Prague 2014: 30th ICM Triennial Congress
On Sunday 1st June, Wendy Gadsden and I flew to Prague for the 30th Triennial Congress of the International Confederation of Midwives, feeling a little nervous with the anticipation of presenting Birthlight intrapartum practices live as part of the the highly selective four day programme. We missed the opening ceremony as we went straight to our hotel and swatted on our powerpoint presentation, pruning it down to highlight the aspects that midwives had reported as most useful to them in Wendy’s Birthing Lightly courses for maternity professionals. We rehearsed several times with our pelvises, alternating our respective parts to make the presentation lively and interactive. We timed every section of our 80 minutes - as we had agreed that Lesley Page, the President of the Royal College of Midwives and Patron of Birthlight, would join us and talk for the last 10 minutes of our full 90 minute session. We decided to turn on music on and off manually for the moves from Wendy’s little sound machine rather than risking technological glitches by embedding audio files in the presentation. It felt very lucky that we were due to present on Day 1, Monday, so that we could enjoy the rest of the congress after our talk.
In the beautiful congress centre in Prague, entering the hall for plenary sessions that held all the 3,800+ midwives who congregated from 108 countries was quite emotional. I have always felt a citizen of the world but being in the midst of midwives from all over the world was a peak experience. Unlike other international meetings I have attended, there was a genuine atmosphere, a sense of shared purpose, an immediate friendliness. I felt in tune, at home, relaxed and eager to engage with all these special women. Through the four days, the messages that stand out from my notes are to do with the importance of evidence based research and appropriate education, the urgent need to make normal birth an accessible reality and the crucial role of midwives in forging women’s long term health in their communities by improving antenatal care, the quality of birth attendance and postnatal care in continuity. The overall theme of this 30th Triennial Congress was indeed the relation between midwifery and women’s global health, the relatively neglected Millenium Development Goal No 5.
As we set out for our presentation that was one of four concurrent sessions, people kept coming into the meeting hall. Soon we had rows of people sitting on the floor at the front, and standing at the back and to the sides. We were a little daunted that so many chose our session. In true Birthlight style we had to adjust on the spot. Wend spoke from one side of the screen and I heard her say ‘Francoise get on the table’ as people at the back could not see our demonstrations. We ‘managed’. It was clear that all the audience were involved and interested and we got consistent positive feedback in the following days from attendants who spotted us when we met here and there. After our talk Wend was surrounded to give out leaflets on the Birthlight Yoga for Maternity Professionals trainings and we sold out of perinatal and postnatal recovery booklets. Our audience was very international and for the first time in the history of Birthlight with the exception of a couple of World Baby Swimming congresses, the inter-cultural quality of our practices informed by anatomy, physiology and other research came across clearly. Midwives are ‘with women’ and the moves we showed in relation to pelvic anatomy, both micro-movements and moves for aligning and grounding, make sense for all women’s bodies across cultures. Jane, a Birthlight trained midwife from New Zealand and friend of Wend, kindly filmed the workshop but we need to wait until the close of her European honeymoon trip to get the footage.
It will take weeks for Wend and me to assimilate the richness of our experiences at the Congress. We attended some sessions together and others separately. I mingled with the Latin American midwives and on the last day the French delegation invited me to be on their photo. Wend met some of the 500 strong Australian delegation (there were 300 midwives from the UK) and two of her colleagues-friends from New Zealand were at our hotel. I enjoyed chance encounters with Sheena Byrom, from Lancashire, who will speak at our September conference, as well as with Jan Tritten (Midwifery Today), Jenny Smith (London), and my dear friend Barbara Harper (Waterbirth International); It was also exciting to make new friendships, sometimes around the buffet tables or in the coffee queues. Mostly, sessions were opportunities to hear and meet speakers whose articles I had read (or not) and whose work resonated with our Birthlight approach and objectives.
