The Dr Elizabeth Newnham Session

I thought it was wonderful. I would recommend anybody who is thinking of doing a PhD, to do one because it is very flexible, its creative, it is inspiring. I mean the downside is the money…it is rubbish…

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Listen to the Interview with Dr Elizabeth Newnham

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Q&A with Dr Newnham…

What is the title of your PhD: The epidural complex: A critical ethnography of hospital birth culture

Where did you complete your PhD: UniSA, School of Nursing and Midwifery

What year did you graduate: 2016

What undergraduate degree/s have you completed: Bachelor of Midwifery and Bachelor of Nursing (both Flinders); Bachelor of Arts (Hons), Adelaide Uni

What is your job title, today: Midwifery Lecturer, Griffith University

Professional Page
LinkedIn
Towards the Humanisation of Birth
Humanising Birth: A guide for practice e-book
Transforming Maternity Care Collaboration

Transcription

Interview with Dr Elizabeth Newnham

Tamara – Today we’re talking to Doctor Elizabeth Newnham, who graduated from the School of Nursing and Midwifery at University of South Australia in 2016. Following the completion of her PhD, her thesis, “The Epidural Complex, A Critical Ethnography of Hospital Birth Culture” was published as a book under the title of “Towards the Humanization of Birth. A study of Epidural Analgesia, and Hospital Birth Culture” in 2018. She is passionate about the role of midwives in birth and this drives her research interests on cultural and political analysis of birthing practice policy and ethics. She has held leadership roles in the Australian College of Midwives and is currently International Advisor on the Midwives Association of Ireland Committee. These days you will find her at Griffith University, though her role allows her to spend most of her time at home in South Australia, her career path is as interesting as it is varied.

Welcome, Liz, thank you for coming today.

Steph – So just so just set the same. We’ve already heard what your current role is, but we want to expand on that a little. What are you doing right now? What is your current role?

Liz – So my day I mean, my role is a lecturer in midwifery at Griffith University, and my day can look very different depending on where we are in the semester or the sort of the plan for that day. So for example, I’ve just finished a lot of student marking. That that can takeover. It’s interesting because it ebbs and flows as well. There are these huge kinds of pressure times in that academic role as far as I’ve experienced it, and then there are times when it just eases off a bit, and you can sort of spend more time thinking about what you might want to do in the future or work on some research projects. So yeah, my day usually involves some kind of writing, some kind of reading, some kind of talking to somebody, and that might be teaching students or trying to carry on with my own research.

Tamara – So this time during Covid because you are based in Adelaide, but teaching in Brisbane, it’s not really being a major difference for you in terms of having to a lot of students having to pivot from face to face.

Liz – No. So Griffith University already had committed to what they call their 5th campus, which is online campus. I’m teaching primarily in the postgraduate Masters of primary maternity care and that was all online and that was the reason that I could be a bit flexible. The undergraduate program still has face to face. And so, there was more that had to be done in that in that space. But there was still a lot online already.

Tamara – Be difficult to teach somebody how to birth a child online, I suppose.

Liz – Yeah, you do that. Certain things you need to be….

Tamara – So going back to the origins of your PhD, were you first to go to University in your family? Or did your parents go to uni?

Liz – Yeah, both my parents went to University and my dad actually taught at the University and he was a lecture in the philosophy of Education. And my mother was a teacher, and she was music and maths primarily, so she had done a degree in, I think she did music. Oh, actually sure. I think it was music and then a Dip Ed so that was sort of the way into teaching. But then yes they were both at University, but it wasn’t necessarily an expectation either.

Tamara – So when you finished school, did you know what you want to do? Did you go to uni straight away? You had it at all mapped out for you there.

Liz – Yeah, I had no idea what I wanted to do. I matriculated with languages, arts, English and classics, and I went to University enrolled in a BA and ended up majoring in politics by default because there was just a really good lecturer there, so I ended up taking more politics than anything else. But I also did study some anthropology and feminist theory, and so it was a really good grounding, actually. Then in my second year I was in a relationship and fell pregnant with my first baby. Gave birth for the first time and just went ‘Oh my God that was amazing. I just need to get more of that and like how do I do that’? So, then I just jumped straight over. I realised I had to do nursing first. Did that. Thought I would hate it but actually enjoyed it quite a lot. Then did my midwifery education and then started working as a midwife. Then I went back, finished my BA in politics about 10 years later and went into the honours stream and did an honours thesis.

