Book review of: N. Carr (2025). Superbloom. How Technologies of Connection Tear Us Apart, W. W. Norton & Company, 272 pages.
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Higher education is tasked with preparing students for a culturally diverse and globalizing world. Additionally, western nations have an increasingly diverse student population and know the success of their students will depend in part on being able to navigate diversity. There is therefore good reason for institutions of higher learning to promote and facilitate the development of ‘global citizens’ – people who can work and relate across borders and boundaries, both real and perceived. However, teachers are not necessarily equipped to foster this learning. Many teachers are used to a reproductive way of teaching while the learning that is needed here is identity learning, directed at dialogue, internally as well as externally. This chapter proposes the potential of creative, expressive and reflective writing as a way in which personal development – a form of a reflexive internal dialogue – can be fostered to promote cultural healing and global citizenship. The writing method will be described and a case study on cultural healing in the context of Canada’s reconciliation efforts with Aboriginal people will be used to illustrate the learning process involved. The processes of writing the self and re-narrating identity has several promising benefits for both students and teachers in higher education. First it allows us to learn more about ourselves and what blocks our learning (i.e. promotes self-reflection). Second, it allows us to change our story and our identifications and therefore choose differently (i.e. self-direction). Third, it is a companion on the road of life where we literally learn to talk and listen to ourselves and articulate the tacit knowledge that can be unearthed through narrative, journal, and poetic writing. Fourth, the method is playful and creative and although tears are frequently shed in the process, students report a great enjoyment in writing and sharing their stories with others. It is a meaningful dialogue about experience and also has the potential of promoting cultural (Lengelle, Jardine, & Bonnar, 2018) healing in the context of a very diverse student body (Banks, 2015). It also has the potential for creating new bonds in the classroom and allows teachers in higher education to engage in the difficult work of facilitating global citizenship learning. The internal dialogue described here also allows us to ‘clean up’ judgements and become aware of the need to reach out to others. Not only the actual sharing of vulnerable writing in a class or online setting shows us we are not alone, but ‘writing the self’ focuses deliberately on where we have become fearful about our own and others’ identities and allows us a learning process to unearth those things, heal them in order to reach out to others.
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Background Variations in childbirth interventions may indicate inappropriate use. Most variation studies are limited by the lack of adjustments for maternal characteristics and do not investigate variations in adverse outcomes. This study aims to explore regional variations in the Netherlands and their correlations with referral rates, birthplace, interventions, and adverse outcomes, adjusted for maternal characteristics. Methods In this nationwide retrospective cohort study, using a national data register, intervention rates were analysed between twelve regions among single childbirths after 37 weeks’ gestation in 2010–2013 (n = 614,730). These were adjusted for maternal characteristics using multivariable logistic regression. Primary outcomes were intrapartum referral, birthplace, and interventions used in midwife- and obstetrician-led care. Correlations both between primary outcomes and between adverse outcomes were calculated with Spearman’s rank correlations. Findings Intrapartum referral rates varied between 55–68% (nulliparous) and 20–32% (multiparous women), with a negative correlation with receiving midwife-led care at the onset of labour in two-thirds of the regions. Regions with higher referral rates had higher rates of severe postpartum haemorrhages. Rates of home birth varied between 6–16% (nulliparous) and 16–31% (multiparous), and was negatively correlated with episiotomy and postpartum oxytocin rates. Among midwife-led births, episiotomy rates varied between 14–42% (nulliparous) and 3–13% (multiparous) and in obstetrician-led births from 46–67% and 14–28% respectively. Rates of postpartum oxytocin varied between 59–88% (nulliparous) and 50–85% (multiparous) and artificial rupture of membranes between 43–52% and 54–61% respectively. A north-south gradient was visible with regard to birthplace, episiotomy, and oxytocin. Conclusions Our study suggests that attitudes towards interventions vary, independent of maternal characteristics. Care providers and policy makers need to be aware of reducing unwarranted variation in birthplace, episiotomy and the postpartum use of oxytocin. Further research is needed to identify explanations and explore ways to reduce unwarranted intervention rates.
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