To sum up highlights of sessions that can impact on the development of Birthlight does not do justice to the insights and inspiration from the Congress, which will certainly nurture us as well as the other delegates for the coming three years. Moreover I can only convey my personal networking in a multi-layered, multi-faceted event in which new trends in global health were shaped through addresses, discussions and reports. Wend’s set of contacts will reflect another network. Perhaps she will write about her experience from the double viewpoint of practicing midwifery in the UK and in New Zealand. If I was already aware of the urgent need to evaluate and research our practices, Professor Cecily Begley (Dublin)’s plenary address fired me into action and I hope to involve all Birthlight teachers in a collective effort. I was not the only one to be fired up! there was a massive rush to the stalls of publishers in the exhibition hall after her presentation that she kindly sent me and I will seek permission to disseminate among Birthlight teachers. Research is getting big in midwifery and there were lots of PhDs among delegates. Professor Mary Renfrew (Dundee) who is pioneering a new Lancet Series, spoke eloquently about the need to broaden the scope of midwifery in the community and to focus on quality of care, not just outcomes. She voiced an opinion visibly shared by a majority in the Congress that more and better equipped hospitals, while necessary, were not necessarily the best way to improve women’s health globally. There was however a minority, including doctors and policy makers, representing the dominant model according to which increasing hospital births is the fastest and best way to reduce mortality in developing countries. This is the view that has led to the situation I am following in Peruvian Amazonia, where indigenous women suffer acutely from the ban on traditional midwifery practice. There is a clear dilemma between numbers of mothers and babies saved and quality of care.
Besides inspirational plenary sessions, many of the parallel sessions in Days 2 and 3 were relevant to what we do in Birthlight. All the avenues for promoting ‘normal birth’ were explored. Several sessions evaluated different birth positions in relation to outcomes and there was a strong focus on pelvic floor care that generated a lot of discussion. Ann Frye’s anatomy animations addressed the oversight of the urethra and the levator muscles in the pelvic floor due to the tradition of studying anatomy on lying down corpses rather than standing live women. We got her DVD. A lot of the insights add to Blandine Calais Germain’s insights, which also confirm our own understanding of the importance of the three sphincters for the shift from vagina to birth passage and then back to a toned pelvic floor post partum. Regarding body-based practices, there were several mentions of the demonstrated efficacy of acupuncture; Wend attended a Shiatsu workshop and I spotted a ‘magnetic passes’ session (drawn from Castaneda and inspired from Toltec shamanism in Mexico): there was a lot of overlap with our ‘energetic practices for birth’ that might now be more openly attributed to their shamanic sources. Apart from our workshop there was only one poster on yoga and surprisingly little on hypnobirthing.
Day 4 was dedicated to ‘culture and practice’ and was perhaps the most interesting day for me as an anthropologist. While the plenary address by Chinese midwife Ngai Fen Cheung emphasised nutrition during pregnancy that is so salient cross culturally, the well-studied need to understand women’s local values and preferences rather than imposing international health protocols was reiterated in other sessions. Japanese posters showed the enduring importance of cultural values in maternity care. I enjoyed a session showing rapid positive outcomes when midwives were assigned to Australian aboriginal communities and collaborated with women elders in contrast with standardised hospital transfers that made women feel isolated and frightened. Other sessions addressed the needs of immigrant women in host communities, teenage maternity, midwives’ involvement in contraception and even in some cases safe abortions in war zones. It was an emotional day as the issue of increasing gender violence against women and also against midwives came to the fore without easy solutions. A White Ribbon Alliance film showing the day of a midwife in a rural West African health post was an eye opener, as midwives no longer enjoy the special status and security that ensured their protection in past generations. At the other end of the global social spectrum, some forced C sections or mandatory places and ways of birth in affluent countries violate basic human rights.
Speakers at the Congress generally acknowledged that modernity and medicine have not improved global women’s reproductive health as anticipated in World Health Organisation agendas, but they were resolutely optimistic that midwifery care embedded in women’s lives, families and communities can solve many of the current problems and reduce expenditure. In alliance with midwives, community support professionals among whom Birthlight teachers are particularly well prepared can play a significant role in improving continuity and greater quality of care. While the programme of this Congress reflected the fact that Postnatal care is still the ‘Cinderella of maternity services’, the well attended multi-lingual baby massage sessions offered by Johnson & Johnson, the main sponsor for the Congress, showed midwives’ interest in catering not just for mums but also for babies and dads. There were also several sessions on the promotion of breastfeeding. Traditional midwives are always there before, during and after birth, ensuring completion and re-integration of new mothers in their communities. In today’s world, midwives cannot do it all. Birthlight’s holistic model of support linked to care fits well with the increasing global awareness that women’s and families’ health is held in nurturing relationships, even around high tech hospitals, in the most diverse settings where women give birth around the world.
At all times we felt warmly and efficiently hosted, fed and supported by Czech organisers and stewards. Wend and I went on the congress dinner cruise on the Vlatava river, from which we could enjoy the famous Charles Bridge and historical buildings in Prague. Social events are part and parcel of a good congress. I wondered about midwives in Hungary, whose practice is tightly controlled, and missed our friends from Russia as due to an incident that I was not able to elucidate Russia was not included in the ICM.
