VIDM 2023 Programme

Facilitator: Jane Houston 

Join us at this pre-conference event with colleagues from the World Health Organization (WHO) celebrating the worldwide contribution of midwives.

Welcome and introduction from the World Health Organization (WHO) by Frida Berg with video greetings from 

• Chief Nursing Officer:  Dr Amelia Latu Afuhaamango Tuipulotu
• Director General: Dr Tedros Ghebreyesus

We will then explore the following topics: 

1. Evidence to reality in 6 countries, strategic findings  (Clara Fischer and Prof. Lorena Binfa)  
2. Evidence to reality – From STAGE – recommendations on midwifery and how to take this forward  (Justine Le Lez)
3. Essential Childbirth care course and the Interprofessional Midwifery Education Toolkit  (Dr Florence West and Indie Kaur)
4. What’s new in WHO? (Dr Emily McWhirter)

Following a Question and Answer period, Dr Anshu Banerjee will provide closing remarks from WHO. 

Recording: https://www.youtube.com/watch?v=6OAqCOOGfz0

Onwards and upwards. Turning a pandemic into midwifery opportunities

Speaker: Sarah Stewart

Facilitator: Deborah Davis

Fifteen years ago I started the Virtual International Day of the Midwife (VIDM) on my kitchen table. The first year I pretty much spent talking to myself. Who could have guessed all these years later that a global pandemic, which would cause such devastation, would also make virtual conferencing an everyday occurrence. And that the organising committee could leverage COVID-19 into an opportunity to grow the VIDM to an audience of thousands across the world. In this presentation I will be reflecting on the lessons I learned over the years I was facilitating the VIDM about leadership, collaboration and innovation which are critical elements we need to influence and shape midwifery and women/people-centred care as we transition out of the pandemic.

Recording: https://youtu.be/TeuD1XwAEU0

Speaker: Paola Wilkin, Jane Houston, Megan Arbour 

Facilitator: Paloma Terra

Postpartum Haemorrhage (PPH) remains one of Peru’s leading causes of maternal morbidity and mortality, with nearly 20% of maternal deaths caused by PPH in 2019. Early recognition of PPH and prompt treatment remains challenging in low-resource obstetric settings, including among Mestizo midwives in Peru.  Midwives and obstetricians may experience barriers to the timely diagnosis and management of PPH including access to quantitative blood loss measurement methods, and timely haemoglobin blood laboratory tests. In addition, formalized PPH diagnosis and management training may not be available.

PURPOSE/AIM: The purpose of this quality improvement initiative is to increase the accuracy of postpartum blood loss measurement by Mestizo Peruvian midwives through hybrid educational sessions.  

Methods: 3 international midwives collaborated to develop this quality improvement project. Clinically practicing midwives, midwifery interns, and midwifery students were recruited from the 2 main public hospitals in Arequipa, Peru to participate in a web-based training module, and subsequent live skills demonstration regarding how to quantitatively assess postpartum blood loss.  The primary author is a Mestizo Peruvian dentist and midwife, and all materials were developed in a linguistically and culturally safe manner.

After the web-based training module, participants were surveyed on their level of comfort and self-efficacy with quantitative blood loss measurement using google forms, distributed via WhatsApp. 

This quality improvement initiative was deemed exempt by the Frontier Nursing University IRB.

Results: Preliminary results and the next steps will be available and shared during the presentation.

Recording: https://youtu.be/UTrVPckPWUY

Speaker: Elisabeth (Lizi) Jones

Facilitator: Caitlin Goodwin

Indigenous peoples and others living in Alaska and the circumpolar north are geographically remote and face climate conditions that can be extreme. They live in close connection to their environment and have developed characteristics of hardiness and resilience in the face of global pressures such as climate change and colonialism. Long-standing cultural traditions influence birth practices and expectations and are valuable to maintaining a shared sense of connection and caring for one another in these remote communities. Temporary relocation for childbirth has deleterious social effects and there is considerable support for traditional communal birthing in combination with modern techniques and technology. This presentation will describe a selection of Alaska Native and circumpolar childbirth traditions and outcomes, as well as the importance of birth in cultural continuity. Consideration will be given to the preservation of traditions and reflection on one’s own cultural humility and sensitivity, the value of incorporating ancient ways of knowing into modern medical practice, and the importance of promoting sovereignty and reclamation of birth by indigenous midwives worldwide. This presentation draws from a student assignment called “Celebrating Diversity in Childbirth” and is the 8th Annual Georgetown University Midwifery Student Café at the VIDM.

Recording: https://youtu.be/F6hXGnr4pP4

Speaker: Elizabeth Arnold-Leahy

Facilitator: Caitlin Goodwin

Persistent Occiput Posterior Position of the fetus is the most common variation or malposition during labor. Despite a midwife’s knowledge that 90% of Occiput Posterior fetuses will rotate to Occiput Anterior during the course of labor either spontaneously or with coaxing, we also know the abominable outcome statistics for birthers whose fetuses remain posterior. These births are associated with higher rates of operative intervention, as well as maternal and neonatal morbidity. 

Midwives have a variety of techniques to facilitate the rotation such as repositioning, exercises. The ultimate technique in the midwife’s tool bag is Manual Rotation which has been shown to increase rates of vaginal birth. Current global midwifery research on strategies and techniques, risks, benefits, alternatives, education and considerations, incidence for outcomes, sequelae, and community and hospital site considerations are reviewed. This presentation will discuss of various strategies to promote and facilitate rotation to Occiput Anterior will be presented 

Recording https://youtu.be/qF_DCXhKyPc

Title: Arte de la Partería Indígena: Resistencias, desafíos y continuidades

Speaker: Tania Pariona Tarqui

Facilitator: Paloma Terra

Recording: https://youtu.be/zuIlj3va4E4

Speaker: Susana Ku  

Facilitator: Paola Wilkin

We are a growing transnational collective consisting of members from the Global South and North, including midwives, doulas, scholars, educators, and mothers calling for an expansion of midwifery research to include what we coin “Critical Midwifery Studies”. We envision a Critical Midwifery Studies that uses three principles: 1.engagement and collaboration with rapidly developing fields within critical theory, 2.midwifery-led, 3. self-critical (developing ways to implement critical theory into practice). Systemic injustice is a threat to sexual, reproductive, maternal, and newborn health, hence the application of the art and science of midwifery. The effects of this injustice are reflected in the high maternal and neonatal morbidity and mortality rates in formerly colonized countries of the Global South, in marginalized communities of the Global North, and in underprivileged classes around the world. We aim for an open discussion about midwifery research, education, practice, policy, and regulations, that are largely White and Western-centric, using positivistic and universalist principles of biomedical research. Although we recognize the global struggle for legitimacy that midwives face as they work to make their models of care more accessible, this coincides with pressure to engage with dominant and dominating paradigms, using language and approaches that are valued by regimes of power.

Our presentation will include a summary of our experience launching the first bilingual summer school for Critical Midwifery Studies held on July 2022, with delegates around the world. We will explain how our collective planned this activity including principles of equity and accessibility https://tinyurl.com/yc55dbw6.

Recording: https://youtu.be/TKrSfdmC9nM

Speaker: Jade Qiong Zheng 

Facilitator: Jane Houston

Stillbirth is a unique phenomenon with various manifestations influenced by culture and spirituality. Different cultural and religious beliefs may influence the emotional response to perinatal grief as well as the demand for bereavement care. The majority existing research on perinatal grief comes from Western society. Under Chinese cultural context, post-stillbirth grief healing for bereaved mothers is not applicable. 

Objective: This study investigated the role of culture and spirituality in the grief healing of mothers with stillbirth in China.

