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Midwifery: bridging culture and practice

Thursday, June 5th: The last day of the 30th ICM Triennial Congress started with a truly interesting session titled ‘promotion of midwifery as a career’. Chaired by Ingela Wiklund (ICM Board Member) and conducted in partnership with the White Ribbon Alliance (WRA), it was an interactive workshop focused on an exploration of what it means to be a midwife around the world today, examining the stereotypes in different countries and identifying strategic ways of challenging them. Nester Moyo, ICM Senior Midwifery Advisor, started the session by saying that midwifery has been described as an aging profession. Unfortunately, there are not many young people striving for a career in midwifery, due to the negative image portrayed about midwives. Brigid McConville (WRA) introduced a short film called ‘Mythbusting Midwives – The Downside’. Midwives around the world shared some words that they heard people using to describe them and their work. A midwife from Malawi shared her experience saying that ‘what I feel is that midwives have a bad reputation’, they are often called ‘bossy, dismissive, unskilled, uneducated, old fashioned, strict, without compassion’. Voices from the audience shared: ‘The bad image presented by the media is due to the fact that midwives support pain and labour, therefore are sometimes perceived as bossy and unkind’. A male midwife from Malawi shared that the majority of people in his country consider midwifery as the lowest level on a professional scale. The second part of the movie, called ‘The Upside’, presented the good things people say about midwives and included: ‘caring, helpful, gentle, emphatic, loving, listening, understanding, strong, warm, indispensable, compassionate, humane, supportive, sensitive to unspoken needs, magical, passionate about their work, knowledgeable, calm, extraordinary’. Many countries face low enrolment in midwifery education programs, for example Tanzania has seen a 90% decrease in student intake compared to a decade ago. Reasons include the status of midwives, negative perception of midwives’ role, poor pay, and working conditions. Nester Moyo said the issue lays in our society’s perceptions about midwifery, ‘the power gradient that midwives create between them and the women they serve’, said Nester. ‘Society sees midwives as those people who don’t want to work with anyone else, don’t listen and don’t understand’. Secondly, Nester said that the entry qualifications for midwifery education are not competitive, they are often called ‘academic leftovers’. The third theme that came through was the education process itself, because of the perception of student midwives. ‘We are not producing confident individuals, we need to change the ways we address, interact, and treat young midwives’, added Nester. The fourth point Nester made were the conditions of service; ‘the economic level of a country does not necessarily reflect the conditions midwives work in’. Nester also stated that midwives don’t have a uniform image around the world, therefore people ‘don’t want to join this feeling of vagueness’. Frances Ganges, ICM Chief Executive, shared her experience in the US and said that on several occasions people asked her ‘are you really a midwife? They still have those?’ She added that midwives in the US only attend 10% of births. When she worked as a nurse, one would be sent to a postpartum unit as a punishment as it was believed that didn’t require skills. Mary Chuwe, WRA Tanzania, shared the example of a campaign that was carried out to promote midwifery in her country, called ‘Be in Science – Choose Midwifery’. Before the campaign, ‘midwifery was seen as a last resort, not the ‘career of choice’, said Mary. By establishing youth clubs in schools and encouraging students to take science classes, the campaign promoted a very high awareness of midwifery and as a result – more students enrolled in midwifery programs. 

Dr Ngai Fen Cheung, Adviser to Chinese Midwifery Expert Committee, Chinese Maternal and Child Health Association, was the final Congress speaker and gave a presentation on cultural sensitivity and midwifery. ‘Cultural sensitivity is a key concept running through the ICM Essential Competencies for Basic Midwifery Practice’, said Dr Fen. ‘The concept of culture is a set of rules and ideas that guide formation of groups’. Dr Fen added that culture is a way of life with implications for health, thus cultural variations must be considered for midwifery and MNH. ‘Midwifery is an indispensable culture. Midwives have brought not only physical comfort to the birthing woman, but also cultural comfort’. Cultural sensitivity in midwifery care is meeting the cultural needs of women and families in childbirth; overcoming those cultural practices that harm women and babies; and having a healthy culture of its own to meet these challenges. Midwives need to learn about the cultural aspects that affect maternal health: religion, rituals, nutrition, etc. ‘Midwives often provide cross-cultural care. They need to understand cultures and cultural changes’, stated Dr Fen.

The closing ceremony started with student midwives presenting a scroll with 1000 signatures gathered for Precious Cargo. Frances Day-Stirk thanked the Board Members who finished their second term: Deliwe Nyathikazi, Mirian Solis, Mary Higgins, Maria Papadopoulou, Marian Van Huis, and Debrah Lewis. She also welcomed the new Board Members: Dr Jemima Dennis-Antwi, Sandra Oyarzo-Torres, Dr Rafat Jan, Myrte De Geus, Dr Rita Borg Xuereb, Serena Debonnet. Frances Day-Stirk also thanked the host association, stewards, Congress Manager – Malcolm MacMillan, professional Congress organizer, translators, ICM staff and ICM Chief Executive. She also thanked all the midwives who tweeted about the Congress and helped spread the word. In her thank you speech, she said ‘We’re building relationships and expanding collaborations. We can’t do it alone!’. She added ‘If we don’t change, we don’t grow. If we don’t grow, we aren’t living. I look forward to a future, where there are more midwives in the world, where midwives are the norm – not a novelty. I look forward to the development of many more programs for midwifery education. I look forward to a strong ICM network, strategic partnerships and collaboration’. A wonderful and heart-warming video was screened, showcasing the highlights of 30th ICM Triennial Congress: messages from participants, fun times, sessions and workshops, singing and dancing, five exciting days wrapped up in little under 10 minutes. A Czech orchestra, Dulcimer Pralinka, had the participants clapping cheerfully and continuously to the musical interlude. Finally, the Congress baton was passed on to Canada, for another fantastic 31st ICM Triennial Congress in 2017! The Canadian Association of Midwives (CAM) invited everyone to Toronto and performed ‘Amazing Grace’ with lyrics adapted about midwives and midwifery. The spectacular closing ceremony ended with a dance performance.

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