Jane Webster PhD Researcher TUTORIAL RECORD 2022-23
Supervisors
Dr John Miers
Dr Hannah Ballou
Geoff Grandfield
How can choice and confidence be encouraged in the experience for birthing Mothers through Illustration Animation practice?
“There is no such thing as a normal birth.” Emily
McMorrow –Maternity Support Worker.Working in collaboration with Specialists, Midwives and Maternity support workers at Kingston Maternity Unit, this research aims to document and evaluate how illustration animation practice, as a documentary research method, can acknowledge and communicate diverse perspectives of the childbirth experience. Then strive to offer new innovative interdisciplinary visual approaches to empower women to make informed decisions at all stages of the birthing journey.
Key to the development of this proposal has been attendance at ‘The Big Room’ bi-weekly team meetings at Kingston Hospital’s Maternity Unit with clinical staff. Experiencing these meetings has illuminated how childbirth often does not align with their initial expectations for many women. Pregnant women are encouraged to consider a detailed birth plan - to identify the birth location, agree pain relief options, who will be present at the birth and how they would like to hold and feed the baby post-delivery. However, many women experience their baby’s birth considerably differently from their ‘birth plan’, resulting in an unexpected story. There are a considerable number of factors that can determine the narrative of any birth experience pre, during and postpartum. Typical issues may include short staffing, induced birth, a change in the mother’s blood pressure, weight and gestational diabetes or health. Some complications or issues with the baby’s growth rate or heart rate condition. 1 in 10 babies requires additional help in the neonatal unit following a premature, complicated, or emergency birth story.
The unknown, and changes to an anticipated birth plan can dramatically alter a birth story and be frightening. This can result in a sense of failure or disillusionment for the new mother can have implications and associations with postpartum depression.
Practice-based elements for the project will utilise documentary drawing processes to improve understanding of the narratives, choices and the preparation needed for women giving birth by visually communicating the processes. The environment and equipment can provide a space for women and their support networks to experience the range or potential of choices in giving birth.
It is anticipated this research can assist in improving rapid decision-making that is often required within the clinical setting to communicate complex information to women giving birth and their partners.
Visual representation would provide immediate communication, which potentially can cross language barriers and issues with reading ledgibility
KMU’s focus is on improving foetal maternal outcomes for all of their women. Staff report there is no visual language to communicate the stages and importance of foetal heart monitoring, what happens in the induction of a pregnancy, or the screening processes for gestational diabetes, amongst other procedures and protocols. Medical Illustration exists on the body’s physiology, but these do not communicate a narrative and are not necessarily patient-orientated in the tone of the visual language.
Drawing-Documentary drawing is a powerful method to share knowledge and to create a hierarchy of information for the viewer. It is a form of visual journalism, where the illustrator captures and records events as they develop. The reportage or documentary practitioner’s premise is that of a storyteller or a narrator of the experiences unfolding at that location or event. As a visual form it has a unique facility to edit, select and focus upon the part of the story that requires attention at a particular point in time. This project will be based in drawing on location at the hospital, then developing those drawings in the studio to develop them through time and animation process. Giving birth is a time based event, encompassing several stages, developments, and transitions. We respond to drawing in a wholly different way than we visually identify with the photographic image. Historically this drawing practice made sense of ritual, places, and events of time. This project will be rooted in the practice of visual journalism for education purposes.
Documentary or reportage drawing does have standard links with photography and filmmaking. However, the unique aspect of documentary drawing is that the narrative communicates through the hand of the illustrator. The live, immediate, eventbased process of recording an event can provide insight into which words alone fall short. Through the choice of the drawing medium and aesthetic decisionmaking, documentary drawing has a language that can be articulate across spoken language.
The documentary illustrator has the facility to edit, select, and focus on the momenthat needs clarification so that the viewer, in this instance, the patient, can better understand the experiences or the choices available to her. Drawing can spotlight or delineate the complexity of an event, location or action. A visual information hierarchy can allow the audience to process and understand what they may experience.
