Change the question and you change the answer

We believe in the support-change partnership. Skilled and timely support can be the difference between taking a first step and staying trapped. We use the analogy of a river, where change is the crossing. The support role is to help a person find their strengths and capabilities, to find their way over.

The Partners in Change education programme is built on defining this support role for health professionals working to address lifestyle behaviours that undermine health and wellbeing, especially during pregnancy. This page is developing as a place to share case studies.

Reflections of midwives

"From my point of view, I couldn't believe how easy the conversation felt and how well my raising the subject of smoking was received. I've always been worried about women feeling harassed and becoming defensive."

"Two of the biggest things for me from the course was learning reflective listening and using the talk cards. Each day I use these excellent tools and I have become more familiar with them. With each visit I have become more confident and able to practise in recognising cues in each discussion."

"A high percentage of the women I work with are teenage Māori women who smoke. I feel I can be more useful to them now, challenging beliefs, behaviours, giving them something to think about and partnering them in smokechange. I see generational smoking behaviours. I work with women whose grandmothers and mothers smoke, who sometimes haven't considered anything different for themselves or their children."

'I remember a time when I justified to myself that the reason I didn't pursue smokefree as a goal in my provision of antenatal care was because I was busy enough, and my job was to look after this woman and baby, and help her give birth, not fix her life! Consciously, I 'overlooked' the physical impacts of smoking and looked at it as a social issue only. I founded this decision on the advice I was given as a midwifery student in 1993, that to promote reduction of smoking during pregnancy was to risk miscarriage, and not worth the stress. Obviously this Smokechange course was a timely revision of these teachings!'

"Overall I have found that the workshop has freed me up. I no longer feel apologetic when raising the subject and see how I can handle it professionally, as with other aspects of antenatal care. I can present it in a matter of fact way, without my previous baggage. By asking "Would you like to know … ?" "Would you like me to explain ….. ?" "Has anyone told you before….?" I am fixing my client's interest and gaining their permission. I feel concerned to ensure they have the facts. I am comfortable in the knowledge that by doing so, I enable them to decide what action to take."

Janey's Story (provided as an unexpected course case study by a participating midwife)

Describing the Case: This is not the case study you would be expecting, but during the seminar I suddenly realised we were talking about facilitating change of deeply entrenched and resistant behaviour, and that the concepts being taught could be applied to many entrenched behaviours, not just smoking. In particular, for the last 10 months, we have been providing foster care for a little girl now aged six.

Background: When she came to us she was five, and would regularly soil her pants. It was rare that she ever managed a poo in the toilet. At times she would wet her pants, but that was less common. Initially we didn't attempt any behaviour modification, as we thought we would see what there was to deal with once she had had time to settle. After three months she was regularly dry at night and daytime wetting was not happening much, but she was still soiling her pants almost every day. Over the next six months, we had tried a variety of plans, in conjunction with the paediatrician, with very little success. In fact, I had become very frustrated and it had become a source of upset and conflict between us.

Reason for selecting this case to present: The day of the seminar I saw straight away that I had missed the first two steps of the 'change' programme.

1) I hadn't established whether or not 'Janey' was even interested in change

2) I had not made a plan with her, but rather we had imposed a plan on her.

So the first step was that I sat down with her, and said that I realised I had made some mistakes in that I hadn't even asked her if she wanted to have clean pants and that we were so keen for her to have success that we had made a plan without her agreement. I apologised and said she must have felt very bossed around. She told me firmly that she had!

Next, I told her that we loved her whether she pooed her pants or not. That we had been so concerned because we wanted her to have a happy and successful life; that we wouldn't want anyone teasing or being mean to her, and that when she was a bigger girl, boys might not like her if she still pooed her pants.

I then asked her if she would like to stop pooing her pants. She thought for a bit and said yes she would. So I then said "Great, maybe we could make a plan together". She promptly told me all the things she hated about our previous (imposed) plans. After some discussion, we came up with an agreed plan, based on strategies, with no punishments or 'consequences'.

The Plan: She agreed:

1) to sit on the toilet after breakfast, afternoon tea and dinner for about three to five minutes, with her feet on a foot stool, and a book to read while she was there.

2) She would clean her own pants if they were soiled at the end of the day.

3) We would keep a chart, with a sticker if she was clean at the end of the day, (which we had been doing) but that we would also write on the chart every time she was successful in pooing in the toilet.

Outcome: 'Janey' has successfully pooed in the toilet every day without fail from the day we started our agreed plan, as much to her surprise as ours. There have also been some occasions when she has soiled, but this has become the exception. 'Janey' has clean pants about 90% of the time now. For the first time, I really know we are going to have long term success with this issue.

Most of the successful times on the toilet have occurred during the scheduled toilet 'sit times' but just in the last few days she has been recognising her own body signals and going in to the toilet of her own accord, with success. The unlooked for bonuses have been the restoration of the warm relationship between us and a 98% reduction in tantrums since we began the new agreed plan.

I would like to say thank you very much for an extremely well researched, well presented programme, and for what has been achieved in our home.