childcare services can better support breastfeeding mothers. I gained most of these ideas from early childhood staff who attended the expo to promote their services. I actually found it intimidating to approach women and discuss breastfeeding with them. The first couple I talked to were hesitant to comment, so I backed off and focused on my existing contacts. I did talk to one woman for a good period of time, however she was wearing a wrap and I got the “I’m a breastfeeder” aura from her. She had some good suggestions, though, so I’m glad I had the chat with her.
Another thing I achieved today was that M and I had a teleconference with the Manager of Health Promotion for the area. I have emailed her a couple of times, but hadn’t yet spoken to her. M and I filled her in on the project and she seemed happy with the developments. She was actually quite annoyed by the involvement of the ethics department in delaying the survey for mothers, which humoured me a bit. It sounded as though she considered them being overly intrusive. It’s all a bit political, really! Oh well, I may or may not get to survey the mothers, but will have to pull my finger out soon and call the early childhood services for their telephone survey. I am quite curious about whether or not the Breastfeeding Kit has actually made it to the appropriate place, and whether it has been helpful. I don’t recall seeing evidence of it (posters or anything) when I’ve visited students in the babies rooms, so I have a feeling they’ve been filed somewhere safe…. (AKA never to be seen again!).
I hope those of you who are still doing placement are enjoying yourselves. I’m all shades of jealous of Ivanka for finishing hers! Only 6 more months for me left…. (waahhh!)…
At the end of the weekend, I’ve been thinking about what I’ve learnt locally so far. Here’s a list:
- early childhood services need more respect from the general community for the job they do. Educators contribute so much – they often resource their centres from their own pockets, and they certainly are not paid well.
- Visual and dramatic play equipment is required. Posters of breastfeeding mothers – not huge, but A4 or under. They can be put in dramatic play area and on the walls of the breastfeeding welcome section – with fridge, sink, hand washing area.
- Inclusions of breastfeeding images in newsletters, enrolment information, breastfeeding-friendly language.
- more info in the media about breastfeeding – not to make people feel like shit who can’t /don’t want to, but we make it easier for those who do.
- Every hospital (or at least maternity hospital) should have for hire breast milk pumps. Our region doesn’t have this, Neither through ABA nor public health.
Thinking the things I’m supposed to think (part 3)
Community Needs Assessment links:
- The following is the toolkit used by Primary Health Networks in Australia to determine the health needs of their communities: Primary health networks needs assessment guide
- This next link was provided by Erika Langham in week 3 of the course in Community Needs Assessment. It takes you to an online toolkit that steps the reader through the methods of determining community needs: Assessing local needs and resources
- The Manitoba Community Health Assessment Guidelines is another document linked to by Erika in this course.
- This link is to a toolkit that assists community groups to engage with the African (and possibly other CALD communities) in assessing their alcohol-related needs. It was developed by the Hunter Multicultural Drug Action Team.
This next link is not related to this question, but is something I found while searching around the internet. It might prove useful to me later in the project, so I’m dropping it here for now… Evaluation tool for breastfeeding programs and projects
Could a community needs assessment inform my project, and how?
I believe a needs assessment could inform my project and I intend to complete one soon. I will be telephone surveying Eurobodalla’s early childhood (EC) educators who provide services to infants under 6 months . Their EC services have been sent a copy of the Breastfeeding Support kit, but there has been no follow-up to determine whether the kit was passed to the correct area of the EC Service, whether the strategies have been implemented, or whether the kit has been useful. It’s important to evaluate the value of the resource kit to determine where to move with the project next.
I also believe it is important to find out how mothers who use childcare services feel about breastfeeding their infants, and whether the return to work / placement of their child in care has influenced their breastfeeding practices. As I said in my previous blog post, I created a survey for these mothers, but it requires ethics approval before being used. It may have to be changed entirely as it may ask leading questions or could possibly reinforce “mother guilt” of those women who were unable to continue breastfeeding after leaving the hospital. I would hate it if the survey did either of those things so I’m grateful that these issues have been highlighted before use. Whatever the means, I think it is important to discover the felt needs of this group of women.
Follow on from my ponderings in yesterday’s blog…
After I blogged yesterday, I had a look at some of the research papers I’d printed off at work the day before. I find it so much easier to read from paper than online – do you? Maybe it’s a generational thing? I have students who prefer to type their assessments up on their phones… That would drive me bonkers!
Anyway, I printed off the following paper, which was like reading my own thoughts only formally recorded and referenced, not splattered onto a blog page! Ethical problems with information on infant feeding in developed countries (Fahlquist & Roesler 2011). They agree with my concerns about paternalism in the breastfeeding policies and promotion, and I their point that ‘public health policy should be compassionate’ (2011, p. 199) and ‘value women’s embodied wellbeing’ (Blum 1999, cited in Fahlquist & Roser 2011, p. 199) resonates with me. And today it is interesting reading this paper again, just after I’ve covered week 5’s information in Community Needs Assessment, where Erika talks about aggregated data, as their point is that ‘there are problems related to balancing aggregate wellbeing versus individual wellbeing’ (Fahlquist & Roeser 2011, p. 192). The language of the breastfeeding promotional material is focused on the risks of formula feeding, and the benefits of breastfeeding; however there are 2 sides to this argument, with the alternative argument not being shared. This language and lack of balanced discussion causes women guilt if they can’t (or choose not to) breastfeed.
I just love that I found somebody who agrees with me and my concerns!! I don’t know what I can do with this information, but I feel somewhat empowered by it 🙂
References
Fahlquist, JN & Roeser, S 2011, ‘Ethical problems with information on infant feeding in developed countries’, Public health ethics, vol. 4, no. 2, pp. 192-202.