In return, she potentailly feels more prepared and aware of the range of options for her particular birth story.
Context: in practice, in research and theory:
The Birth rites collection is the first and only contemporary artwork collection dedicated to the subject of childbirth. Through the presentation and dissemination of the work in the public domain, BRC encourages debate and increases awareness around childbirth practice. Issues like the shift towards medical intervention in birth and explores the impact of biomedical advances in technology. They explore whether society’s focus on propelling women on to an equal footing with men in the workplace, erodes their importance as mothers and investigate how women are able to give birth in a way they want.
https://www.birthritescollection.org.uk/
For nine years, this organisation has been building a big chain of birth stories. The link gets longer all the time, so if you’d like to add to it, please get in touch. Whether a waterbirth or caesarean, induction, or a breech birth or home. Parents are encouraged to share their stories to support others – especially new parents.
http://www.tellmeagoodbirthstory.com/
NOOR ALBAKER — Glasgow School of Art School of Simulation and Visualisation
Foetal beat: the development of interactive 3D digital models and animation of the heart as a comprehensive digital source for anatomical and medical education.
SUZY ROAN — Glasgow School of Art School of Fine Art
Counter-narratives of childbirth in the UK: developing visual languages of embodied birth through expanded drawing practice.
MERLIN EVANS is an educator, writer and artist, director of ‘Drawn to Medicine’ she specialises in the complexities that makes us human through drawing and live performance work.
Methods: specify the various methods you are going to use to answer your research question. and meet the project aims
The interviewing of staff at KMU. What are the barriers to communication with expectant mothers? What expectations fall short? The four stages of birth- How can the stages of the birth experience be better framed and understood so patients are better prepared when a birth plan requires changes or intervention. What are these interventions? and what is unclear? Who are their patients? What do they need regarding the level of engagement
and understanding of their pregnancy and possible birth experience?
The Big Room- Attending the weekly Friday meeting where staff from all roles of the Maternity Unit come together to reflect, plan, and improve their services and the experiences for their women. A case study is presented and discussed where staff from all unit roles can offer commentary and experience the range of pressures each encounter and how measures can be taken to improve their experience.
The attending of Susanna Pereria’s baby Lifeline training sessions CTG Cardio (Heart) Toco (Uterus) Graph master classes. She reports there has been a well-documented need for multi professional improvements to CTG interpretation for decades to improve neonatal and maternal outcomes. Errors with fetal heart rate monitoring was the most common theme found in Five years of cerebral palsy claims:
A thematic review of NHS Resolution data (2017).
NHS England (NHS England, 2019, 2016) recommends effective foetal monitoring in labour as one of the key elements of care designed to tackle stillbirth and neonatal deaths. These courses aim to provide evidence-based training on CTG interpretation based on foetal physiology and pathophysiology of intrapartum hypoxic injury so as to reduce hypoxic ischaemic encephalopathy whilst reducing not necessary operative interventions.
The interviewing and listening to women in the first, second and third trimester of perceived preconceived birth experienes. What do women expect? The questioning of new mothers, what do they feel, required clarity? What was that experience, and did they feel prepared? What could have enabled them to feel more prepared?
Documentary drawing, and observing a range of birth stories, including low risk spontaneous vaginal birth, assisted instrumental delivery with forceps and vontous. Breech birth, Higher risk birth –women with hypertension, pre-eclampsia, gestational diabetes, raised BMI. Planned and emergency Caesarean Section birth. Multiple birth pregnancy. The recovery after birth stories. The neo-natal unit. Was that experience as expected? Was it good,bad, disappointing, surprising, shocking, fanastic disempowering, delusional, failed, feeling left feeling cheated or grieved?
Reflecting- how can the stories be told from the perspectives of the clinical team and the woman. What is the depth of
information for the demographic of their patients? What do they require?