Methods: The study was grounded in an interpretivist constructionist epistemology. In-depth interviews with mothers suffering stillbirth within the previous year were used in a qualitative study. Thematic analysis was used to analyze the data. 

Findings: 28 women were interviewed by trained interviewers. Three key themes were identified: 1. The impact of culture on grief expression with four sub-themes: Restrained expressions of grief, Unattainable mourning ceremony, Hospital policy as a barrier, and Others-oriented grief; 2. Cultural characteristics of post-stillbirth experiences with four sub-themes: The paternalistic medical culture, “KongYuezi”, The embarrassment of postpartum visiting， and Cultural taboos on dealing with deceased babies remains; 3.Significance in cultural and spiritual healing behaviour with four sub-themes: Finding the meaning of the event, Accepting and Reconciling with the event, Reshaping beliefs and worldviews of life and death, and Gaining and self-growth.

Conclusion: Culture and spirituality play an important role in bereaved mothers’ post-stillbirth grief healing. Caregivers should avoid preconceived notions about grief. A bereavement care guideline that is culturally and spiritually appropriate for China is required. 

Recording: https://youtu.be/eDXegqWbIHk

Speaker: Linda Deys

Facilitator: Linda Sweet

Midwives traditionally guide, create safety and share goals with women through labour and birth. Childbirth is recognised as a woman’s right of passage, with a positive experience associated with a sense of control and  how she is treated and made to feel. When the birthing landscape is an operating theatre, women lose their autonomy and the midwives’ role of being ‘with-woman’ is challenged. Separation of mothers from their infant is common. 

Design: Using a feminist phenomenological framework, fifteen women who experienced non-medically indicated separation from their infant at caesarean section were interviewed. 

Results: Preliminary data analysis using a Modified van Kaam approach shows feelings of powerlessness, loneliness, sadness and frustration which lasts well beyond the perinatal period. It impacts their personal relationships and plans for future births. The results reflect a patriarchal, staff-focused environment where women are disregarded and do not feel safe.

Conclusion:  Separating mothers and babies at caesarean section negatively impacts birth experience. Midwives have the opportunity to recognise power imbalance and create a sanctum within the surgical environment. Recognising that birth is more than the mode of delivery, midwives are often the only ones in a position to be the woman’s advocate at a caesarean birth. Midwives have the opportunity to create an environment where the woman has power and agency over her body and baby. Separating a mother from her baby can negatively impact her birth experience and future personal relationships. 

Recording: https://youtu.be/is7ho3NoP4w

Speaker: Wendy Foster

Facilitators: Belle Bruce and Siti Khuzaiyah

Problem: Across the globe midwives are leaving the profession. Moral distress may contribute to this attrition. While moral distress is broadly understood within health care disciplines a contextual understanding of moral distress in midwifery is limited. Current tools available to screen for moral distress are not as suitable for use in midwifery practice. 

Methodology: This project is an exploratory sequential mixed methods design that occurred across four phases; concept analysis, in-depth interviews, an e-Delphi study and a pilot study. This presentation will present key findings from the first three phases.

Results: Midwives report feeling demoralised and confirmed the presence of moral distress in practice due to excessive workloads, unnecessary intervention and hierarchical medical systems. Health care organisations are identified as placing midwives in morally compromising situation that are significant factors in the development of moral distress. Negative psychological outcomes are a key feature in moral distress with midwives describing symptoms of work-related stress and anxiety, increased sick/personal leave, feelings of powerlessness and burnout. Importantly it was identified that moral distress was likely to occur across a continuum from low (moral frustration), moderate (moral distress) and severe (moral injury). A pilot tool to screen for moral distress across a continuum has been developed. 

Conclusion: Moral distress is a significant issue in midwifery practice. The development of the midwifery moral distress screening tool has enhanced the conceptual understanding. This study has provided additional language for midwives to describe their experiences and may assist organisations to identify and address ethical challenges within workplaces. 

Recording https://youtu.be/Czfj3EUg6g4

Speakers: Giyawati Yulilania Okinarum, Venny Vidayanti and Sri Hasta Mulyani

Facilitator: Rizka Setyani

Yogyakarta is a popular tourist destination in Indonesia, but lactation rooms in public facilities in tourist areas are currently difficult or nonexistent. The lack of lactation rooms and facilities will affect breastfeeding activities for mothers who spend their daily lives in public places. Researchers propose a solution in the form of an innovative portable public breastfeeding room. Its goal is to assess user satisfaction with the newly developed public lactation room facilities. The descriptive-analytic method is used in this study. A questionnaire is distributed to determine user satisfaction. Then proceed with the selection of participants based on the results of the questionnaire distribution. Purposive sampling of 122 respondents who were breastfeeding mothers according to the established criteria was used in this study. The color and design of the lactation room received the highest mean satisfaction score (4.92), while ventilation received the lowest (1.66). The Ruang Sehati Lactation Room is an innovation that was created in response to the needs of users, specifically tourists who are breastfeeding mothers in Yogyakarta City’s tourist area. This innovation is also a pilot that can be shown nationally, presenting an image of Jogja City as a mother- and child-friendly tourist destination.

Recording: https://youtu.be/1WLiv8AkX34

Speaker: Linda Sweet and Vidanka Vasilevski

Facilitators: Paola Wilkin and Diana Adarmes

Waste disposal is a significant cost to healthcare organisations. This study sought to understand the impact of a midwife-led intervention to improve waste segregation on staff knowledge and attitudes, waste volume, and waste management-related costs. 

Design: A multi-method study including pre and post intervention staff waste management knowledge and attitude surveys and waste audits of bins located on the postnatal ward. 

Methods: The intervention included education sessions, posters and signage by waste bins, and monthly newsletters distributed throughout 2021 to raise staff awareness of correct waste segregation processes. Pre-and post-intervention surveys were distributed in early 2021 and early 2022 respectively. The waste audits occurred on three occasions in 2021. The waste audit included total waste in kilograms, waste in kilograms by segregation, and identification of correct and incorrect segregation. Waste audit and quantitative staff survey data were analysed using descriptive statistics and Chi square. Qualitative data from the staff surveys were analysed using content analysis. 

Results: Knowledge and attitudes to waste management were similar across pre- and post-intervention staff surveys. Knowledge of accurate allocation of specific items to waste streams was variable with errors identified in both the pre-and post-surveys. Waste audit data showed reductions in clinical waste at each measurement, with a 71.2% decrease in clinical waste from baseline to the final audit. The accuracy of waste segregation also improved from the baseline to final audit, resulting in a 48% reduction in waste management costs. 

Conclusion: The midwife-led initiative improved waste segregation and achieved waste management cost reduction.

Recording: https://youtu.be/54KV1prNN_w

Speaker: Fatimah Siti and Andari Wari Astudi

Facilitator: Belle Bruce

Marriage and pregnancy in adolescence affect the health, financial and educational status of adolescents. Pregnancy in adolescence also creates stigma and negative issues in society and families. This Scoping review aims to find out the latest evidence based on the experience of adolescents who early marriage in decision making during pregnancy and childbirth. 

The method used in this scoping review refers to the framework of Arkshey and O’malley and is documented into the PRISMA Flow Chart. Research article search strategies used include using inclusion and exclusion criteria, using MeSH (medical subject heading), truncation and boolean operators. The databases used include Pubmed, Sciencedirect, Proquest, EBSCO, and Wiley Online Library and also use grey Literature such as Google Scholar. 

From 2,134 articles, the initial search found 9 articles that are eligible for a thorough review and resulted in 4 main themes, namely the decision-making process during pregnancy and childbirth, factors affecting decision-making during pregnancy and childbirth, forms of support in decision-making and expectations in decision-making during pregnancy and childbirth. 

