The virtual birthing unit project/Introduction for educators

Context of the Second Life birth unit
Teaching midwifery students about their role in promoting normal birth has become increasing difficult with the medicalisation of childbirth. Despite being taught the evidence that supports physiological birth, the reality is that hospital policies, physical environment and medical surveillance restrict students’ exposure to normal birth.

Second Life is a virtual world that is accessed via the Internet. Second Life allows midwifery educators to simulate scenarios and learning opportunities that are not easily reproduced in clinical laboratories or real-life clinical situations. Second Life gives students the opportunity to practice their clinical thinking, problem-solving and decision-making in a safe environment. This video Second Life and Public Healthexplains some of the ways that Second Health can be used in health care practice and education.

The Second Life Education New Zealand midwifery project has developed a virtual birth unit in which students can work their way through simulations of birth in which they support women and make midwifery decisions. Te Wāhi Whānau/ The Birth Place is a place where students can learn more about birth, the birthing environment and how the environment affects outcomes for women and their families. It aims to support students as they learn about integrating research into practice, and develop problem-solving and communication skills. This innovative project will also provide opportunities for collaboration with other students and midwives, as well as Second Life users, in a safe environment that has no restrictions, unlike the real life environment in which they work. The intention is not to replace face-to-face or real life clinical experience but to augment the current programs.

Here is a video Te Wāhi Whānau/The Birth Place that demonstrates what the birth unit looks like, how it was designed and developed. It also explains how educators can use Second Life to explore the tension between the increasing medicalisation of birth in hospitals and normal birth in a more natural environment.

First stage of the birth unit project
The birth unit project is part of a wider project investigating the use of Second Life with adult learners. The midwifery aspect of the project has been a collaboration between the Otago Polytechnic and Christchurch Polytechnic Institute of Technology schools of midwifery, based on their three year undergraduate midwifery degree programs. Sarah Stewart and Deborah Davis are leading the midwifery elements of the project. Carolyn McIntosh and Ruth Martis are coordinating the project in the two schools of midwifery. The midwifery team acknowledge the invaluable contribution of other SLENZ team members - Dr Clare Atkins, Leigh Blackall, Todd Cochrane, Aaron Griffths and Terry Neal.

The birth unit project has evolved into two stages which have been designed to meet the needs of students with a range of learning styles. The project expands the range of media that are currently being used by Otago Polytechnic and Christchurch Polytechnic Institute of Technology and has been designed for use both on and off campus.

The first stage has been developed for the first year midwifery students. These students have midwifery clinical knowledge at a beginning level so the four learning activities aim to stimulate thinking about birth and birth environment in a general context. The learning activities are designed to take students on a journey as they consider what is an ideal birthing environment in Second Life, explore alternative birthing environments, identify aspects of the virtual birth unit that may not be ideal in social and cultural contexts other than that of the New Zealand Pakeha context, and apply their learning to their own midwifery practice. The learning activities are formative activities. They are voluntary, will not be assessed and do not contribute to the overall marks for students' courses. However, they are designed to complement the students' courses and studies. Informal feedback will be provided by lecturers at the sessions in Second Life, on Facebook and the face-to-face tutorials.

Second stage of the birth unit project
The second stage of the project has been developed for the second and third year students, with a clinical midwifery focus. Here is a video that demonstrates how Second Life can be used to support health care students as they learn about clinical practice.

The normal birth scenario has five scenes in which two students work together as 'midwife' and 'mother' throughout the time frame of the mother's labour and birth. The midwife will be required assess, plan and act on information and behavior provided by the mother. At the end of each scene the midwife will receive feedback from the mother, and be able to self-assess her own performance. The midwife will also be required to document her actions and submit them to lecturers for feedback at a later stage. Here is a brief video that gives an overview of how the normal birth scenario can be used for midwifery education.

The second stage of the project will be available to students from the 11th August 2009.

Here is the link to the information about how to use the normal birth scenario.

Preparation for Second Life
Students will be briefly introduced to Second Life in the face-to-face context and then supported to continue working through the learning activities at a distance, at times of their own choosing. An orientation package has been developed that will guide them as they set up avatars etc. Lecturers will be available in Second Life every Friday at 10am to support students in-world.