Design -how can this information of verbal, clinical, aural and drawn experiences be communicated to explain and empower future mothers and encourage understanding of clinical language. Where the potential placement of this design exists and in which form.
Testing- introducing visual communication to KMU. How does the material work in clarity and accessibility, and does it translate and bridge the gap between medical terminology and expectation?
Reflective Practice- The analysing and critically reflecting upon the work. What can be made more transparent, and how can be it be improved? Can it be applied to other medical processes and procedures or communities?
Ethics:
Ethics will play a vital role within this project and informed consent is essential. The intention of research will be made clear through a written statement and outline of the project. Informed consent forms will be draughted for all women to agree to being interviewed. Recorded in a written or a recorded form. To be drawn and any drawing that has a recognisable aesthetic be agreed to be part of any public outcome. I will be applying for NHS ethical clearance
Potential outcomes and impact:
The research sets out to create a visual method for expecting mothers to understand the maternity environment better. Familiarising women with what the unit itself looks like. The visual language of specialist equipment and rooms. How is a baby monitored? Which possible intervention(s) be experienced? The beneficiaries are from both sides of the experience. The clinical and care providers will have a visual translation of what birthing mothers expect and understand of their birth narratives. Through illustrated animated language, the patients will have a clearer understanding of the types of birth story they may encounter. I propose that the outcomes for the research can be easily accessible and not have print costs. To be accessible in the clinical setting to bridge the gap of verbal information and be used as a tool where language is a potential barrier.
“From an improvement perspective, we heavily promote visualisation as a means of influencing behaviour. This might be about using visualisation to communicate data more effectively, or visualising
“From an improvement perspective, we heavily promote visualisation as a means of influencing behaviour. This might be about using visualisation to communicate data more effectively, or visualising instructions and process flows to help people carry out a task to a particular standard in a consistent way. This links closely with heuristics, human factors or behavioural science: how do we make it as easy as possible for people to do the right thing in a given situation, particularly when they may be very busy or fatigued.’
“Well-designed visual aids tend to be highly effective tools for improving informed decision making among diverse decision makers.”
Quote from Jon Grellier Kingston Hospital’s Head of Improvement
Designing Visual Aids That Promote Risk Literacy: A Systematic Review of Health Research and Evidence-Based Design Heuristics
Rocio Garcia-Retamero, Edward T. Cokely
Ethics clearancePriscilla Harries as contact. Principle of drawing home birth experiences has been agreed by the midwives at KMU home birth team.
To book- Hannah has sent link on 19.02.23
Previous experience: grants for documentary drawing practice. Work as a well established freelance Illustrator. Teaching experience: socially conscience design interests. Visiting and drawing the pregnancy models at the Wellcome Trust Collection
Drawing - Blood test visual explanation as the patient, showing their perspective and experience.
PhD meeting 2.
John Miers and Geoff Grandfield in attendance. Bullet points of the meeting and what to take forward.
*Looking at KMU’s Birth statistics as a foundation.
*Looking at what a doe a modern day ‘Godsip’ or female birth role model look like?
*Looking backward to plan what form this research take in the next academic year
As above- what is meaningful? To which groups of people using KMU’s services?
Hello Geoff, so you and John be used to these forms.
I’ve seen them since 2015, you know.
Great- that will be very helpful
They don’t have to be particularly lengthy.
I’ve populated most of it, but I’ve just got it in one form. So what would be fantastic is to just clarify what that bit is, what that bit is, what that bit is, and then I can go back through it and edit it back again.
John is joining us in a moment- what you do in 1A is bring up several that could be considered aims or particular phrases. If I were you, I’d be careful about how many you introduce at this stage or the ones who do get in there.
You say these are the ones you’re focused on now because of you. Hence, you talk about a visual narrative based on observational drawing now that in itself as a research topic is enormous because you’ve got, you know, the twin disciplines of what is a visual narrative and what is observational drawing. So those two territories are immense in their own right.