From the review of articles conducted, it is known that most teenagers lose autonomy in decision making because it is often done by older family members and is considered more experienced. The existence of programs and/ education related to adolescent health using gender and cultural approaches is expected to increase participation and  role in decision making.

Recording: https://youtu.be/cmj5HN8i_ss

Speaker: Rizka Ayu Setyani

Facilitator: Terri Downer and Scarlet Woolcott

One of the obstacles to handling HIV is late diagnosis due to a lack of access to diagnostic services in health facilities. In addition, the negative stigma against this disease also makes people reluctant to diagnose at health facilities. Early diagnosis needs to be done, especially in pregnant women, as an essential condition that needs to be known in childbirth and breastfeeding. Unfortunately, the HIV testing policy in Indonesia still has loopholes for the mother or the patient to refuse to take the HIV test. Health workers are required to offer HIV testing, but the mother’s voluntary willingness determines the HIV test. This implementation trial pilot study used random cluster sampling to select seven intervention and seven control sites in Yogyakarta city, Indonesia. Seven intervention health facilities used the EKSTRIM website for three months, from January through April 2022, to educate and do HIV counselling with pregnant women patients. EKSTRIM website was designed for use on mobile phones to improve HIV testing among pregnant women. Health workers managed to record 1,594 visits and were able to increase HIV testing by 6.7% in pregnant women. The EKSTRIM pilot demonstrated the feasibility of implementing a digital healthcare-integrated solution in a low-resource setting, health worker capacity building and patient self-care into a single robust and responsive system. Although the implementation phase was only three months, the pilot generated evidence that EKSTRIM could increase HIV testing uptake.

Recording: https://youtu.be/tG1Vs6rwvHQ

Title: Professional Midwifery: Revolutionising Maternal Care in India

Speaker: Indie Kaur

Facilitators: Red Miller and Suman Lata

Research shows that midwife-led care reduces unnecessary interventions, and mothers go on to have better birth experiences. In 2011, Fernandez Hospital piloted an in-house professional midwifery education and training program when such a cadre did not exist in India. Unnecessary interventions like episiotomies and epidurals decreased, and women’s positive feedback increased yearly. Looking at this success, the Government of Telangana and UNICEF partnered with Fernandez Hospital to pilot midwifery training in its public hospitals.

These midwives created a paradigm shift in maternity care, helped increase normal births, and promoted respectful maternity care in the state’s public facilities. This led to the government investing in the need for separate training for midwives in India and launching ‘Guidelines on Midwifery Services’ in 2018. This was a historic moment for midwifery in the country, recognising the need for a separate professional training building on a strong cadre and rolling our midwifery care to women and new-born in the country.

The Foundation has since partnered with The Government of India and Telangana State with the support of The World Health Organisation (WHO) and UNICEF to train midwifery educators in India, strengthening midwifery services.

Recording: https://youtu.be/m-SDNI7B7dA

Speaker: Nurul Hidayah 

Facilitator: Gita Nirmala Sari and Mahanutabah Hamba Qurniatillah

Latar Belakang: Kehamilan remaja merupakan kehamilan yang terjadi pada usia remaja kurang dari 20 tahun. Depresi postpartumadalah suatu kondisi depresi berat yang terjadi dalam 4-6 minggu setelah melahirkan. Tujuan: Menggali bukti ilmiah kebidanan terkait kejadian depresi postpartum pada ibu remaja. Desain: scoping review menggunakan ceklist PRISMA-ScR Metode: Penulis menggunakan kerangka Arksey dan O’Malley. Pencarian artikel menggunakan tiga databased PubMed, Proquest, Science Direct yang mencakup dari Januari 2012 sampai 2022. Alat penilaian digunakan. Seleksi review dan karakterisasi dilakukan dengan penilaian critical appraisal menggunakan studi Joanna Briggs Institude (JBI) tool. Hasil: Dari 809 artikel yang berpotensi relevan, 7 artikel dimasukan. Artikel penelitian tersebut berasal dari 5 Negara yang berbeda, dan metode RCT, Cross sectional dan kualitatif. Hasilnya disajikan dalam tiga tema : Prevalensi depresi postpartum pada ibu remaja, faktor resiko depresi postpartum pada ibu remaja dan pelaksanaan layanan kesehatan dan hambatan dalam menangani depresi postpartum pada ibu remaja.

Kesimpulan: Berdasarkan 7 artikel yang dilakukan review, ditemukan bahwa bahwa 32% ibu remaja memiliki kemungkinan depresi postpartum yang memerlukan tindakan segera pada penilaian awal, deteksi dan intervensi. Faktor-faktor yang berkontribusi terhadap perkembangan depresi postpartum pada ibu remaja termasuk dukungan sosial yang tinggi, masalah perkawinan, tekanan dari orang tua dan masalah ekonomi. Asuhan kebidanan berkesinambungan, strategi dan tindakan pencegahan yang tepat termasuk skrining secara berkala untuk ibu remaja dan penyedia layanan mental diperlukan untuk mengurangi resiko depresi postpartum pada ibu remaja.

English: 

Background: Teenage pregnancy is a pregnancy that occurs in adolescents less than 20 years old. Postpartum depression is a condition of major depression that occurs within 4-6 weeks after delivery. Objective: Explore obstetric scientific evidence related to the incidence of postpartum depression in adolescent mothers.

Design: scoping reviews using PRISMA-ScR checklist Method: The author uses the Arksey and O’Malley frameworks. The article search uses three databases PubMed, Proquest, Science Direct covering from January 2012 to 2022. Assessment tools are used. Review selection and characterization were carried out by critical appraisal assessment using the Joanna Briggs Institude (JBI) tool.Result: Of the 809 potentially relevant articles, 7 were entered. The research articles are from 5 different Countries, and RCT, Cross sectional and qualitative methods. The results are presented in three themes: The prevalence of postpartum depression in adolescent mothers, risk factors for postpartum depression in adolescent mothers and the implementation of health services and obstacles in dealing with postpartum depression in adolescent mothers.

Conclusion: Based on 7 articles reviewed, it was found that 32% of adolescent mothers have a chance of postpartum depression that requires immediate action on initial assessment, detection and intervention. Factors contributing to the development of postpartum depression in adolescent mothers include high social support, marital problems, pressure from parents and economic problems. Ongoing obstetric care, appropriate strategies and precautions including periodic screening for adolescent mothers and mental care providers are needed to reduce the risk of postpartum depression in adolescent mothers.

Recording: https://youtu.be/x2ko_70X4qY

Speaker: Tsegaw Biyazin

Facilitator: Caroline Maringa and Meron Tessema Bekele

Antenatal fetal surveillance is a method of monitoring fetal welling during intrauterine life. Fetal movement counting is one parameter of antenatal fetal surveillance and it has a vital role to reduce stillbirth and prenatal mortality. This study aimed to assess maternal knowledge of fetal movement among pregnant women in Jimma Medical center, Jimma, Ethiopia.

Method: A facility-based cross-sectional study was conducted at Jimma Medical center from June 1 to July 30, 2022. A structured and pretest questionnaire was used to collect data. A systematic sampling technique was applied to collect data through a face-to-face interview. Binary and multivariate logistic regression was carryout to identify candidate predictors and significant variables respectively.

