Midwives and Social Media

Midwives are becoming more engaged with social media and electronic communications in both their professional and personal lives. Because there has been controversy with the use of social media by a few health professionals lately, I explore some of the pitfalls, precautions and powerful possibilities that social media offers to midwives in this post.

Social media and midwifery

Midwives love networking - whether sitting in the tea room, hanging out at the ‘desk’, having dinner out with colleagues or catching up at midwifery conferences, workshops and meetings. The buzz of midwives conversations and laughter is inevitable. The move to using social media as a way to stay in touch and keep connected has become easy for midwives.

What is social media?

The term ‘social media’ is an umbrella term which covers the multiple ways that technology is used for social interaction. Social media differs from traditional media, such as newspapers, television and radio; in that anyone using mobile and web based technologies can publish and receive information at any time. Real time interactive dialogue enables the co-creation of meaning and value of all aspects of social life - perfect for a socially-based profession such as midwifery.

Forms of social media

Mobile and web based technologies take many forms. The main forms used by midwives are: Email, Texting, Forums, Facebook, Twitter, LinkedIn, Blogs, Ning, Wikis, OneTrueMedia and YouTube. Wikipedia has an extensive categorized list of social media. There are links on the Wikipedia page to an explanatory note about each modality.  Google ‘social media’ and you will be amazed with what comes up for you to explore.

Uses of Social Media

Social media offers a means through which people can post their experiences as they go about their activities and enables their ‘followers’ and/or ‘friends’ to be updated instantaneously. You will be familiar with email and texting, so I won’t go into those tools in this article. Most of you will be familiar with Facebook too. Midwives who engage with social media tend to use Facebook as their social network platform, sharing their lives and their photos. Some midwives also use LinkedIn, a platform used by business owners and other professionals.  The microblogging site, Twitter, is popular with midwives too but most of them are from the USA.

Apart from social networking and updating friends on daily/hourly activities, social media is an excellent tool for raising awareness about issues, sharing information and organising events.  As recent world events have demonstrated one of social media’s most powerful roles is in mobilising community support for political and/or public interest issues. When the Gold Coast birth centre was threatened with closure in 2010, a massive campaign was launched on Facebook and Twitter to inform people that closure was imminent. The social media campaign culminated in a well publicised rally, traditional media became involved and the birth centre remains open.  Facebook and Twitter were used effectively as both official and unofficial sources of news and information during the Queensland floods at the beginning of 2011. The immediacy and success of that social media intervention dramatically increased the profile of social media for both government and the general public.

Ning is a useful social networking site for groups as it is password protected and requires moderation to enable access. You will find midwifery, birth and parent related communities on Ning. Another popular social media tool is blogging. Many midwives blog. The word ‘blog’ is the contraction of “Web log” and is a website which functions as an open online journal maintained by an individual. The blog owner, or an invited guest, writes regular commentaries about events, ideas and/or experiences. An example of a midwifery blog is Queensland’s Rachel Reed’s MidwifeThinking.

If you would like to find out more about the way that health professionals use social media, Sarah Stewart, the social media guru midwife has a blog article A discussion with health professionals about their use of social media with a video discussion on the use of social media. Sarah has initiated and coordinated the immensely successful and popular Virtual International Day of the Midwife, a virtual conference held over a 24 hour period on May 5^th. This year, 2011, marks the third year of that conference. Details can be found on Sarah’s blog.  Social media is making inroads into health care as health care facilities and doctors seek to improve patient doctor communication. Dr Kevin Pho, has a popular Medscape blog, KevinMD, He also discusses on YouTube Social Media to Traditional Media the way that social media helps to prepare doctors to talk with patients and the general public.

Traps for the unwary in using social media

Some of my greatest learning has been from sharing stories about birth with other midwives. Sitting in the tea room or going out to lunch and talking ‘shop’ is usually safe for discussing clinical issues and we are all aware of the need to ensure confidentiality in those forums. Those words we shared disappeared into thin air and only our memories recorded what we talked about. However, the online environment and communicating through social media permanently records our conversations. The fact that what we say and how we say it can be read by anyone forever in the online world means we as health professionals must be careful to project a professional persona in all our online communications. A rule of thumb for engaging in any social media is to ensure that you don’t write or say anything that you wouldn’t want to read on the front page of the national newspaper.