Then you do a universal communication tool. Well, that is, it’s a nice phrase, isn’t it, but it’s again it’s a bloody massive subject. What is universal? A lot of visual communication is culturally specific, and it’s being coded by culture, so that must be handled carefully.
You talk about the misunderstanding, fear, shyness, and intimidation that come in; those are all amazing but also complex emotional elements, aren’t they? So, do you want me to go on as you go?
Yes, please.
Is it useful? So you then talk about a phone base. Now that, as you know, we know it’s like there’s loads of complexity in that in terms of how big an image can be if you’re going to view it through your phone, how much detail, so the scaling of the imagery becomes a research question, what is going to work if someone’s holding a phone.
Then you talk about visually engaging, well again, as a phrase, it’s compelling, but what does it mean? Do you know what it is? I think this is one of the critical things that you’re going to be examining is this is the is like the spaces between what is visually informative and what is visually engaging, because there is this kind of thing that if it’s just diagrammatic, then it’s not emotional, it doesn’t have a sort of a load into it does it, and you refer to the thing about how your practice is about making something that appeals to the eye you know it’s like something that people engage with?
There’s a question there, and as I say, you don’t have to do all this. I mean, this is just like, but every time you include a particular topic at this stage of your inquiry, you’ve got to be absolutely careful you don’t include topics and then don’t demonstrate that you’ve, you know, looked at that so you might want to take some of that stuff out. So in your experience, as you know, you’ve seen several projects through what it sounds. The last one you just talked about is about visual information that engages through it, not feeling cold.
Is this the thing that I need to focus on?
Absolutely. Is there an emotionally reassuring because you are identifying particular characteristics that you want to bring to this?
Still, one is clarity, but one is like demystification; one is saving time, and one is joining up the current fragmented nature of the existing visual forms that might be encountered.
You’ve got to be careful about using the universal because it’s too massive to think you’re going to. I think you want to bring it down to NHS and current materials because even that is probably a pretty massive thing to evaluate what is currently out there, take a look at what does work, what doesn’t work, and why doesn’t it work and do questionnaires or something for people to try, because you comment on it and say it’s dry and outdated, but what’s the evidence for that? Another person could say what you call dry is very clear, so it’s like halves to an outdated again. What does that mean it’s like this thing about up-to-date is that because we now have more sophisticated imaging devices for what goes on inside the body or can the more sophisticated scanning, CAT scan, all that stuff, be able to generate so much information, it becomes less clear about what you’re looking at. This is precisely where, as you described, like the hand of an artist, it’s like somebody who can select and prioritise the information rather than throw everything at somebody.
Absolutely, and that is entirely the intention of the project and the research.
So, Hello John- Geoff’s been helpful in just talking about some of the aims that I’ve been talking about are enormous and bringing those down into what is tangible and manageable in a six-year project at illustration language and how it’s perceived through diagrammatic processes but also the hand of the artist and how we understand an image or a moving image where it’s not. Did you see in the third reader, I was lookng at the work of that lady called, uh, ‘@badassmotherbirther’? So, looking at her- content’s terrific. She’s got an enormous following and calling to get to her classes. I was drawing her content. So on Instagram, you’ve got provocative content,-explicit content, in some instances
deemed as ‘pornographic’ context. It shows how, and I think what was interesting from looking at all the work and several different people is that we’re not used to seeing anyone give birth. If someone’s got a dog that has puppies in the house, that’s very exciting, but still, it’s a bit ‘ewww’ and surprising. We grow up in a culture where we don’t ever see that.
Well, that might well be a contributing factor. I mean, you talk about the kind of shyness or the fear and things like that,
In 1a, which is the progress that made section, and then a couple of other bits, but basically, Jane-as yet has not tackled two yet 2.1, which is the four domains knowledge and intellectual ability personal effectiveness research governance and organisation and engagement interest impact. So what all I was doing was advising that the scope and range in 1a as it can you access it in essence.
