Back 26 October 2016

Voices and realities from "Zebra midwives"

Following the launch of the Midwives' Voices, Midwives' Realities Report, which reveals that too often midwives report their efforts are constrained by unequal power relations within the health systems. The report also highlights  the need to provide midwives with professional support (including better working conditions); stronger education and regulatory environments; a stronger advocacy around midwifery. We asked the Young Midwives Leaders (YMLs) to share their 'voices' on what they are doing in their countries to advance the midwifery agenda. In this article Yoana Stancheva tells us about a conference she participated in organizing and 'Zebra midwives' - a project she runs with colleagues, which is the only midiwfery practice registered in the country.

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One of the participant stressing a point during the conference 

Bulgarian women, midwives and obstetricians rarely consider childbirth to be uncomplicated, physiological event. Different clinical and cultural perceptions have merged to persuade the general population that a woman has one foot in the grave while in labor. Midwives have very restricted scope of practice to be able to convince women otherwise and support them in pursuing evidence-based practices. It is hardly surprising that this climate has led Bulgaria to a C-section rate of 43% and a rate of interventions which does more harm than good.

The conference "Contemporary Research and Practice in Physiological Birth" took place on Sep 18th, 2016 in Sofia, Bulgaria, and featured ten prominent speakers from different EU universities and hospitals presenting on the application of evidence-based medicine in the labor ward. The speakers are also members of the large-scale EU project COST IS 1405 ( - an interdisciplinary network of global academics and clinicians working together towards producing quality research on normal birth. We referred to the conference in Sofia as "the COST conference" because it reflects the goals of the network and the speakers donated their time and effort as part of their commitment to keeping each COST country up-to-date with global midwifery standards.

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Yelena Stancheva, Young Midwife Leader from Bulgaria 

More than 160 local midwives and obstetricians from different parts of the country gathered for the conference to get exposure on quality midwifery research, evidence-based protocols and optimal care for physiological childbirth. For the first time in Bulgaria physiological birth was emphasized with such academic excellence from renowned names in the field. The relative isolation of Bulgarian midwives and obstetricians was suspended for a day and many could recognize the need for a move towards implementing evidence-based care in Bulgarian hospitals. Even though the contemporary research and practices presented at the conference ran counter to what Bulgarian clinicians identify as routine, the importance of the event was that they could expand their views for a new organization of care which is less costly, more rewarding and beneficial to mothers, babies and professionals alike.

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Zebra Midwives' in one of their meetings 

As a local organizer, the event was able to position the midwifery practice that my colleague and I run on a new, well-founded and globally recognized plain. "Zebra Midwives" ( wishes to walk in the footsteps of our foreign colleagues and the evidence-based practices they uphold. Zebra is a project of less than 1 year and is the only midwifery practice registered in the country. This is why the conference was crucial to establishing a name for ourselves and setting standards for midwifery which have been long abandoned. We could only hope that those who were already inclined to think of midwifery as an evolved form of caring for mothers, babies and public health in general could see the possibilities that this conference opened up for them. Bulgarian midwives and obstetricians will certainly have an even greater interest in the topic the next time we organize a similar event because the first step, and the hardest, has already been made.

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Yelena Stancheva with her colleague from 'Zebra Midwives' 

What comes out as a conclusion from the conference is that it is essential for midwives to fight for their right to work autonomously and in line with ICM regulations of their profession. It is urgent that healthy mothers and babies can be cared for by midwives who are trained properly to make clinical decisions for them in pregnancy and birth. We are in the process of establishing partners to design such a training curriculum and a space where evidence-based care will be valued. At the moment, it is far too early but we have commitments from clinical staff who is willing to re-learn the art of midwifery and allocate space for its confident application. 

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Working autonomously in a country where midwifery services are not valued and the basic scope of midwives' competencies are not legally supported is challenging but exciting. There is nothing we can say or do as midwives without bringing women on board with our demands. We need a critical mass of women supporting our vision for maternity care based on evidence. While we are working on engaging women with this political stance, we are also supporting our friends who are in the process of graduating from midwifery school for the very same reasons we graduated - to see how much we can get done to make it easier for the new, capable and confident midwives to emerge and contribute their share to healing the broken society we live in.

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