Students will be asked to join a Second Life group called "SLENZ Midwives". This group will be a closed group and admit only students and midwives who are involved with this project. This will enable students to see who else is a member, when they are in Second Life and communicate with them. It will help students and lecturers meet each other and share resources and learning experiences. The group will be administered by Sarah Stewart, Deborah Davis, Carolyn McIntosh and Ruth Martis.

Students will also be asked to join the SLENZ Stuidents' Group. This will allow them to receive group messages and set the birth unit as their 'home' in SL.

Facebook classroom
A group has been set up in Facebook that will act as 'classroom' for the students. The students will be asked to join. The group will be a closed group and admit only students and people who are interested or involved with this project. The group will be administered by Sarah Stewart, Deborah Davis, Carolyn McIntosh and Ruth Martis.

This classroom has been designed as a place for students and lecturers to discuss their learning and support each other. It will also be a place where students can deposit their learning artifacts so that educators can monitor their progress.

NB: Educators do not have to be 'friends' with students to join the group. The only information about each other that members of the group will have access to is each member's front page - members will not have access to any personal information or updates unless they make a specific member a 'friend'.

Timeline 2009
July 6th First year midwifery students will be sent the link to the introduction page and invited to start working their way through the learning activities. July 20th Second and third year students will be sent the link to the introduction page and invited to start working their way through the learning activities that have been designed for the first year students. This will help them build their skills and confidence.

11th August Second and third year students will be sent information about the normal birth scenario.

September Evaluation of the project

Role of the midwifery educators
The main role of the midwifery educators is to support, encourage and motivate the students as they work their way through the learning activities and normal birth scenario. This is a crucial role as evidence shows that students' learning experiences in Second Life are much improved if they are able to process their learning with their lecturers.

Lecturers may support students in a variety of ways such as instigating discussion in tutorial sessions, meeting students in Second Life and contributing to discussions on the Facebook page. All support that is given by lecturers to this project and the learners to make this project a success is hugely appreciated by the SLENZ team.

The second role of the lecturers is to read the documentation that is generated by students in the normal birth scenario and give the students feedback. The aim of asking students to submit their documentation is to get feedback about what they are doing well and how they can improve their documentation in the future. Look at the section below for more information about how to do this.

Educators are encouraged to get a Second Life avatar, join students in Second Life and list the the names of their avatars in the Facebook group.

For further information, please contact:

Sarah Stewart (sarahstewart07@gmail.com)

Deborah Davis

Carolyn McIntosh

Ruth Martis

How to get to Te Wāhi Whānau/ The Birth Place in Second Life
Go to the Second Life website to set up an account, create an avatar and download Second Life onto a personal computer.

Here is an orientation package that provides information about how to get started in Second Life.

To go directly to the Te Wāhi Whānau/ The Birth Place in Second Life, click on this slurl.

For further information, please contact Sarah Stewart (sarahstewart07@gmail.com)

How to access the midwife/student's documentation and give feedback
One of the important elements of the normal birth scenario is encouraging the students to document all their decisions, midwifery actions and advice they give the woman - just as they would in 'real life'. Once they have completed their documentation, they will post it into the filing cabinet in the Midwives Office, in the birth unit.

Educators are encouraged to read the documentation and give feedback to the students about how and what they have written, as a means of increasing their learning. Thus, it would be greatly appreciated if educators would do this every time they visit the birth unit.

1. Make sure that Sarah Stewart (sarahstewart07@gmail.com) knows your Second Life name so she can make sure you have access to all the resources involved.

2. Go to the Midwives Office in the birth unit.

3. Click on Filing Cabinet so you can retrieve any documentation that is in the cabinet.

4. You will be sent an folder called "Filing Cabinet" - click onto "Keep".

5. Go to your Inventory (bottom right hand corner of screen) - click onto the tab called "Recent Items". Then, click onto the folder called "Filing Cabinet" to open it.

6. Inside the "Filing Cabinent" folder will be all the notecards that students have deposited for feedback. Open each notecard, read it and make any comments that you wish. Then click "Save".

7. To send the feedback to the student concerned find the profile of the student, open the profile, drag your feedback notecard out of your inventory and drop onto "Give item" which is at the front of the student's profile. The next time the student is in Second Life, she will be able to read your feedback.