Return of the traveller – back to reality
Hey guys, I’m back!
That was fun! I am much more rested now as I partied like a 90 year old and most nights was in bed by 9.30!! I was told before I left that you need a recovery week after cruising, but I managed to nanna myself quite well and snooze like a champion! Bliss… Actually, bliss came from the numerous massages, spas and saunas I treated myself. I wish I could have brought the masseuse home though, I’d like a good massage now!
Anyways, I had my first day back at placement on Wednesday. It was a funny day. Both M and I had been away for some time, so neither of us were really sure what we were up to. I ran into M as I parked my car, and she told me about the session she’d had with the Health Promotion manager a couple of weeks ago. She’d been asked by her manager whether ethics approval was required for the project, which M had forgotten to look into. After contacting this department, and completing an ethical assessment document, M realised that the survey/s I’d developed to use with mothers required more in-depth ethical approval, so we’ve canned that idea for now. I was going to be using them next week at a local Baby and Toddler Expo, and the approval process takes longer than we had, so I spent most of Wednesday getting prepared for plan B.
What is plan B?
Well, it’s a suggestion box. I’ll now be talking to mothers and asking for ideas on how child care services can better support the needs of breastfeeding mothers. We both doubt that there will be a huge gathering of information, but it may point to the need for additional research. I will also need to do a literature review. So the rest of the day I looked through the department’s database of research papers after shopping downtown for wrapping paper to turn the photocopy paper’s box into a pretty baby-oriented post box. Yeah, I did arts and crafts today!
I understand the need for this ethics approval, but I’m still disappointed that I can’t use the survey to gather data. I feel like I’m just filling in time; working on a pre-existing project with nothing tangible to show at the end of the placement. Having read the blogs of the other students on placement, I’m envious of their completed projects and resources they’ve created. I suppose that’s the drawback to doing placement with NSW Health and not a community based organisation? Or maybe not? What do you think? Anyway, I’ll get over it, and do my best with this placement. It just is what it is.
Talking about ethics, I’ve just caught up on week 4 of Community Needs Assessment, which looks at ethics, and it’s reminded me of the conversation I had with M at the end of the day on Wednesday. I told her about my ranty splat blog I wrote before I went away (I’ve now hidden that blog, it’s a bit ranty splatty sweary for general viewing) and we talked about the rights of mothers. We were debating whether mothers have the right not to breastfeed if they can, but don’t want to. She’s challenged me to look at this from the perspective of the UN rights of the child, and that a woman doesn’t have this right. I don’t want to! I’m not sure how I can balance this perspective with the rights of a woman to terminate a pregnancy. Does it mean that if a woman chooses to have a baby, she doesn’t have the right to choose what happens with her body in relation to the baby when it’s born? And while formula feeding doesn’t provide the infant with the optimum nutrition, or support the mother’s health (that results from breastfeeding), it doesn’t mean that a woman who chooses not to breastfeed is starving their child. Ethical dilemma!! Confusion!!
Oh, and please don’t take this to mean that I’m anti-breastfeeding. I think it’s incredible and amazing and splendiferous that our bodies are able to produce this nectar for our infants…. BUT, if a woman can’t do this, even if it’s that she resents the time / feelings / inconvenience / whatever is behind a decision not to breastfeed, I believe she should be provided with equivalent support as those who do breastfeed.
I’m going off track a bit, but that’s the beauty of a blog (I think). I don’t have to be all forwards and logical, I can write how my brain processes things, wibbley wobbley (like Dr Who… haha). Weeks ago, when I was talking to the local ABA support person, I was in her home and her child was demanding the breast for a feed. The child was over 2, I think, and I imagined myself in that position, and thought I’d probably resent the child from grabbing at my body in this way. Who does the breast belong to, the child or the mother?
So M and I were talking about whether mothers want to breastfeed. Perhaps health workers exist in silos where they expect everyone to want to do this, but maybe women return to work so they can give up breastfeeding?? When I was on the cruise, I talked to my cousin and other women who have children, and my cousin (who works in welfare) reckons that anybody who breastfeeds beyond 6 weeks deserves a medal! Also, I’ve heard stories of women who have felt wounded by the “breastfeeding nazis” (ABA, lactation consultants, maternity nurses) and I’ve now started finding research from this perspective too. The paper I read the other day, ‘When breastfeeding is unsuccessful’ (Larson & Kronborg, 2013) finds that mothers who successfully feed their child, regardless of the form of feeding, feel more securely attached to their infant than those who struggle with breastfeeding. Secure attachment is essential for ongoing emotional and psychological health of the child…
So, anyway, I’ve been pondering lots of things this week and since I had that blog explosion before the holidays. My head swirls with thoughts about this… Is our capitalistic, individualistic culture creating conflicting stories and expectations of women who work and have children? What do feminist theories say about this? Are we allowed to say we just don’t want to feed from our own body? What are the realities of breastfeeding? Perhaps it’s really hard to breastfeed? Or really hard for some people to breastfeed? Maybe it takes ages and it’s really hard to express breastmilk? I don’t know… Is it? Are the WHO’s recommendations that infants are exclusively breastfed until they are 6 months old realistic? Are we allowed to challenge WHO? Lots of questions…
References
Larson, J & Kronborg, H 2013, ‘When breastfeeding is unsuccessful – mothers’ experiences after giving up breastfeeding’, Scandinavian journal of caring sciences, vol. 27, no. 4, pp. 848-856.
Placement blog for S0238690 