Tamara – So before you even started, your PhD had been at University forever.

Liz – Yeah. I’ve got three Bachelor degrees, which is kind of over the top.

Tamara – I suppose it prepares you for life in academia.

Steph – So where was your Bachelor of Arts?

Liz – Adelaide University

Steph – And then you did your nursing Adelaide as well.

Liz – And I did my nursing and mid at Flinders and my PhD at UniSA so I’ve actually been an alumnae at all three universities

Steph – It just means three times the email’s asking for money.

Liz – Exactly

Tamara – So you went straight from school to uni?

Liz – Yeah, but I sort of took a deviation with motherhood and stuff. Oh, no I took a year off in between, but I did have a year off in between the school leaving and the University beginning.

Tamara – OK, So what did you do in that year?

Liz – Just sort of travelled a little bit and not much, actually. I think that I tried to get a job.

Tamara – Do you think it was a good choice to take a year out. Would you recommend your kids take a year out?

Liz – I think it’s where you’re at. I don’t think there’s a real answer to that, no.

Tamara –  I had 16 years out, yeah.

Liz – See you well, you know.

Steph – Different folks, different strokes for different folks. At what point in the moving between your bachelors and motherhood did you decide you wanted to do a PhD?

Liz – That came after my honours degree, so I did that over two years. Part time with really excellent supervisors in the Politics Department. Carol Bache and Chris Beasley who are quite well-known feminist researchers, and they were just really great and I did a for Foucauldian Genealogy of Australian Midwifery and I just loved it. So, then I went right, I want to do more of this now. You know it’s a bit like having the baby and going. How do I get more of that? I was like how do I get to do more of this? OK, what’s the next step? Do a PhD. I didn’t really know what I was getting into actually, and I think maybe that’s the case for some of us. You know, I guess some people know exactly that path, but for those of us that stray into it semi accidentally….

Steph – Suddenly you find yourself in a PhD going “how did this happen”?

Liz – Yeah, and I remember the day I emailed a professor at UniSA. There was only one Professor of Midwifery in the state at that time.  Adelaide Uni he doesn’t have Midwifery. So I emailed her and said I want to do a PhD. Can I do it with you and she said, yeah, I’m overseas, that sounds great. Let’s talk soon and that was great and I just remember the day that I walked in to meet her and the woman that would be my Co supervisor – Jan Pincombe is the Professor’s name and Lois McKellar was my Co-supervisor and I just remember walking out after that meeting going I’ve found my place. Like this is, you know just insanely comfortable. And feeling so grateful in those first few weeks that I could actually spend time thinking and planning and writing. And yeah, it was incredible.

Steph – So did you get to pick your topic? Then you had a lot of control?

Liz – Yeah I picked my topic, I picked my methodology. So in the emails, Jan said, oh, that sounds great. Maybe you could do it like this. So I wanted to look at epidural analgesia and….

Steph – For those of us who don’t know, Could you just explain that?

Liz – Yeah, so epidural analgesia is a common form of pain relief and it’s sort of like an anaesthetic type block. They use anaesthetic drugs and pain-relieving drugs that go into the spinal fluid and it basically gives you a numbness, from the waist down and it’s

Steph – I think I’ve heard this described by friends who have had kids as just nothing.

Liz – Yeah, nothing below the waist, yeah? Yeah, and I mean sometimes they don’t work as well as that, but generally speaking it’s a much safer kind of analgesia than, say, general anaesthetic for surgery, so it’s quite good in that way, but my main problem with it was that I didn’t think women really knew what they were…

Steph – Signing up for?

Liz – Yes, so that was my issue. So then, Jan suggested a couple of things and I sort of knew what I wanted to do and she was very relaxed about letting me do that and just kind of holding the sides while I made my….

Steph – So were you able to get a scholarship for while you studied?

