Library clips

It’s funny, I just finished reading a book that has nothing to do with my usual interests, but yet it relates so much. This put a smile on my face as what I’m learning is not confined to a bubble, I’m learning the essence of things that transfer, relate and apply to anything in life. Which suits me fine as parenting is just around the corner

Men at Birth, Edited by David Vernon

“I read the standard birth texts…they told me about the physiology of birth. They told me how things should work and a bit of why things worked they way they did. They told me about ‘normal’ labours, ‘normal’ pelvis sizes, normal ‘contractions’ and ‘normal’ women. Unfortunately the texts use the term ‘normal’, when they mean the mathematical term ‘mean’, ‘median’ or even ‘mode’. But I found all the talk about ‘average’ births to be unhelpful because I knew from friends and family that every birth is an individual experience.”

“Interestingly, I found it was the birth stories that really gave me a handle on birth. They told me the practical things from an individual’s point of view and they told me how it felt for a woman to give birth. They told me about real experiences. There were no ‘normals’ here. Amd the stories told me how things did work, and sometimes differed from the textbook statement on how things should work.”

“These stories were not attempting to meet the rigours required of a textbook. The stories left it up to the reader to decide what the ‘take home message’ was from each story. For me, the stories made our upcoming birth all the more real, all the more exciting and something that we really looked forward to.”

What I got out of it is that midwifes are facilitators in uncertain situations.

No two births are alike, and nearly all births don’t fall on the planned date.

Every “mother to be” is different and the midwives both have to deal with people and their situation. They don’t know what to expect as they have not seen the “mother to be” going through a birth, either has the “mother to be” if it’s their first (even if it was the second or third baby, not every birth is the same anyway, so not even the “mother to be” knows how she will react to new circumstances, especially in different environments).

The “mother to be” can tell them their plan, but they don’t even know themselves what’s coming.
The midwife also has to deal with the surrounding environment, and the actual birth itself. When all this comes together, it’s a very unique situation, so the job of the midwife is to go with the flow and facilitate.

No best practice method or text book is going to teach a midwife these subtleties, but the multitude of stories and of course actual experience are, as they deliver the uniqueness of experiences.

Reading a hundred stories, and attending a hundred births is going to do wonders to their ability.

Not only because these stories are the antithesis to “normal” or “average” or “best”, in that they cover so many different contexts and situations, but also because stories leave more of a memorable imprint in our minds (something to do with visual, narrative and emotion).

This post is about facilitation, pattern-recognition, decision-making, sense-making, context, uncertainty, narrative, adaptive behaviours in relation to birthing and midwives.

They learn to respond and adapt to uncertainty and rapidly changing situation (real rapid, by the minute).

These stories and experiences imprint a pattern in their mind and attach an emotion which has great impact for recall, and to also be able to take fragments from different stories and blend them to the situation at hand.

Stories have know-how woven in pattern form which is in tune with how our brain best functions.

They are more aware of the thousands of different things that may happen at a birth - what fails, what surprises, what’s available at hand (eg having to think on the spot to facilitate a birth in a toilet) - a text book ain’t gonna cover this.

David Snowden refers to this, and I have posted about this concept:

“…we live in a world subject to constant change, and it’s better to blend fragments at the time of need than attempt to anticipate all needs. We are moving from attempting to anticipate the future to creating an attitude and capability of anticipatory awareness.”

David Snowden from the same article:

“…we have demonstrated that narrative assessment of a battlefield picks up more weak signals (those things that after the event you wished you had paid attention to) than analytical structured thinking.”

This applies to Gary Klein’s work on decision-making via Erich Nehrlich:

“The situation is evolving constantly, and an expert will know which elements are important to follow, and which are not. The expert has been in a situation enough times before that they can mentally simulate what should be happening, and recognize when things are deviating from their expectancies, which is a sign of danger. Another good example: a fire commander goes into a building for what he thinks is a regular kitchen fire. As he’s scouting around, he realizes that it’s not behaving like a normal fire. It’s too quiet, and too hot. He doesn’t like it, and pulls his team out of the house. A few moments later, the floor of the house collapses - the fire was actually in the basement. He had no idea that there was even a basement, but his experience let him know that something was wrong, and that he needed to figure out why the situation diverged from his expectations before he continued.”

“…how experts “see the invisible” (because they know what signs to look for), generate a course of action, mentally simulate the results of that action, and then carry it out”

Mark Gould has more on decision making and how it relates to KM:

“…what impact does KM have on people? Exactly how will they be better at decision-making as a result of our work?

My instinctive answer is that I want them to become experts (and therefore able to act swiftly and correctly in an emergency) in whatever field they work in. That means that we should always return our focus to the people in our organisations, and respond to their needs (taking into account the organisation’s direction and focus), rather than thinking solely about building organisational edifices. The more time that is spent on repositories, processes, structures, or documentation, the less is available for working with people. In becoming experts in our own field, we also need to be more instinctive.”

Brad Hinton on Dave Snowden’s pattern recognition:

“Snowden explained how human decision-making is based on pattern recognition. Our brain sees multiple fragmented patterns assembled to fit our needs in particular contexts. In decison-making, our brain makes a first-fit pattern from which we act.”