A few main speakers’ profiles and quotes:
Lisa Kane Low, Associate Professor and Director of Midwifery Education at the University of Michigan, keynote speaker. : ‘We know that access to quality midwifery care is a consistent challenge. Health is more than just access, social conditions and education are important too. Midwives are a critical part of increasing access to care and promoting reproductive health globally. Ensuring every woman has access to a midwife is a way of tackling inequalities in health; they are avoidable’.
She quoted Dr Mahmoud Fathalla, Medical Professor in Cairo: ‘Women are not dying because of diseases we cannot treat. They are dying because societies have yet to make the decision that their lives are worth saving’.
Judith McCara-Couper (New Zealand): ‘at the heart of midwifery is the strongly-held truth that women are informed of their choices and supported in the choices they make. ‘If midwifery practice is not driven by women’s choices, what would it be driven by?’ The majority of attendees agreed that midwifery care is not currently women-centered, however everyone agreed that it should be..
The State of the World's Midwifery 2014 report is the second global report on Midwifery workforce, a central issue for Maternal and Newborn health. The first one was launched at the ICM Congress in Durban 2011. This second report is providing data on 73 countries and is taking stock of progress made in planning, producing and managing midwifery workforce. The report is also analysing the context and making projections towards 2030. (for details visit the ICM website http://internationalmidwives.org/news/?nid=151
Her Excellency Toyin Saraki, Founder-Director, Wellbeing Foundation Africa
As the First Lady of Kwara State, Nigeria, from 2003-2011, Toyin fought for Child Rights and enhanced the access of every citizen to healthcare and education. As Founder-President of the Wellbeing Foundation Africa (WBFA), Toyin advocates internationally for MNCH and the improvement of the health systems across Africa. WBFA’s Personal Health Record© is currently aiding in reducing child and maternal mortality in Nigeria and will move Africa towards attaining Millenium Development Goals 4 and 5. A global advocate of the UNs’ Every Woman Every Child effort, Toyin acts as Board Chair of the White Ribbon Alliance Nigeria, Chair of the FIDA International Committee on Law Protecting the Rights of Children, and sits on the boards of the Global Foundation for the Elimination of Domestic Violence and The Africa Justice Foundation.
Prof. Cecily Begley, Chair of Nursing and Midwifery, Trinity College Dublin, Ireland
Prof. Cecily BegleyProf Begley, a registered nurse, midwife and midwife teacher, is Chair of Nursing and Midwifery in Trinity College Dublin. Prof Begley has been successful in obtaining €7.5m euro in research funding in the last 6 years, as Principal Investigator, and has supervised 21 PhD students to completion. She is a member of national and international research review committees, has published over 100 peer-reviewed research papers, and is Section Editor for BMC Pregnancy and Childbirth.
Her main research areas are: normal birth, midwifery-led care and expectant management of the third stage of labour. She is at present co-ordinating (with Prof. Mike Clarke and Deirdre Daly) the MAMMI study (Maternal health And Maternal Morbidity in Ireland) and leading an FP7 Health-funded study on increasing VBAC through women-centred care (OptiBIRTH).
Ngai Fen Cheung PhD MSc RM RGN, Adviser to Chinese Midwifery Expert Committee, Chinese Maternal and Child Health Association. Ngai Fen Cheung, UK trained midwife and researcher set up the first Midwifery Research Unit and the first Midwife-let Unit in Hangzhou, China. Her main research interest is in childbearing women’s well-being, theorizing normality of childbirth as an approach to developing midwifery and midwifery education in higher education in China; established a teacher-student exchange programme with the University of Edinburgh; prepared and organised ‘the Normal Labour & Birth: 7th International Research Conference’ in China in 2012 and ICM-Chinese midwifery gap analysis in 2014. She did some cross-cultural studies in Childbearing experience of Chinese and Scottish women, caesarean decision-making in China. Other projects that she is currently involved in are a randomised controlled trial of the midwifery-led care study in 10 hospitals in China, and ‘Challenging inequality: the maternity care study of migrants in China’. The latter study is a part of an on going four year international project ‘Childbirth Cultures and Consequence’ (COST IS090 by professor Soo Downe.
These two images, independently from Prague ICM, (kangaroo care in a Unicef project in Ghana and two Brazilian VBAC mums recently attended by a Birthlight trained doula in São Paulo in a pro-normal birth center) embody the message of the Congress. Low-tech approaches backed by research can work a treat for the majority of women and not cost the earth, keeping the high tech resources for life saving emergencies.