If monitoring reports Committee date on the 5th of July. This is what I need to be looking at. So you’ve got until the 31st of May. Right. But for you, for John, for you to review this. Yeah. And then open it for others, for Hannah and then for me, and it goes in that kind of linear thing. This is not good or bad, but this is how they do it here. So the progress you made during the year is that you put a lot of speculative things in here which are essential for you and what you’re doing, but they’re about something other than the progress. The progress all it needs to be is like. What did you do in the last year?
Really OK, well the progress, I assume the progress is all in the readers that I’ve done that shows what I’ve been doing. I can put that into words.
I wouldn’t elaborate any more than you need to. It can be shorter than what you’ve done. It is just describing what you’ve done this year. OK, what is one ‘B’? Is as if you know any difficulty one ‘C’ has any positive features? If I were you, I’d be put the development of the readers in there or something to say that that’s your strategy of dealing with this thing as a practice-based researcher rather than an academic researcher. You’ve got your conference in there. 1E, any ethical issues have arisen. You have had discussions with the ethics people. So it’s a good idea to give a little commentary on, if you like, you can call it the tension or the friction or whatever because you’ve had some people ask....
The head of ethics at Kingston said why do you want to scare these women?
I wouldn’t go journalistic on it, but you just described what’s been happening. When we get to two, you start discussing the knowledge, like what you’ve learned. In B, how well have you? Now I might get this wrong, so John, please correct me, but personal effectiveness is like how well you
have managed to negotiate and handle the research you’ve conducted and how you’ve negotiated that. Research governance and organisation is very much about how you’ve taken what you’ve discovered and started to organise it in a form you will use as a basis for the next stage of the plan.
As far as I understand, the engagement, influence and impact are whether you have actually shared, so in that case, it would be the conference, and you wouldn’t need to put the description in there because you’ve already described it. I would suggest the response or the discussions you had when you were at the conference that would be a good place for that, and then yes, specific areas and particular skills again if you say, well, you know I’ve never done this before, so that’s the place to sound kind of well actually it’d be constructive for me to have something in that particular field.
Gosh, no, that sounded right to me, Geoff. It is one thing. Can you go if we can go back to? I mean overall, you know, overall this is about documenting what you’ve done and, you know, I take, I tell you’re correct to say that yes you have covered that in the reader, but of course, you know, we’re dealing with a formal university process here. So, as we are familiar with, it’s got to be put into the particular set of boxes they want it put into.
So, yeah, we’ve covered that. So that information does need to be extracted from the reader. But it was worth saying that, so we’re looking at this page at the top; it’s researcher development, not just research development. So it does; it frames it in terms of research skills training.
So how you’ve developed your research skills during the past year, and what training you’ve undertaken? So in each of these domains, let’s say in engagement, influence and impact. I mean engagement with relevant scholarly communities you had through your experience of presenting in Baltimore. Still, also you know if you’ve been to any search training.
I have, reporting as a postgraduate researcher.
This needs to go as a standard format to a panel looking at around 150 of these across two or three days.
Okay, thanks so much both of you. Tha’ts very inciteful. I know Hannah is going to add some thoughts as she isn’t here.
JW- blue
GG -black
JM- red
Tutorial date 4pm Tuesday 23/5/23
Feedback from Hannah 24/5/23
1. I may only take on illustration PhD students after the luxurious reading experience you’re giving me, Jane!
2. Joking aside, it is so interesting to see how you collate and understand and ultimately manifest some form of embodied knowledge about the ‘practice-review’ by drawing all the the votive figures and models etc. This raises a methodological question for me; does drawing these models (as opposed to simply looking at them) inform your own designs? Why (and how?) or why not? To give an example from a different discipline while I amass an enormous practitioner-framework in my own research (i.e. watching performances) very rarely would I re-perform the work, though of course it influences my own practice. Is this a standard method in illustration practice research?