Steve Barth on decision-making and intuition:

“Even at the level of the expert or the executive, the human brain is capable of reaching conclusions and finding solutions to difficult problems by using and trusting “gut” feelings. When these decisions are based on deep background knowledge and experience, intuition can be just as effective a tool as analysis—and considerably faster.”

Erich Nehrlich on stories and memories:

“Stories are how we structure our memories. If you ask me about what I was doing on June 25, 1994, I’d say, “Um, what?” But, when you prompt me that that was the day that my friends Brian and Jen got married, I’d be able to tell you all sorts of details about that day. Our memories are not filed like a computer’s, with dates and times. Our memories are filed like del.icio.us, with tags on various memories that are associatively linked in a spaghetti-like fashion.”

David Weinberger on the knowledge creative:

“Implicit knowledge isn’t explicit knowledge that we’re not currently thinking about. Implicit knowledge isn’t there the way ore is buried. It’s “there” only in the sense that we can generate it when required. Most simply: That we can come up with an answer doesn’t mean that the answer was lying dormant in us all along. Answering questions is a creative act.”

David Snowden also refers to this:

“Critically fragmented material can combine and recombine in novel and different ways, a form of conceptual blending”

Text books will have a plan and the writing will be focused on achieving that goal. But stories don’t have an outcome to achieve, rather they are in the moment, they are raw, you hear lots of peripheral information and many other things that would not be included in a text book as those things may seem unnecessary or excluded as they are tangents or just the fact that they don’t belong in the narrow focus of the outcome. But it is infact these nuances that all come together to paint the holistic picture…just ask a detective

In contrast

What did I learn from the stories about hospitals and obstetricians?

They abide by procedures and processes that do not cater for the individual person. The “mother to be” is just a number, she is the average person, she is homogeneous. The system runs like a factory, it runs on control and risk management.

They are certainly not a facilitator, they are dominantly in control. They treat the mother as if she were the “fictional average person”, use medical interventions where not necessary, and need her out of the baby factory as quick as possible eg. inducing, episiotomy, epidural, vacuum, forceps, caesarian…

There is also something called the “cascade of interventions”, which refers to an intervention to fix a problem the previous intervention caused, and so on.

Whereas the midwife has continuity of care - she has a relationship with the “mother to be” from start to even after the baby is born. The midwife facilitates the situation, she interferes as least as possible, it’s seen best to let a natural approach arise as much as possible. This approach is more in tune with human behaviour and the natural dealings of the world, they are there to re-tune the situation where needed so it realigns itself and does it’s thing naturally, rather than take the force of control, overriding nature.

I guess they surf the biodiversity of the situation rather than try control the biodiversity itself, which is an oxymoron.

When you think of it, this approach is empowering for the “mother to be” as the midwife is facilitating her to reach her human potential, rather than taking over.

Of course all this translates into the workplace with leadership and a more self organising role based organisation.

Listening, respect, trust and sharing

This leadership role and knowledge worker empowerment are great conditions for knowledge sharing and transfer…especially listening skills.

Years ago, part of my wife’s Counseling diploma included some work experience, so I decided to tag along with her and did telephone counseling for 6 months (every Saturday). Our role was to tie people over and support them till they could get their usual help. The first thing we learnt is that we don’t give advice, instead we listen and support, just being there spoke volumes.

Of course lots of people wanted advice and solutions to their issues, but we were there to support them, trying to create an environment so they could see their issue and solve it with some guidance (like probing, triggers, re-framing questions, seeing same issue from someone else’s perspective)…much more empowering, much more personal ownership.

And of course lots of people just like talking, it’s like I wasn’t even there, then at the end of the call they would thank me. I think “listening” is the greatest thing we can do (for me it’s sometimes hard to sit back and not offer advice), but offering little building blocks so people create their own answer (or co-create) is much more effective. They now have a skill and may use it to adapt to new situations, or riff off that skill.

The more you listen, the more you are respected as people like to feel heard. Further to this their transactions with you lead to them being empowered, so there is something about you that is improving their life. And I think this type of transaction or relationship leads to trust. When we trust and respect people we want to do things for them. Ultimately this leads to sharing, and a high chance of transfer in what is being shared since we have come to know each others way.

And then there were the suicide callers. Having a framework is helpful with these calls, it keeps you grounded, but you still freeze, and the only way you can best deal with them is hearing stories and experiencing them. There is no time to search for a best practice when the person on the other end of the line is fading away. You have to immediately react, and somehow fragments of memories all come together into a decision.

Why am I writing about this?

My wife is expecting our first child in a couple of months and we plan to have a home water birth. We believe hospitals are only for sick and injured people, and this my wife is not.
But, if during the birth my wife displays signs of risk to her health and the baby, that the midwife cannot deal with, then we will transfer to a hospital.

For some interesting points of view on “birthing” in Australia, here’s a link to an episode of an audience based TV program called Insight. You can watch the episode online, get a transcript, see the comments, and also view the Cover It Live post program chat. Or download it. They are also on Twitter.