VIDM 2023 Programme

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

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: 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: 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

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: 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: 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: 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

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

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: 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