A recent study found that there were inappropriate physician comments on Twitter. The researchers in this study identified 3% of the posts that were unprofessional because the posts contained:

• Discriminatory statements;
• Potential violations of patient privacy;
• Profanity
• Sexually explicit material (Rettner, MyHealthNewsDaily/MSNBC, 2/17).

About 1% of posts included unsupported claims about a product or repeated promotions for certain health products. Ten of these tweets contradicted medical guidelines or knowledge (HealthDay, 2/17).

The results of that study are demonstrated further in a situation concerning the indiscriminate use of slang on twitter by several doctors. Anne Marie Cunningham, a GP lecturer from Cardiff, Wales wrote a professional and reflective blog post Social Media, Black Humour and Professionals about her experience when she sought to discuss privately what she thought was unprofessional language on social media with the doctors concerned.  Her post led to a very heated response from some, including an item on the Facebook page of The Medical Registrar in which Anne Marie was called a 'humourless old trout' amongst other things.  I've blogged about this situation which some wag labelled #hcsmgateuk (health care social media 'gate', referring to the watergate affair in the US). 

The Australian Medical Association, concerned that its members could find themselves in trouble through inappropriate behaviour on social networking sites, developed A guide to online professionalism for medical practitioners and medical students (available on their website). Even Liberal Party MPs now have a Liberal Party guide to social media, after several MPs were forced to resign for posting controversial tweets.

People do strange things, like calling in sick and then updating their status on Facebook talking about what they are doing for the day - neither wise nor honest.  Even parents complaining about childrens' messy rooms can sometimes find their words have fallout they couldn't imagine. Employers don’t take kindly to employees who bad mouth their workplace on social media sites either. Remember that the information and images you post on social networking sites are there forever.

An increasing trend is for employers to check prospective employee’s online information and take that information into their consideration of the applicant’s suitability for the position. Employers are looking at what their current employees are writing. I was told recently that someone employed at a university was advised to ‘defriend’ another person who posted a negative news item about the university on their Facebook page. Women in our care, and our colleagues, may also check us out on social networking sites.

As a summary of the perils that befall the unthinking, here is a list of “dont's” that have led to people being  fired because of their behaviour on social media.

Don’t post off-color remarks

Don’t post confidential details

Don’t badmouth your clients

Don’t disrespect your employer

Don’t post inappropriate photos

Don’t create animated videos of your co-workers

Don’t talk trash about your boss

Don’t play hooky - and then post about it

Netiquette and Social Media

So how do we engage in social media and stay safe?  While I’m sure the mistakes made in the examples above will not be made by any midwife, there are other pitfalls that need to be considered. We need an appreciation and understanding of the set of social conventions regarding online communication to ensure our communication will not offend others or land us in ‘hot water’. An important consideration is that there are no body language cues available for people to ‘read’ what we mean in online communication. The lack of body language cues means that humour can be misread or misinterpreted, especially what we may consider as merely ‘sarcasm’ and ‘wit’. We therefore have to ensure our message is clear and personable. Other important aspects of Netiquette are:

• Capital letters for whole words indicate shouting and is considered rude
• Keep emails short and put the important part of the message in the top sentence
• Make sure the email subject line is appropriate to the email topic
• Don’t expect or demand immediate responses when emails or texts are sent and don’t send another one immediately if there isn’t a quick reply
• If something private or urgent needs to be discussed, ring the person or direct message (DM) them. Don’t put it where everyone can see it
• Don’t conduct personal, private conversations on social media unless the site is locked and even then realise that the information, even DMs and emails can be subpoenaed by a court 
• Be courteous and polite
• Ensure the message is the message you send: reread before posting and ask yourself, how will this message be interpreted by the person who receives it? 
• Avoid the use of profanities
• Avoid any words or images that victimise, blaspheme or vilify
• Avoid any words or images that are racist, sexist  and  anti religious 
• Treat everyone and talk about everyone in positive terms, remember, what is written lasts forever   
• Don’t post and/or tag unflattering or compromising photos of friends. Be aware of your own photos and ensure the photos you are posting are professionally appropriate
• Be wary of who you ‘friend’ and your privacy settings; often you are required to take some action to ensure privacy
• Be aware that privacy settings are still vulnerable
• Ensure spelling and grammar are correct
• Remember that you are projecting your professional image whether you realise it or not
• If someone else makes a mistake, be kind. If you choose to correct them, do it privately and kindly       Be respectful of intellectual property

The USA’s Centre for Disease Control and Prevention produced an excellent Social Media Toolkit for health professionals you will find interesting and useful.

