VIDM 2023 Programme

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

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

Speaker: Tania Pariona Tarqui

Facilitator: Paloma Terra

Recording: https://youtu.be/zuIlj3va4E4

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: 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: 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: 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: 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

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: 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

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: 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