Liz – Yes. I applied for a scholarship and was just over the moon when I got the letter was just before Christmas in 2009, I think and yeah I was just overjoyed about that opportunity. So grateful

Tamara – Yeah, it is a relief. So, your project was exploring that experience for women in hospitals and then you did an ethnography. Can you explain what an ethnography is, and how did you do it?

Liz – Yeah, ethnography is a study of culture, so it comes from it sort of comes from anthropology, but their version of ethnography was much more about sort of living in these, you know. And it was all a bit racist when you look back at the early anthropologists. And they write these big books. But then sociology started getting in on the scene and they would very often look at urban situations and started looking at their own culture. It’s become something that you can really just take and use to just explore any kind of culture. For me that was wanting to look at hospital culture and how does that actually play out when you’re in there? Because we know as a professional body, you know, as a professional group of midwives, we have this kind of speak that we speak and this philosophy that we hold on to. But I think there’s a difference between what we think we do or what we want to do and what we actually do. And that’s influenced by lots of different things and so that’s sort of what I wanted to really unpack. How do I do it? I did observation on a labour Ward, so I sat in a Ward. I didn’t go into the rooms of the women because I didn’t want to knock on people’s doors and say can I?

Steph – Be part of this really personal experience.

Liz – So that was more about being in the general area. But then I recruited women in the ante-natal, when they were pregnant, and I interviewed them twice.  And then I asked if I could attend their birth at the hospital and six of those women said that I could do that and then I interviewed all of them postnatally as well. It gave me a lot of data and then I also did document analysis, so with ethnography you often have this what they call triangulation of data. So you have your observation. Sometimes interviews or informal interviews, often an analysis of documents or artifacts,

Steph – So you get the story from a range of angles.

Liz – Yeah. It just gives it more rigor.

Tamara – And so, how long did it take you to do all of that? Did you have women all pregnant at the same time? Or….

Liz – Yeah, the thing about pregnant women is it does take you nearly a year really to see what happens. I did recruit women from after 20 weeks. I think it was the first interview was about 28 weeks gestation so how long did it take me? I did six months in the labour Ward 2-ish days a week and then the interviews with them. It was probably a year of data collection all told.

Steph – And were you asking women about their whole pregnancy, birthing experience, or you really focused on their drug experience?

Liz – I was focused on – the questions I asked when they were pregnant was about their thoughts about birth and what the influences were and how did they come to their decisions? And it was really just so interesting to hear about…. Yeah, there was one woman in particular who changed. She wanted an elective caesarean section when I met her in the first interview and throughout the pregnancy, she sort of went on this journey and changed her mind about all sorts of things, and it was just really interesting to hear about what women hear about birth.

Tamara – Were they first time mothers?

Liz – Not all of them. That woman was, but some of them no. I didn’t want to limit it to that and some women, when they spoke about their previous experiences kind of added to my collection of stories. But I was interested in yeah, their experience of Labor and pain and pain relief. So it was just sort of the whole of it, really.

Tamara – What was the most challenging part of that of that of well the PhD – of the whole field? Ethics was maybe an issue?

Liz – Ethics was an issue for me. It took me eight months to get ethics approval, and you’re in a time, you know, limited time. So, um, I actually wrote the 1st paper I wrote from my PhD was about the ethics.

Steph – As a how to?

Liz – Yeah, well just mentioning some of the issues that I had.

Tamara – Maybe we should sort of preface this with what ethics is in research and that ethics is a process that every researcher needs to go through when they’re working with humans and a committee who are responsible for making sure that we as researchers don’t cause any harm or risk or burden, particularly when populations are vulnerable, which, well, most populations are vulnerable in some ways. Pregnant women are particularly vulnerable as well.

Steph – So they’re there for a good reason, but, still like 8 months….

Liz – Yeah, and I think the problem with ethics committees, and this is one of the things I put in that paper, is that they’re really, I mean they come out of the sort of Nuremberg trials and the unethical research that happened during the Second World War and then sort of builds on from there. So it’s absolutely fabulous that they are there. They don’t tend to understand qualitative research, or at least the way that often you have to fill out the form….