3. I laughed when you noted that the maternity unit in Surrey bought your Soft Pregnancy (1997) as a piece of hospital art instead of their intended use as communicative tools. Then I realised that depending on where they are displayed, they might be doing their job after all; we do spend A LOT of time in those waiting rooms. Perhaps blurring lines between aesthetics and functionality.
4. When you and Phoebe are discussing the birth plan as a design challenge, that made me wonder (and forgive me if we’ve already discussed this) whether an illustration tool for articulating the plan (or ‘preferences’ as we all know them to be) is something that would be one of the outcomes? Using the same visual language that you use for communicating the clinical information? Unbelievably some hospitals still make pregnant women haul around an enormous folder of notes to each appointment, and if I recall correctly, the ‘preferences’ are just notes jotted down by a rushed midwife. Last time we talked I remember discussing the enormous scope of the gestation and birth experience and you note the necessity of narrowing down the ‘key stages’ and ‘specialist stages’ that will be the focus of the practice. Has the birth plan/preferences fallen within that? Again, apologies if I’m behind on this.
5. How did you go about designing your questions for your interview with Phoebe, and is there anything that you would have added or changed upon reflection?
6. That ‘cost of harm’ graph is incredibly grim.
7. I was struck by the inclusion of the pregnancy dolls in the misemono popular entertainment in 19th century Japan. Women’s reproductive physiology seems to reside in a ‘need to know’ category in contemporary Western culture.
Schedule of Studies Part Time
Academic Year 2023-24
June 2023
*Re- Interviewing
P. Halstead, A. Phillips, M. Tsakiri-Scanatovits
All one month to go
Completion reader Three
*Application for Ethics Clearance
July - Summer Break
August 2023
*Re- Interviewing
P. Halstead, A. Phillips
M. Tsakiri-Scanatovits
All 4-6 weeks postnatal
SEPTEMBER 2023
Birth Rites Collective Summer School
Themes include:
*How the collection informs and unpacks different perspec tives in midwifery, medicine and education, and its potential to improve practice and policy.
*Artistic and midwifery practices that address reproduction in the digital age including AI, simulation, VR, blockchain and NFT tech and, new reproductive technologies.
*Changing perspectives on the non-binary and notions of kinship.
*The Collection’s impact on feminist art practices and the rehabilitation of visual discourses of birth into art history. Censorship of artworks on birth, institutional responses, ethics and the law.
October 2023
*Re- Interviewing
P. Halstead, A. Phillips
M. Tsakiri-Scanatovits
3 months postnatal
Design and production of Reader Four
October 2023- May2024
Continuation of Reading List/ Literary Review- focussing on academic titles including:
Chadwick, Rachelle (2018). Bodies That Birth Vitalizing Bith Politics
Routledge ISBN 9781138123342
Dahlen, Hannah/ Kumar-Hazard, Bashi/ Schmied, Virginia (2020).
Birthing Outside the System: The Canary in the Coal Mine Routledge ISBN 9780367506605
Kitzinger, Sheila (2006). Birth Crisis
Routledge ISBN 0-415-37266-6
Penn Handwerker, W (2021). Births and Power: Social Change and the Politics of Reproduction
Routledge ISBN 9780367163129
Marland, Hilary (1994). The Art of Midwifery: Early Modern Midwives in Europe
Routledge ISBN 9780415116756
Mander, Rosemary/ Fleming, Valerie (2002). Failure to Progress, The Contraction of the Midwifery Profession
Routledge ISBN 9780415235587
November 2023
Development of questionnaires for pregnant participants for NCT Group
November 2023 February 2024
Drawing for Animation
Completion of animated tests
Blood test animation
Pregnancy animation
January2024
Design and production of Reader Four
March 2024
Sharing visual tests with Kingston MU and Royal Free MU
Feedback loop
April 2024
Writing up the narrative and findings of this year.
Production of Reader six
May 2024
IMR.