Result: A total of 422 respondents involved in the study. The majority of respondents 189(46.7%) were in the age group of 25-31 years. Regarding marital status, more than three-fourths of 323(79.8%) participants were engaged. Only one hundred twenty-two (30.1%) of respondents had good knowledge regards to their fetal movement count. predictors includes residence [AOR=.29, 95% CI (.16-.56), P value;.000], gestational age [AOR=.42, 95% CI (.24-.76);P-value;.004], high-risk pregnancy [AOR=5.34, 95% CI (2.46-11.60); P-value;.000] and health care provider [AOR=2.61,95% CI (1.49-4.56); P-value;.001) were among significant variables with knowledge of fetal movement counting.

Conclusion: the overall maternal knowledge regards fetal movement is unsatisfactory. Respondents’ residence, gestational age, pregnancy status, and source of information were significant predictors of maternal knowledge. Health care providers.

Recording: https://youtu.be/1P-fOkA9tPg

Speaker: Katrine Kjærulff and Abra Pearl

Facilitator: Anitah Kusaasira

Maternity Foundation provides access to updated WHO aligned clinical guidelines via the Safe Delivery App. Over the past years the Safe Delivery App has been integrated into national training initiatives and curricula in countries such as Ghana, India and Cambodia. We want to share our experience working with partners to integrate a digital, evidence-based tool in midwifery education and for continued professional development and learn from peers about their experience with using and integrating digital tools.

Recording: https://youtu.be/TqNkhsdZtOc

Speaker: Yasmin Rose

Facilitator: Caroline Cherotich Bii

This lecture will walk through the journey of the cord blood from the moment a baby is born, what purpose it serves and why it is paramount babies receive the full amount of blood. The cord blood not only increases the volume of the blood, but is instrumental in setting up the lungs properly. We will look at the difference between fetus circulation and newborn circulation, the difference between waterborn babies and land born babies, and understand why 1 minute cord-clamping is not sufficient. The aim is to achieve optimal cord clamping for every birth.

Recording: https://youtu.be/wVhJ9z3UEsA

Speaker: Lia Brigante

Facilitator: Caroline Maringa

Midwifery continuity of care (MCoC) has been associated with improved maternal outcomes and with lower levels of preterm births and stillbirths. The majority of MCoC studies have focused on women without risk factors and little has been published on women with obstetric complexities. The aim of this study is to explore the views and experiences of women identified as a higher risk of preterm birth who have had continuity of care from midwives.

Design: Face-to-face, semi-structured interviews with 16 women identified as at increased risk of preterm birth and experienced continuity of midwifery care across pregnancy, birth and the postnatal period. Care had been provided by the pilot intervention group for the pilot study of midwifery practice in preterm birth including women’s experiences (POPPIE) trial.

Findings: Women valued continuity of midwifery care across the care pathway and described the reassurance provided by having 24 h a day, seven days a week access to known midwives. Consistency of care, advocacy and accessibility to the team were described as the main factors contributing to their feelings of safety and control.

Key conclusions: Recognising that known midwives were ‘there all the time’ made women feel listened to and actively involved in clinical decision making, which contributed to women feeling less stressed and anxious during their pregnancy, birth and early parenthood. When developing MCoC models for women with obstetric complexities: access, advocacy and time should be embedded to ensure women can build trusting relationships and reduce anxiety levels.

Recording: https://youtu.be/iK-Cr2puBZg

Speaker: Sarah Smits

Facilitator: Liz McNeill

Sharing knowledge and stories to promote the work of The Midwife Project. A project to support the preservation of Mayan midwifery wisdom and bridge the gap between the knowledge of the younger generations of clinically trained midwives and the elder traditional midwives. Honouring and understanding the importance of both the knowledge of modern and traditional midwifery practices to best serve their community. 

Lake Atitlan, Guatemala has a prevalent population of Mayan people still practicing Mayan cosmology and ways of life. 

Due to cultural practices and barriers to accessing the only hospital around the lake, many women birth at home with Mayan midwives. Yet the Mayan midwifes, some of whom have been practicing midwifery for 40 years, report how births are becoming more complicated and welcome the opportunity to learn different skills to support their communities growing needs. 

The Midwife project aim to bridge this gap. A 6 month training program was initiated in 2022 whoch offers the opportunity for the elder midwives to learn clinical skills and for the younger generation of midwives to learn the traditional Mayan practices. 

Every week more and more women, some as young as 12 who have had the calling to become midwives join the project. It is an important opportunity to strengthen the community of Mayan midwives, so they can better support their community. 

Recording: https://youtu.be/mILlyDhuadE

Speaker: Ponsiano Kabakyenga Nuwagaba 

Facilitator: Hayat Gommaa

In low- and middle-income countries, several barriers impede utilisation of antenatal care (ANC) services by women with disabilities, yet ANC is a critical entry point for pregnant women to receive quality maternity care services. We investigated the experiences of pregnant women with physical disabilities in utilising ANC services to suggest strategies for improving the services. 

Methods: A qualitative study using a multiple case study design was conducted. Twelve women with physical disabilities and six midwives from three health facilities in Sheema District in rural south-western Uganda, were selected as study participants. Women were sampled using snowball sampling. Midwives and health facilities were sampled using purposive sampling. Data was gathered through face-to-face interviews and a focus group discussion between November 2020 to January 2021. Data was transcribed, translated and thematically analysed. Ethical approval was obtained from University of Cape Town and Uganda National Council for Science and Technology. No competing interests declared. 

Results: Women had mixed experiences of midwives and other health workers, noting that sometimes midwives would be supportive and other times, they would be unapproachable. Participants felt that midwives had limited knowledge on disability and were emotionally unprepared to attend to pregnant women with disabilities. There were suggestions for disability inclusion, including a dedicated ANC clinic and making connections with stakeholders, for fit-for-purpose ANC services. 

Conclusion: Midwives have limited understanding of the implications of physical disability on women’s utilisation of ANC services. Respect for women with disabilities’ dignity and needs should be emphasized in midwifery education and training. 

Recording: youtube.com/watch?v=ihQOrbHdI2M

Title: When art and science collide: towards a political philosophy of humanised birth

Speaker: Elizabeth Newnham

Facilitator: Red Miller

In this presentation I draw together the various threads of my work to propose a political philosophy of birth space and practice. I first examine how the ‘science’ (of knowledge production) affects the ‘art’ (of midwifery practice) using the example of epidural analgesia, water immersion and constructions of ‘safety’ in obstetric discourse. From this, I introduce the conceptual framework of the ‘institutional paradox’ – the framing of particular practices as safe or risky, the effects of ‘institutional momentum’, and the precarious positioning of midwives as ‘guardians of normal’ within a system that views birth as, at best, risky, at worst, pathological. I then show how the influence of this institutional paradox leads to a form of rhetorical informed consent that enables dehumanising birth practices, before using the lens of care ethics to turn to the work of humanising birth, with a focus on relationality and the concept of attentiveness.

Recording: https://youtu.be/AshmJUtO7nI

Speaker: Tom McEwan and Moira Lewitt

Facilitator: Adetoro Adegoke

Respectful of ‘artistry’ within midwifery, a recent research study conducted with Professor Moira Lewitt explored how midwifery students understand the concept of professionalism and how their professional identity develops during midwifery education.  Midwifery students learn and adopt complex professional behaviours in a variety of academic and clinical settings throughout their educational journey. The aims of this study were to explore how midwifery students understand the concept of professionalism and how their professional identity develops during midwifery education.. The method used a conversation about professionalism with a group of final year midwifery students that was transcribed ‘in the moment’ and immediately performed to the group as poetry. Themes emerging from analysis of the conversation are also presented as poetry.  The results demonstrated that midwifery students, moving between university and practice, emphasise the importance of close connections between these spaces and the role models in them, for learning. External constraints generated a sense of fear and stress that was seen to limit midwives’ ability to properly support the needs of ‘their woman’.  We concluded that the notion of ‘spaces’ is important in maternity care and developing education for future midwives. Poetry is a useful multidimensional tool in research.  This utilised poetry as an innovative multidimensional tool for research.  The process of conducting this research, the key themes identified and the poetry generated will be discussed in this session.