Liz – It lends itself to a more quantitative kind of.

Tamara – You’re not drawing blood, you’re not taking organs…

Steph – How do you explain to someone the burden that you might, or the stress you might be putting them under when you have to describe a conversation you haven’t had yet.

Liz – Exactly, and because ethnography is very explorative, you can’t, you don’t know exactly what you are going to find, and interestingly they asked me to do two things, which I thought were less ethical, actually, in practice, which was, the women weren’t supposed to know that it was a… They asked me to change my information sheets to say that the study was about pain relief in general rather than just epidural because they thought it would be too biased, which again shows a misunderstanding of qualitative research because you come into it with a bias and you’re very open about that, which is very different to quantitative research. And the other thing they asked me to do – get consent from the people on the Ward or that the clinicians could sign an opt out form.

Steph – How does that work in practice?

Liz – So I told everybody that I could and had a few meetings and introduced myself to the staff and said I’m here. I’m doing research. This is what my study is about I’m going to be watching and observing and taking notes, and if anybody doesn’t want to be part of it then you can opt out and there these forms that I had. Nobody signed one, of course. I thought that was interesting…

Steph – I don’t even know how it would work? Do they wear a sticker saying Don’t look at me?

Liz – I know.

Tamara – They’re like the pixelated person in the picture.

Liz – Yeah, I know. So it’s interesting. I mean, and that’s the problem again, with thinking that everyone has to sign a consent to opt in though – you can’t really do that with ethnography either so I can’t actually remember what my plan had been, but it wasn’t that.

Tamara – Yeah, because I imagine that, especially when it was very busy, if somebody had said I don’t want to be observed, would you have to close your eyes when they walk past or something, you know?

Liz – Yeah, and the thing is that people aren’t named. There’s absolutely no possibility of identification at that level. So, anyway, it isn’t unethical…

Steph – So you persisted in the face of challenge by writing a paper about it?

Liz – Yeah

Steph – You used your time wisely. So, the flip side of challenges – what was the most exciting thing about your PhD?

Liz – The most exciting thing was grappling with the analysis. No, that wasn’t exciting thing. The analysis was hard and I spent a good year or so just not really sure exactly how.

Steph – You are going to pull this together?

Liz – Yeah, and then I remember, this one moment I was actually drawing it all. I was sort of doing these mind mappy-things and circles and links and this leads to that and I and it suddenly it all fit together, and it was like a Eureka thing. I mean it wasn’t as important as discovering whatever it was gold. But um. It was just such a good feeling to have felt like it had… something had come out of that, that I thought of myself, and you know? Yeah it was amazing.

Tamara – What came out of your project in terms of, did it affect policy? Did it affect the experience of women in hospitals for childbirth?

Liz – Kind of. So what happened after that? I was able to actually approach the perinatal guidelines, so SA has a state-wide guideline for Obstetric and Midwifery practice. I did approach them with a few concerns about how analgesia was presented, I guess. There was no guideline at all, so we did write a guideline basically and I was the lead author on the epidural section. It was run by an anaesthetist, she took the whole thing, but it included lots of different forms of analgesia and also at the beginning of the guideline we put a bit of a prologue about things that supported physiological birth and other that other things need to be considered as well.

Steph – And those guidelines are still in place?

Liz – Yeah

Steph – Wow, yeah, that’s quite an outcome for a PhD.

Tamara – Best way to describe this learning Journey Yours is I’ve affected policy, so well done you. So based on your experience as a student and as a now a supervisor of students, how would you describe the life of a PhD student?

Liz – I thought it was wonderful and I would recommend anybody who is thinking of doing a PhD to do one because it’s very flexible and I mean, I guess for some people that doesn’t work, so well, but for me it did. It’s creative, it is inspiring. I mean, the downside is the money’s rubbish.

Steph – Get used to living on two-minute noodles.

Liz – Yeah, I went from my sort of, you know, a permanent clinical position in the hospital where I was earning pretty good money to a PhD scholarship. So that was that was quite disappointing. But you know, I guess it’s what drives you as well. That’s the thing and I would just say, follow your interests in that way, if anyone’s thinking of doing it.