The rule of thumb bears repeating here. Don’t post anything you would not want to see on the front page of the national newspaper.

Remember, even with all those social networking rules, engaging in social media is fun and informative. The various forms of social media provide great tools for keeping in touch with family and friends. Social networking is a wonderful way to promote midwifery and you can make friends across the world in your areas of interest and expertise. Here's a link to a post Medical Students and Social Media: How to get involved that has some good tips for using social media to your advantage.  If you keep the ‘rule of thumb’ in mind, you will enjoy the sense of connection social networking brings and even feel free to develop a blog and tweet, secure in the knowledge that you are safe professionally and personally because you know the rules of engagement.

I look forward to seeing you online!

This article was first published in the Australian Midwifery News, a publication of the Australian College of Midwives newsletter in the Autumn edition, 2011.  I'm reproducing it here with permission and with some extra information added.

Hastie, C. 2011, 'Midwives and social media', Australian Midwifery News, Vol. 11, No. 1, Autumn 2011, pp.

Health Care Hashtags Resource on Twitter

I've been learning more and more about Twitter. 

Twitter is a great resource for information about anything you may find interesting.  The river of tweets provides ongoing and rapidly changing news headlines. Tweets are text-based posts of up to 140 characters displayed on the user's profile page. At any moment, you can see what people are experiencing, what is important to them and what they are thinking. If the topic of the 'tweet' is your subject area, then you can choose to interact or not. The stream of information lets you know something of interest about what is important to you. Of course, it's sensible to only 'follow' people who's work/life and/or philosophy is of interest to you.

Last week, in response to something I tweeted, I was invited to join a scheduled twitter chat about the use of social media and healthcare on Sunday night.  Here's the link to the conversation. As the benefits of social media in health care, in particular, maternity services and information sharing, is of great interest to me, I joined in.  I found the process confusing at first. The conversation is like being at a big party where everyone is talking at once.  If you read the transcript of the session you will see what I mean.

How amazing that a transcript of the event can be produced and stored in a virtual file to be accessed at any time! That resource is so useful to me.  I was able to return to the information and read it at my leisure. What's the purpose you may ask?  That conversation has much to offer. I was looking for links to any useful information; I wanted to check out how others are thinking about the use of social media, the benefits and pitfalls of doing so. I was also interested in how practitioners are talking about ways to keep professionally safe using the medium; all of which and there was much more in that conversation to explore,  provides food for thought.

For those of you who are interested in health care, Twitter offers a real opportunity to engage in real time with people from anywhere in the world about your topic of interest, from the comfort of your own home/computer.  No need to travel and lose time in getting to different parts of the world to learn from people who know what you want to know; the only expense is your computer and internet server/connection.  A really important and liberating aspect of Twitter is that there is no 'status' to get in the way of discussion or communication on Twitter.  People who are technology nerds, CEO's, journalists, mothers, fathers, PhD's, scientists of all kinds, anyone who is interested, communicate and collaborate in an open, respectful way about their chosen topic.  If anyone is not respectful, they are 'unfollowed' - no one is interested in 'fighting' or engaging with those who 'troll' and disrupt.

This morning, when I was checking the twitterstream # tags for twitterchats on health care and the use of social media (#hcsm and #hcsmanz), I found a tweet about a site that compiled all the twitter conversations about different aspects of  health care.  That site is found here.   I noted that midwifery didn't have a hashtag, so have filled out the form to create a midwifery presence on that site.  I've just been exploring the site that hosts the hashtag directory  and that web page is interesting too, well worth having a look at and considering what an online presence is all about.

If you are interested in exploring the conversation about health care and social media tonight (Sunday) on twitter, join us using the hashtag #hcsmanz in your twitter posts. If you are not yet on Twitter, go here  to learn about Twitter and to open up an account (it's free) and start tweeting!  You can 'follow' me - which means you follow my conversation. You can tweet back anytime you like in response to any tweet. If you do follow me, then put the hashtag #hcsmanz in the tweet. After you post, you can click on the hashtag and that will take you to the list of tweets about that subject. Then you can save that search as a list which can be accessed, with updates, at any time.