Recording: https://youtu.be/nglnqbG26vs

Speaker: Arafin Happy Mim  and Toma Ray 

Facilitator: Margaret Aoro Adongo and Yosef Alemayehu Gebrehiwot

We are two young midwife leaders (23 years old) in Bangladesh who are board members of our midwives’ association (MA) and have recently graduated from an international leadership development programme. One works in a government health centre, the other in a Rohingya refugee camp.  During 2022 we used quality improvement (QI) methodology to help our MA recruit and retain its members, and to develop guidance on responding to various types of emergency situations, which happen frequently in Bangladesh. 

Discussion: MAs are examples of women-led civil-society organisations that can improve gender-equity and access to sexual and reproductive health rights, and act as agents for the profession (Mattison et al 2021). They have potential to impact each element of the ICM’s professional framework for midwifery.  As midwifery is a new profession in Bangladesh, the midwives association (the Bangladesh Midwifery Society) is led by young women who are enthusiastic but inexperienced in organisational governance and leadership. A structured programme that taught us QI methodology was helpful for our leadership development, enabling us to drive change in our workplaces and in our MA. 

Conclusions/Summary: We found it hard to apply QI methods to organisational development but we made it work. By sharing our lessons learned we hope to help other midwives and midwives’ associations understand how they can improve the quality of their services. 

Reference:  Mattison et al (2021) doi:10.1136/bmjgh-2020-004850

Recording: youtu.be/IcuXTEOj7WQ

Speaker: Laura Abbott and Tanya Capper

Facilitator: Liz McNeill

It is well understood being pregnant in prison results in risks to the safety and wellbeing of women and their unborn babies. Pregnancy in Prison Partnership – International (PIPPI) is a midwifery and health academic collaboration between Australia, UK, USA, New Zealand and Canada. PIPPI is committed, through collaboratively working with and/or undertaking research, to illuminate the plight of and improve the health and wellbeing of pregnant women and new mothers in prison around the world as well as be global network to build best practice for and with women prisoners. Our presentation will focus upon how our philosophy of working together lead to the birth of PIPPI. Our current and projected international collaborative work will provide a worldwide perspective with recommendations to improve the health of perinatal women in prison highlighting the known health impacts, inconsistencies and challenges of delivering midwifery care within patriarchal carceral institutions designed for punishment rather than health. As an inclusive international group, we look forward to presenting our work and exploring opportunities for future collaborations.

Recording: https://youtu.be/GjL2D3C1INk

Speaker: Joy Kemp  and Sharmin Shobnom Joya

Facilitator: Aisha Salihu Abdullahi

A 5-year twinning partnership between the Bangladesh Midwifery Society (BMS) and the Royal College of Midwives UK was completed and evaluated in 2022; results will be shared in this presentation. Twinning was both organisational and individual.  Midwives are new in Bangladesh; they are negotiating professional space. UK midwifery is more established but the workforce is not representative of the population with Bangladesh heritage (1%); maternal and perinatal outcomes are worse for South-Asian families.  Therefore, twinning had potential benefit for both contexts. 

Objective: To evaluate if twinning had mutual benefit, especially in strengthening midwifery leadership.

Methods: A mixed methods enquiry using document-review, surveys, focus-groups, key informant interviews and participant observation.  Evaluation framework informed by OECD criteria and stakeholder questions. Thematic data analysis.

Results:  BMS’ organisational capacity increased significantly during the partnership. Fifty-one young midwife leaders in Bangladesh were developed and six won international leadership fellowships. Seven quality- improvement projects in Bangladesh were successfully completed, advancing midwifery services. UK midwives valued and learned from their participation. The partnership enabled greater engagement with South Asian diaspora midwives in the UK and highlighted inequity of UK maternity outcomes. The COVID-19 pandemic brought both challenges and opportunities for innovation.

Conclusions/Summary: This partnership strengthened midwifery associations and midwifery leadership and impacted every area of the ICM’s Professional Framework in Bangladesh. Twinning facilitated reciprocal benefits in both countries and may be replicable in other contexts.

Recording: https://youtu.be/jCiv_7LqMnA

Speaker: Amina Abdulraheem

Facilitator: Caroline Maringa

Hypothermia is known to be a major cause of neonatal mortality as it complicates other diseases at early neonatal period. Pregnant adolescents are at high risk of having preterm birth, low-birth-weight babies and sub optimal thermal care practices. The study aimed to evaluate the effect of nursing intervention program on thermal care of pregnant adolescents attending antenatal clinic in Zaria town. A quasi-experimental design using a multistage sampling technique to obtain data from 302 adolescent mothers; assigned to the study and control groups; 151 participants to each group. Data were collected using structured and validated interviewer-administered questionnaire and observation checklist before and after the intervention. Descriptive statistics, chi-square and segmented Poisson regression were used to evaluate the effect. At pretest, no statistically significant difference in the pretest means knowledge (p-value= 0.8179) scores of mothers between the study and control groups. At post-tests, the mean knowledge and practice scores of mothers in intervention group improved significantly (P value < 0.05) at first week, 6th week, 10th week, 14th week and 6th month postpartum. Mothers in intervention group were more satisfied with their role of thermal care than those in control group (p-value 0.0000). The result of the current study is in line with a study in Egypt by Ali Abd El-Salam et al., (2019) and that of Nasir et al., (2017) in Indonesia who reported statistically significant improvement of mothers’ knowledge and practice of thermal care at posttest. There is need for midwives to continue training pregnant adolescents on thermal care. 

Recording: https://youtu.be/g8SydgM09jU

Speaker: Nicola Enoch

Facilitator: Adebukunola Olajumoke Afolabi 

Down Syndrome UK is a charity fully immersed in supporting expectant and new parents of babies with Down syndrome.  We are passionate about ensuring parents have access to contemporary information about the reality of living with Down syndrome and relevant compassionate ongoing support.

We have been conducting research since 2018 in order that the findings of the research can translate into effective inclusive practice to improve outcomes for patients.  

We are currently undertaking collaborative research with University of Warwick as a follow up to the report Sharing the news: the maternity experience of having a baby with Down syndrome. and will share preliminary findings. 

Our previous report published the findings of a survey of 1,410 women which sadly highlighted systemic discrimination towards those with Down syndrome.  It revealed an assumption by medical professionals that an expectant woman will terminate when discovering their baby has Down syndrome. It also highlights the pressure put on women to undergo further tests in addition to a lack of information and of support.  We have also undertaken research and will share findings around breastfeeding babies with Down syndrome.

As experts by experience, we are passionate about sharing the findings of our research with the aim to empower all by promoting best practice ensuring the voices of parents are heard to improve the maternity experiences of future parents.

Recording: https://youtu.be/jTZ4QaPeS38

Title: Biomechanics for birth: New learning & insights for practice: The 3 R’s

Speaker:  Molly O’Brien

Facilitator: Linda Wylie

Midwifery work is wide ranging. In essence we are public health practitioners, protecting, maintaining and enhancing the health and wellbeing of women and their families. As skilled practitioners we seek to understand and mitigate myriad factors that contribute to ill health while aiming to support and optimise birth physiology as per our code of proficiency. 

Specifically, the presentation focuses on labour dystocia and the midwifery skill of recognising when birth goes awry using the art and science of watchful attendance. It looks at ways to support physiology to reduce difficulties during the birth process and seeks to resolve mechanical difficulties by optimising physiology including the use of biomechanical techniques.  