Tamara – Would you do it again?

Liz – Yeah, absolutely

Tamara – That was a very quick yes.

Steph – And you are not that far out, so the trauma has not quite faded.

Liz – No, I mean it is, uh, it changes you as a person for sure. Like it’s a It’s a life changing thing and it’s really hard. Like I you know it is. It is a hard thing to do. But life is about hard things, isn’t it?

Steph – So your decision to go from a clinical kind of role into a PhD, obviously that was a very helpful to you because your site of data collection was in a clinical setting. What would that have looked like if you didn’t have that clinical background? Would you have done that project without your clinical background?

Liz – Yeah, that’s interesting question, actually. I mean, you can. Certainly, ethnographers go into situations where they don’t and there’s a whole kind of spectrum of where you sit as an insider slash outsider, yeah, some.

Steph – Communities can be quite insular.

Liz – Yeah. And so it definitely helped because I had an in, because I knew well I knew some of the people and I knew the language so when they were speaking I could understand what was being said and you know. The other side of that is separating yourself out from the clinician as the researcher and then having to step back and not say things to women. For example, when I was observing their labour and not being involved and not being supportive. And in fact, I remember one woman I was basically sitting in the corner for her whole labour. I gave eye contact just every now and again and said a couple of things as I came in and out of the room just so it wasn’t completely just a weird person hanging in the background and we met twice for the interviews. I remember her saying in her personal interview, ‘I’m so glad you were there. It was, you know, you were so supportive’. And I just thought, I didn’t actually do anything…  But that was that was hard, and if anyone wants to do an ethnography they will come into that literature very quickly about where you sit on that spectrum as an insider or an outsider. And there are pros and cons to both.

Tamara – Totally, I mean being able to understand the language of what’s going on in front of you and not have to go and ask and do quick into informal interviews to understand an interaction that just occurred must be a bonus for everybody because if especially for the clinicians.

Steph – So you came into your PhD already with skills. What skills that you gained in your PhD are you now using in your current work?

Liz – Writing. I really learned how to write doing my PhD and probably thinking. We don’t really talk about thinking. It is a special kind of thinking. It takes you to another sort of level of…. I don’t know, critical thinking.

Tamara – And so what was your first role after you finish your PhD and what roles have led you to where you are today?

Liz – I took a position as a lecturer in midwifery right at the end of my PhD, so there was a position going at UniSA, which I applied for and was successful in, and that was partly because I’d been there doing my PhD, doing casual teaching and stuff. So after that I took a position in Ireland, actually in Trinity College Dublin and that was partly because I just wanted to do more I suppose. I just wanted to see what else was there…

Steph – In the field or outside of Australia.

Liz – Outside of Australia and I was just feeling a bit restless. I had a couple of other things going on which I won’t go into, but it was just the best opportunity and that definitely came directly from having done a PhD and having published work from it and then taking the job there.

Tamara – And so were there any many cultural differences working in Ireland compared to here as both in the field of midwifery but also in academia?

Liz – Yes, there were. And I suspect my lovely colleagues over there – I probably just put my foot in my mouth all the time without actually knowing it, but nobody really ever said anything. But I know I made some wonderful sort of friendships and networks over there and learned a lot. Partly by having that other, you know, having that other experience. And there definitely were cultural differences, which I probably cannot go into now because it’s huge.

Tamara – And also the opportunity to teach at that beautiful University.

Liz – Yeah it was amazing. Yeah.

Steph – Was your PhD by publication or thesis?

Liz – No, it was the thesis. I did publish a few papers, I think maybe three while I was going and then I’ll just put them in as extras, but they weren’t – it was a complete thesis.

Tamara – And where does your thesis sit these days?

Liz – It used to hold my monitor up on my desk. But I found something slightly taller on my shelf.

Steph – You should have written more words. So, I’m probably jumping ahead a little bit, but what is a PhD to you then?