I look forward to our conversations on Twitter.

What do you think, will I see you there?  Comments and questions welcome.

One born every minute: SBS documentary

SBS: Documentary

 The introduction to the US version of this 'documentary' explains:

"Every minute of every hour, a baby is born. But no birth story is ever the same. One Born Every Minute USA is an eight-part series that celebrates what it really feels like to become a parent.

Experience the high drama, humour and overwhelming emotion of child birth as new lives begin and others change forever.

This ground-breaking series observes the dramatic, emotional and often funny moments that go hand in hand with bringing a new being into the world, from the perspective of the soon-to-be parents and family, as well as the hospital staff".

In the lead photo to the US version of this series, a gloved hand, not the mother's, attempts to feed an obviously preterm infant, while the mother looks on with an intravenous line in her arm. The gloved hand is doing the important work.

The introduction for the UK version of the SBS documentary says this:

"Every minute of every day a baby is born in Britain. One Born Every Minute is an eight-part series that celebrates what it really feels like to become a parent, by taking a bustling maternity hospital and filling it with 40 cameras.

Filming from the reception desk and neo-natal ward to the operating theatre and birthing pool, this groundbreaking new series observes the dramatic, emotional and often funny moments that go hand in hand with bringing a new being into the world, from the perspective of the soon-to-be parents and family, as well as the hospital staff".

I am very bothered by both versions of this documentary. I am bothered because the lead photos (shown above and below) show a version of birth that is a complicated one.The mothers are not at the centre of care, which is where they should be.

The very pale baby being ventilated on the resuscitation trolley implies and transmits a subliminal message that birth is dangerous for babies.

That implication is wildly untrue and is a mean, cruel and dangerous association to put into the minds of people. That association undermines women's sense of self and sense of safety around birthing their babies.  I know sensationalism is what brings 'ratings' but good grief, preying on people's insecurities is despicable.

I was bothered because the assumption was and is, that the sort of maternity care that was shown in this documentary is 'normal'.

Yes, this maternity 'care' is normal if you think that women in labour should:

• be apologetic
• be treated like a nuisance
• be told how busy everyone is
• be surrounded by noise: telephones, pagers, beeping machines, talking
• be confined to the bed
• be strapped to monitors
• be left with only their partners and other support people
• have intermittent surveillance
• be attended by a technician that gives pain modifiers as requested
• be spoken to rudely
• be threatened
• be positioned in a way that ensures fetal distress
• have their babies handled roughly
• be separated from their babies

That view of normal maternity 'care' is what is at the back of the current wave of anxiety and mental health disorders in our population. How can I claim that? Our culture has been interrupting, disturbing and derailing mother-baby bonding and attachment processes for many decades now. Evidence is accumulating that early experiences shape personality, health and wellbeing.  Early emotional experiences have the most profound impact. There is nothing as emotional as birth. The corruption of the most primal and important experience in life, as evidenced in this documentary is startling in the way that such cruelty is accepted without any comment.

I have a very different view of maternity care and what is 'normal' during labour and birth.

In my world, a woman in labour is:

• continuously supported by a midwife she knows and trusts
• in an environment conducive to optimal physiological functioning - quiet, dimmed lighting, warm, private
• free to move, be mobile and adopt positions that feel right
• spoken to encouragingly
• free to focus on themselves and their babies
• supported by her partner and family as desired
• free to drink and eat as desired
• continuously monitored only if there is an indication to do so
• treated kindly and with respect
• able to expect her baby will be handled gently
• able to have the benefits of skin to skin with their babies at birth

What's your view of 'normal' maternity care?

Revamping the Blog

I've had a such a great time tonight, working with Sarah Stewart, the queen of using social media for updating about midwifery and education. Sarah has been wonderful, coaching me on getting the twitter link, the 24 hour virtual International day of the midwife link and putting the tags of my posts on the page.

Sarah's blog is well worth exploring as there are some great tips for anyone who wants to use this medium to get their message across. Sarah Stewart's blog  Sarah also has some timely advice for those of us who use Facebook and Twitter in terms of our professional responsibilities.  I think you will find what she has to say very thought provoking and useful.

I would love your feedback about the new look and any other suggestions you may have for my blog.