This presentation highlights areas of midwifery training and education that hinder understanding of anatomy and physiology in relation to the birth process and the baby’s journey through the pelvis. It examines the impact the dominant biomedical model of care has on midwifery practice, the profession as a whole and the women who use the service. 

Recording: youtube.com/watch?v=FVN63zUtXXI

Speaker: Ginger García Portocarrero 

Facilitator: Susana Ku

El Colegio Regional de Obstetras III Lima – Callao, ha venido desarrollando un voluntariado en ayuda a la Maternidad Segura brindando temas en: consejería, telemedicina y campañas de salud reproductiva para los lugares más precarios de la ciudad. 

Para este 2023, estamos relanzando voluntariado con el nombre de Brigada PRO (Primera Respuesta Obstétrica), que incluye temas de: soporte básico de vida, atención prehospitalaria de emergencias ginecoobstétricas y Gestión del Riesgo de Desastres; para asegurar una buena atención en los lugares menos accesibles de nuestra región. También, pretendemos contagiar y compartir el voluntariado para formar la organización: Obstetras Sin Fronteras.

En esta renovación se les dotará de un traje táctico especial para el trabajo de campo que las pueda identificar y desempeñarse mejor en sus actividades. 

English: 

The Regional College of Midwives III Lima – Callao, has been developing a volunteer program in support of Safe Motherhood providing counseling, telemedicine and reproductive health campaigns for the most precarious places in the city. 

For this 2023, we are relaunching volunteering under the name of “Brigada PRO (First Obstetric Response)”, which includes topics such as: basic life support, pre-hospital care of gynecological and obstetric emergencies and Disaster Risk Management, to ensure good care in the least accessible places in our region. Also, we intend to spread and share volunteering to form the organization: “Midwives Without Borders”.

For this project, midwives will be provided with a special tactical suit for field work that will help them to identify and perform better in their activities. 

Recording: https://youtu.be/zfwrQxweOwA

Speakers: Bhavya Reddy

Facilitator: Heather Brigance and Sabina Ojil

Despite decades of considerable economic investment in improving the health of families and newborns world-wide, aspirations for maternal and newborn health have not been attained in many regions. The global turn toward recognizing the importance of positive birth experiences and reducing adverse outcomes signals a critical change in maternal and newborn health care conversations and research priorities. In this session we will introduce QMNC’s new program, communications platform, and approach designed to facilitate our focus on answering “different research questions,” drawing on evidence presented in the 2014 Lancet Series on Midwifery and a research prioritization study conducted with the World Health Organization from 2016. The objective of this workshop is to orient midwifery researchers, and especially future researchers, as well as those in the global south, to connect, collaborate, and develop capacity in research aimed at improving maternal and newborn health outcomes globally. It is critical that the professions of midwifery and midwifery science develop strong collaborative networks and research capacity aimed at answering critical research questions whose answers can reduce preventable maternal and infant death and suffering. The QMNC Research Alliance has acquired the preliminary funding needed to build a global platform and to hire support staff to facilitate this work. This session will be interactive, guiding attendees to identify where their research interests and expertise aligns with the three priorities. Participants who continue to engage with the QMNC beyond this session will also be invited to publish on the process of working together via the QMNC online platform.

Recording: https://youtu.be/Ut7r1QqyREQ

Speaker: Paloma Terra and Maria do Perpétuo Socorro da Silva Rodrigues 

Facilitator: Susana Ku

This presentation will be based on the research project Midwives of the Brazilian Amazon by Paloma Terra funded by Huron University of Canada. The project uses Critical and Decolonial research methodology and did interviews with Traditional Midwives of the Brazilian upper Amazon Region. This discussion will be a joint presentation in Portuguese with Maria do Socorro who is the president of the Midwifery Association Algodão Roxo a Traditional Midwives Association of the State of Amazonas. We will discuss the place of Traditional Midwifery in the modern world and why it is important to work to preserve and strengthen it. Socorro will present in Portuguese the history of the formation of the Association and their current work and struggles. Paloma will share some of the main take aways from the research project in both English and Portuguese.

Recording: https://youtu.be/RQco_ouNrCU

Speakers: Heather Bradford and Jeremy Neal

Facilitator: Catherine Salam

Healthcare providers’ weight bias has been associated with negative patient interactions and poor quality of care. This dissertation is the first to measure weight bias among midwives and determine if the weight bias scores differ from other health professionals and the U.S. public. A research study was conducted which involved electronically surveying AMCB-certified midwives during the 2022 ACNM Annual Meeting and via email. Preliminary findings reveal that AMCB-certified midwives have a preference for people with underweight or normal body weights. The findings may inform future studies to determine if there is an association between perinatal providers’ weight bias and clinical decision-making, quality of care, and perinatal outcomes such as cesarean birth rates among birthing persons with higher body weights.

Recording: https://youtu.be/L-TScIK_7A0

Speaker: Florence Wilcock 

Facilitator: Ally Anderson and Liticia Arthur

I am fortunate to work in the UK NHS within a midwifery-based system of maternity care where the role of the midwife is well recognised and respected. Despite this maternity care can sometimes break down and become a ‘them and us culture’ with conflict between different staff groups with midwives perhaps seen as advocates for women in contrast to obstetricians using a more paternalistic and medicalised model. I know in other regions in the world this can be even more marked with very obstetric based models and obstetric nurses in some countries or else with limited access to either profession in others. In this talk I will discuss my experiences of working alongside midwifery colleagues to try and enable women centred holistic care as well as making some suggestions of how you might build effective working relationships with obstetric colleagues.

(FRCOG aka TheObsPod)

Recording: https://youtu.be/jx2ANo8ZmnE

Speaker: Lieselotte Vandeputte and Elke Van Den Bergh

Facilitator: Eunice Atsali and Hannah Yawson

The annual report on midwifery-led care during childbirth focusses on midwifery-led care in Belgium. It is the second report to address the underreporting and need for transparency of the work that midwives do autonomously in Belgium.

Design and setting: The research was conducted through an online registrations form. Midwives could register each birth they attended or autonomously performed. 31 midwifery practices with 108 self-employed midwives primarily employed in Flanders and Brussels participated in this registration. Measurements and findings: In total 1,587 labours that started in first line and were also initially planned to give birth in first line under supervision of the midwife were registered. Of these 1,587 registrations, 1,311 deliveries were performed autonomously by the midwife: 695 deliveries took place at home, 278 deliveries were assisted in a hospital, 155 deliveries in a birthing house and 182 in a midwifery led unit inside of a hospital. One delivery took place on the way to the hospital. Finally, 276 women were referred intrapartum to the hospital for medical reasons after which delivery took place under the supervision of the gynecologist.

Key conclusions: MLC is safe and of high quality. Women have a higher chance of a physiological birth. Maternal and neonatal outcomes are excellent and in line with scientific literature. Implications for practice: There is a need for expanding the research into French speaking Belgium and to disseminate more the good results of midwifery led care as a safe and valid birth choice, given the increased demand for it.

Recording: https://youtu.be/99ko4df0kdc

Speaker: Margaret Jowitt

Facilitator: Adetoro Adegoke

In ancient times Hippocrates considered that at the appointed hour the fetus put its feet against the fundus of the uterus and pushed but for the last 500 years the baby has been relegated to being a passenger in the story of birth. In the 21st century it is time to consider how material and structural remodelling of the uterus and cervix in the last four weeks of pregnancy unleash the body’s ability to help the birthing baby find the best way through the pelvis. At crowning, the fetus activates his mother’s fetal ejection reflex to release oxytocin and complete his journey. The mother and fetus need to move instinctively to enable each to act on the other to effect a straightforward birth.  

