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: 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: 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: 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
Speaker: Linda Deys
Facilitator: Liz McNeill
Abstract:
The problem: Obstetric violence creates visions of a brutal and purposeful assault, however more covert practices cause similar psychological harm, are less understood, and more likely to be disregarded. Separating women from their well-baby at a caesarean section birth can cause long-lasting trauma. Method: A feminist phenomenological study, using birthing theories to understand the experience of women separated from their baby at caesarean section birth without a medical indication. Results: We identified four main themes that were interlinked: Disconnection, Emotional Turmoil, Insight and Influence. This presentation expands on Influence and the sub-themes of power & control, maternal choice & consent, coercion and staff actions. While obstetric violence was perceived with the physically forceful actions that some of these women experienced, it also showed more insidious events which caused comparable traumatic responses. The term ‘obstetric neglect’ was coined to symbolise maternity care where maternal choice and consent was voided by health care providers using power, control and coercion that influenced participant birth outcomes and experience. Conclusion: Birthing in an operating theatre environment limited the capacity of the participants to bodily autonomy and this vulnerability was not accounted for with woman-centred care. Midwifery training and values align with the need for the protection of, and advocacy for, women. These findings demonstrate the importance of a respectful, empowering and supportive midwifery contribution through every pregnancy and birth, in the development of policies and procedures, done in partnership with women.
Recording: https://youtu.be/bCUeuCB2cLU
Speaker: Belle Bruce
Facilitator: Louela Cordova-Acedara
Abstract:
Background: There is a major research gap relating to the impact of intravenous (IV) fluids administration during labour on maternal and neonatal outcomes. It is biologically plausible that a relationship between volume of IV fluids and primary postpartum haemorrhage (PPH) exists. Aim: To investigate the relationship between intrapartum IV fluids and PPH. Methods: A retrospective cohort study was conducted in a tertiary hospital from September 2021 to September 2022. Inclusion criteria were singleton pregnancy, planning a vaginal birth, and admitted for labour and birth care between 37-42 weeks gestation. The study factor was IV fluids during labour. The primary outcome was primary PPH. Birth and postnatal data were obtained from the electronic medical records and paper fluid order documentation. Secondary outcomes included caesarean section and neonatal weight loss following birth. Results: 1023 participants were included of which 339 had a PPH (33.1%). Our main finding was that there was no association between high-volume IV fluids (≥2.5L) and PPH after adjusting for demographic and clinical factors (ORadj1.02 CI: 0.72, 1.44). However, there was a positive association between high-volume IV fluids and caesarean section (ORadj 1.99; CI: 1.4, 2.8) and neonatal weight loss (ORadj 1.8; CI: 1.09, 2.0). Conclusions: These findings are important to further knowledge relating to the administration of IV fluids in labour and the potential impact of this common practice. It identifies future research priorities around documentation of IV fluids and their relationship with pregnancy and perinatal outcomes.
Recording: https://youtu.be/sjOijsnYkWM