Liz – What is a PhD to me? I mean technically it is a research training program, isn’t it? It teaches you how to do research, but I think it’s definitely like a springboard or something. It launches you into a whole other place and it gives you I guess, coming from a position of being a midwife and being a clinician and trying to change things on an individual level. Having that option, being able to do research and publish papers and speak at international conferences and network globally. I think gives it just gives you more of a voice and yeah, and it’s a political act for me. It’s about you know, making change.

Tamara – And do you think there’s ways that research can be better promoted in the world so that people can value more of the work that we do in less anti-intellectualism.

Steph – Or at least that you know research doesn’t stay in Theses and never makes it to the out to the world.

Liz – Yeah, it’s an interesting one, isn’t it? I think I mean that anti-intellectualism stuff really worries me a lot and I don’t know. It’s probably always been there. You know, and there’s certainly lots of different kinds of knowledges. Knowledge doesn’t have to be only produced in universities. I actually worry about what happens, what’s happening in the University sector and the kind of contraction down to really small, not small, but really focused, outcomes based, sort of…

Steph – Yeah, translation is great, but knowledge generation is still important.

Liz – Yeah, like, how do we know that something that someone’s working on in some backroom that doesn’t really have a product at the end of it that we know of isn’t going to be really useful down the track?

Steph – Some foundation for something else.

Liz – Yeah, and I feel that we’ve lost any kind of value of that of, and I know that money’s an issue, and all of that stuff, but it just makes me feel a bit flat, but, so I don’t really know the answer to that.

Steph – Oh, we only ask the simple questions.

Liz – Yeah, I mean, I really do think that University should be publicly funded, and I think this whole Covid thing has just shown the vulnerability of institutions based on 70% casual workforce is ludicrous and how they expect us all to keep going.

Steph – Universities seem timeless, and then something like this happens and it’s like we’re so close just falling over.

Tamara – Yeah, the foundations are very, very, very, shaky.

Steph – Actually, bearing that in mind, for people who are contemplating a PhD and perhaps a future career in academia and given the numbers of people who start and who complete PhD’s, do you recommend people do PhDs?

Liz – Not as a box to be ticked, but I think if you have got a fire in your belly about something and you are passionate about something, that’s what I would say. I would say follow your interests. Don’t be sort of tempted to do it a different way.

Tamara – You are spending an awful lot of your life writing about it, reading about it, talking to people about it, that…

Steph – It might set the tone for your future career as.

Tamara – Yeah, well and you got to really love it, or be very passionate about it. It can’t be just something that you just pick up for the end result.

Liz – Yeah, I don’t. I mean people do that, but it might not be as rewarding.

Steph – So what advice would you have for people who might be contemplating their undergraduate course like still at the beginning, you know their 17-year-olds who are being asked to decide what to do with the rest of their lives.

Liz – My advice to them would be, don’t stress.  Like people, meander, like I did, and you might not know exactly what you want to do with the rest of your life at 17. Again, I would just say follow your interests. Do the things that keep you happy and fulfilled and wanting to do more rather than, you know things that you think you ought to be doing or that other people think you ought to be doing.

Tamara – This question is about the myths that you hear about academia and about PhD and about being the doctor. What is one of those myths that you would like to just put a pin in. It’s not true. Or maybe it’s a little bit true, but not really.

Liz – This one might have been said already, actually, but that that response that people have of are you not a real doctor…

Steph – I find myself saying that as a joke when you go Oh, you know it’s Doctor Stephanie Champion. They’re like Oh, a doctor? I’m like I’m not a real doctor.

Liz – Because actually the title doctor for a PhD existed first and the medicos took over the time. So probably that one, yeah.

Tamara – Have you ever had an opportunity to reflect on your time doing a PhD before?

Liz – Not in this kind of way, probably with other with colleagues and stuff. You know, like we’ve probably done a bit of reflecting over the years, which we did. Yeah, not really. It’s been a really good opportunity actually. Because I think the path that happens after the PhD can be also hard to navigate.

Tamara – Yes, that may be the topic of our next podcast series. We’ll get you back.

Tamara – Well, thank you very much for your time and your generosity and not getting a speeding ticket on the way from McLaren Vale.

Liz – Thanks, Tamara, thanks Steph.

Tamara – Thank you.