Being with women throughout labour, midwives are ideally placed to advance scientific knowledge of how birth works. They observe the evolving hormonal milieu as labour progresses, they see how the mother’s mind and body work in concert with her fetus to provide a smooth passage. They recognise the importance of the social, emotional and physical environment in facilitating or impeding birth. A better understanding of the mechanobiology of birth will avoid aggressive medical and surgical intervention which can disrupt the transition to confident motherhood. 

The art of midwifery is to educate and inspire the mother to trust the power of her body and her baby to work together in birth, and also to recognise when more help is needed to achieve a safe birth.

Recording: https://youtu.be/K5xj_GBnhVY

Speaker: Brenda Araujo Salas 

Facilitator: Paloma Terra

A partir de las ilustraciones elaboradas por Yaquemilsa Matiashi Vicente, una joven madre del pueblo Matsigenka, perteneciente a la amazonía peruana, describiremos las prácticas tradicionales en salud materna que aún se mantienen vigentes en las comunidades más alejadas de la vida moderna. Se describirán las concepciones y prácticas culturales durante la primera menstruación, los cuidados en el embarazo, la atención del parto por parte de la familia y parteras, y los cuidados en el posparto.

Conocer gráficamente las prácticas en salud materna a través de la mirada de una mujer del mismo pueblo, nos permite visualizar detalles significativos que se dan en la los cuidados de las mujeres gestantes y los recién nacidos. La importancia de este material es educativa y en favor de una mejora en la atención del parto para fundar la comprensión y el respeto a las costumbres y participación de las parteras y especialistas tradicionales de salud, ya que, actualmente, gran parte de las comunidades amazónicas tienen acceso a establecimientos de salud, pero estos ofrecen servicios sin pertinencia cultural. Por otro lado, el material también permite el reconocimiento de la importancia de los conocimientos de las mujeres Matsigenka en los niños, niñas y adolescentes.

English:

From the illustrations elaborated by Yaquemilsa Matiashi Vicente, a young mother of the Matsigenka people, belonging to the Peruvian Amazon, we will describe the traditional practices in maternal health that are still in force in the communities farthest away from modern life. We will describe the cultural conceptions and practices during the first menstruation, pregnancy care, childbirth care by the family and midwives, and postpartum care.

The graphic presentation of maternal health practices through the eyes of a woman from the same village allows us to visualize significant details in the care of pregnant women and newborns. The importance of this material is educational and in favor of an improvement in childbirth care, in order to establish understanding and respect for the customs and participation of midwives and traditional health specialists, since, at present, most Amazonian communities have access to health facilities, but these offer services without cultural relevance. On the other hand, the material also allows the recognition of the importance of Matsigenka women’s knowledge in children and adolescents.

Recording: https://youtu.be/voZyHiTevvw

Speaker: Lucia Monetta

Facilitator: Susana Ku

In 2020, our Argentina Midwifery Association  launched a pilot program to develop a committee to strengthen two areas that have been less explored in our profession: research and leadership.

With the group of 4 young midwives, this committee developed a purpose, objetives and structure that will allow argentinian midwives to develop skills that will equip them to make a visible impact on their communities, by positioning midwifery in the Research Health field and to take on leadership roles in the Health Care Systems and organizations that tackle Sexual, Reproductive, Maternal & Newborn Health injustices and inequities. 

From this initiative, several program were born: internships/mentoring program, educational programs in research studies, conferences, seminars and one of the biggest accomplishments: a registered Midwifery Journal. 

The leadership program has grown over the past three years, achieving important leadership roles, mentoring midwives, as well as, more publishing and research opportunities. 

The Midwifery Journal “OBSTETRIX” continues to grow with more collaborations, more midwives publishing their research work from central, Latin America, and more  than two thousand subscribers. 

In this presentation, we want to encourage midwives to initiate this kind of programs and innovation to develop in their countries. We would like to explore the experiences and opportunities and that can be achieved by working with a unique working environment that allows midwives to develop their full potential and the lessons learned throughout this program. 

Recording: https://youtu.be/vC2DOEfLsLQ

Speaker: Amy Goh, Dia Kapoor, and Anna Nguyen

Facilitator: Olajumoke Ojeleye

Asians and Asian Americans (Asians) have the second highest rate of caesarean birth in the U.S. Asians have the lowest rate of out-of-hospital birth and are low utilizers of midwifery care. This presentation examines cesarean birth amongst Asians who have birthed at U.S. institutions participating in the AABC’s Perinatal Data Registry (PDR). 

Methods: Data from the PDR from 2007-2020 was utilized. Logistical regression was completed to determine the odds of cesarean birth for nulliparous and multiparous Asians in medically low-risk and elective hospitals categories.

Results: 2,983 Asian birthing people were sampled. Multiparous birthing people had 1.5 greater odds of caesarean birth compared to nulliparous birthing people (OR = 1.54; 95% CI, 1.19 – 2.03; p .01). The elective hospitalization group had higher adjusted odds of caesarean births compared to the low-risk and total population (OR = 1.54; 95% CI, 1.23 -1.93; p; .01). Nulliparous people in the elective hospitalization category had a rate of caesarean birth 1.5 times higher than the total (OR = 1.26; 95% CI, 1.09 -1.46; p .01) and 1.36 times higher than the low-risk sample (OR = 1.36; 95% CI, 1.13 -1.63; p .01). 

Conclusion: This study highlights inequities in multiparous and nulliparous cesarean birth among medically low-risk Asians. Further research is needed in disaggregation of perinatal outcomes and on reasons for low utilization of midwifery care and out-of-hospital births amongst U.S. Asians.

Recording: https://youtu.be/jc1ZxhkUvrc

Speaker: Jialu Qian

Facilitator: Heather Brigance

Purpose: The psychological outcomes for many parents who experience perinatal loss depend on nurses’ and midwives’ ability to provide effective bereavement support. However, most nurses and midwives lack the ability in this field. The aim of the study was to explore obstetric nurses and midwifery professionals’ experiences with the Perinatal Bereavement Care Training Programme (PBCTP) after implementation.

Method: This qualitative study was conducted at a tertiary level maternity hospital in China. The PBCTP was implemented from March to May 2022. A total of 127 nurses and 44 midwives were invited to participate in the training. Obstetric nurses and midwives studied a 5-module training programme comprised of 8 online theoretical courses. Semi-structured telephone interviews were conducted with 12 obstetric nurses and 4 midwives from May to July 2022 as a post-intervention evaluation. Thematic analysis was used in the data analysis.

Results: Six main themes within participants’ experiences of PBCTP intervention were identified: aims of the training; personal growth and practice changes after training; the most valuable training content; suggestions for training improvement; directions for practice improvement; influencing factors of practice optimisation.

Conclusion: Nursing and midwifery professionals described the PBCTP as satisfying their learning and skills enhancement needs and supporting positive changes in their care providing for bereaved families. The optimised training programme should be widely applied in the future. More efforts from the hospitals, managers, obstetric nurses and midwives are needed to contribute to forming a uniform care pathway and promoting a supportive perinatal bereavement care practice. 

Recording: https://youtu.be/sx7DJdpik9I

Speaker: Ines Rothman

Facilitator: Elisa Segoni

The population of low-risk pregnant women whose birth is induced has been increasing steadily in many countries. Considerable inter- and intraprofessional variation regarding the medical indications for induction, induction methods and induction term exists. 

The Flemish Association for Midwives did a systematic literature review on the effects of induction of labour at 41 and 39 gestational weeks, both compared to expectant management, on maternal and neonatal outcomes, and on maternal birth experience. This research included almost 40 studies across the 3 PICOs between 2017-2022 and 9 guidelines.

Clinical guidelines and current care policy are based on a limited number of research studies, with significant study limitations. The evidence from our systematic literature review shows that induction does not unambiguously lead to more favourable maternal and neonatal outcomes; new systematic reviews and the wealth of observational studies in recent years more often point to no or unfavourable iatrogenic effects of induction. Induction appears to have a higher chance of a negative birth experience and the shared informed decision-making process is flawed. Women receive insufficiently balanced information about the benefits and risks of induction, the different indications, the induction process, other interventions that may accompany an induction, the impact of induction on freedom of mobility, and the right to refuse an induction. Women often experience the induction recommendation as binding rather than as a choice, sometimes feeling pressured. An open, constructive, interdisciplinary dialogue is urgently needed to evaluate current induction policies. Our research points to several implications which can enrich this debate.

Recording: https://youtu.be/iyoz_CNYZv8

Speaker: Tracy Donegan

Facilitator: Portia Shanduka

80 – 90% of women who stop breastfeeding in the first six weeks are not ready to do so. Initiatives to improve breastfeeding rates have traditionally focused mainly on social policies, support and health promotion activities. In recent years therapeutic interventions such as mindfulness and self-compassion practices are emerging as an effective tool to increase breastfeeding self-efficacy while reducing mental health complications. Traditional antenatal breastfeeding preparation overlooks the influence of a dysregulated emotional state on breastfeeding outcomes. Antenatal breastfeeding classes are a prime opportunity for midwives to provide parents with evidence-based tools to manage psychological distress during this intense transition.

Mindfulness practices support parents to manage emotional turmoil and overwhelm including those who may experience breastfeeding grief. A mindful breastfeeding class can prepare parents with more than position, latch and newborn nursing information. This hybrid approach facilitates the development of cognitive skills to cultivate mental flexibility and emotional resilience to meet common challenges of early breastfeeding with self-compassion and self-kindness. This is critically important for parents with a baby in NICU who are at increased risk of developing mental health complications due to high stress levels. Recent primary evidence suggests that a mindfulness based approach to breastfeeding and postpartum is associated with an increase in breastfeeding initiation, duration, self-efficacy, parenting confidence and improved relationship quality. Infant mental health is also impacted positively.

Recording – https://youtu.be/X_5TJjN7PR0

Speaker: Patricia Marianella 

Facilitator: Paloma Terra

El objetivo fue comparar los resultados materno-neonatales y costos de la resolución de embarazos, en mujeres obesas y con peso normal pregestacional.

Métodos: Estudio transversal realizado en 60 gestantes con obesidad y 120 con peso normal pregestacional atendidas en un hospital público de Lima durante el 2018, seleccionadas aleatoriamente. Se recolectaron datos sociodemográficos, indicadores maternos (índice de masa corporal pregestacional, controles prenatales, edad gestacional, días de hospitalización), neonatales (Apgar, peso, morbilidad, edad gestacional por examen físico, días de hospitalización) y datos de los costos (medicamentos, procedimientos e insumos). Se utilizó la prueba estadística U de Mann Whitney.

Resultados: Se encontraron diferencias entre mujeres obesas y con peso normal pregestacional en los días de hospitalización materna (3 ±1,2 días vs 2,0 ±1,2 días; p=0,000); en el peso del recién nacido (3 615 ± 518,03 gr vs 3 245 ± 426,25 gr; p=0,000), en el costo de medicamentos ($ 19,78 ±16,47 vs $ 3,21 ±15,57; p=0,000), en el costo de procedimientos ($ 40,65 ±46,78 vs $ 27,67 ±49,47; p=0,001), y en el costo de insumos ($ 54,08 ±29,02 vs $ 9,32 ±28,26; p=0,000).

Conclusión: Las mujeres obesas presentaron recién nacidos con mayor peso, contaron con más días de hospitalización y los costos de medicamentos, procedimientos e insumos fueron superiores en comparación con las mujeres de peso normal.

English: 

The objective was to compare maternal-neonatal outcomes and costs of pregnancy resolution in obese women and women with normal pregestational weight. Methods: Cross-sectional study conducted in 60 pregnant women, randomly selected, with obesity and 120 with normal pregestational weight attended in a public hospital in Lima during 2018. Sociodemographic data, maternal indicators (pregestational body mass index, prenatal controls, gestational age, days of hospitalization), neonatal (Apgar, weight, morbidity, gestational age by physical examination, days of hospitalization) and cost data (drugs, procedures and supplies) were collected. The Mann Whitney U statistical test was used. Results: Differences were found between obese and pregestational normal weight women in maternal hospitalization days (3 ±1.2 days vs. 2.0 ±1.2 days; p=0.000); in newborn weight (3 615 ± 518.03 gr vs. 3 245 ± 426.25 gr; p=0.000), in the cost of medications ($ 19.78 ±16.47 vs $ 3.21 ±15.57; p=0.000), in the cost of procedures ($ 40.65 ±46.78 vs $ 27.67 ±49.47; p=0.001), and in the cost of supplies ($ 54.08 ±29.02 vs $ 9.32 ±28.26; p=0.000).Conclusion: Obese women had heavier newborns, more days of hospitalization and the costs of medications, procedures and supplies were higher compared to women of normal weight.

Recording: https://youtu.be/McAV7M1Ub4M

Title: Considering evidence and wisdom in professional reality

Speaker: Céline Lemay

Facilitator: Elisa Segoni

With EBM we also see a proliferation of guidelines and recommendations directed targeting practitioners that are expected to “apply” them and valuing a standardised care. In their daily practice midwives are facing two different important professional orientations: following guidelines/protocols and also providing a woman centered individualized care. How to take the most appropriate decision for the patient then? The reality is complex and often hold ethical tensions. How can we demonstrate a good quality of care? In past years there was a number of publications promoting the importance of more practical wisdom or “phronesis” in health care professional practice. A review of literature on the subject was undertook and 37 papers were selected to answer the main question: how can we understand the meaning of practical wisdom and its place for a good quality of healthcare? Can practical wisdom be learned, taught, developed and cultivated? We will develop the mean findings of our review, highlighting the fundamental place of professional judgement in the profession. It is a question of using discernment and deliberation to decide the best action for the good of a unique person in a context of care.  There is also the valorisation of a reflexive practice in clinical places as well as using narratives of experiences to learn discussion and reflection during undergraduate period. In all context of care practical wisdom can help midwives to use the strengths of EBM AND have a woman centered care. It is seen as a mean to flourish as a professional.

Recording: https://youtu.be/Ir1AJXKZVQs

VIDM is not over yet! Following the closing Keynote speaker, stay right where you are for the closing events. 

Facilitator: Lorraine Mockford

VIDM founder Sarah Stewart is back with a taste of her comedy routine: Donuts, Fireman Sam, and living with a hoarder!

Sarah Stewart is a midwife, nurse and stand up comedian. Sarah has performed comedy around Australia and is a member of the very successful comedy team, The Women’s Room, who have just had 2 sold out seasons at the Canberra Comedy Festival. Sarah has lots to say about being a wife, mother, getting old and of course….being a midwife.  Sarah will be performing in her pyjamas, in bed, and feeling like a right wally because virtual comedy is weird. The good news for Sarah is if you heckle her, she can just mute you! 

Then join the VIDM Organizing Committee, volunteers, and delegates as we say thank-you for another year by sharing our closing video with you.

Recording FINAL closing slideshow selfie photos – https://youtu.be/5r7DqvZ5or4