"I am passionate to raise my midwifery voice at the global level" - Lisa Welcland

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Lisa Welcland 1 blog 2018

  Lisa Welcland , International Representative for Deutscher Hebammenverband (DHV) - German Association of Midwives

Brief introduction to yourself, including member association, area of interest and expertise and why you decided to become a midwife: 

I Have been a registered midwife since 2006 with professional work experience in Ghana, UK and Germany. Since 2014, I have been an International Representative for the German Association of Midwives (DHV). My role is to represent DHV during international meetings and conferences, to explore effective midwifery working models at global level, share knowledge, experience and expertise with international peers and to feedback lessons learned to our members in order to create new visions and strengthen midwifery in Germany. Since 2017, I have been representing ICM at the United Nations in Geneva, which is a great honor to me and offers a new perspective to strengthen maternal and newborn child health services globally.

I am passionate to raise my midwifery voice at global level, to stand in for quality of care in maternal and newborn health services and to explore midwifery-led models that ensure good outcomes and offer good working conditions for midwives. I am still practicing as a community midwife and do advocacy work on midwifery care for women who have experience female genital mutilation and cutting (FGM/C). I promote effective models of service provision for women from vulnerable groups. Furthermore, I lecture midwifery students and facilitate continuing professional development programs to share my expertise with the next generation of midwives, as well as with colleagues. I motivate people to be change-makers and to take on leadership responsibilities.

The transition period to parenthood has always been a fascinating time to me and it is my wish to support babies, mother and parents to be to the best way possible during this journey. My midwifery philosophy is informed by belief in the physiological processes, to work with families and to support informed decision-making in order to gain familial confidence in their own abilities and empower them.

What issues do you think impact the life of women and their newborns the most in your country?

There is universal access to maternal and newborn child health services in Germany. Furthermore, we have a Midwifery Act, where it is stated that a midwife has to be present during each delivery. Midwives in Germany support women and their babies during pregnancy, childbirth and the postnatal period, which means we have a good foundation of midwifery embedded in our society.

However, midwifery education needs to be further developed and shift from vocational to academic level. During a time where interventions rates are increasing more and more, we need midwives to be involved in research in order to challenge current practices. Midwives support women during pregnancy, birth and the postnatal period – so it is essential for a profession - which has such an amount of responsibility and autonomy - to be officially recognised with the right to an academic career, adequate remuneration and appropriate working conditions in order to contribute to society and offer women and their babies the best possible start into life.

What programs currently exist in your country to support women and newborns, and do you think they are working? Why or why not? Independent midwifery services plus community care as well as quality of care, out-off hospital births

In Germany we have a caesarian section rate of 33%, which has been acknowledged by federal states. There are now some regional interdisciplinary working groups that are finding ways of how physiological birth rates can be improved. Some recommendations include the promotion of information material regarding normal processes during pregnancy and childbirth, and for women to have more choice of birth places. There are interdisciplinary workshops on physiological birth and the management of breech deliveries.

The establishment of regional working groups with all stakeholders involved needs to be acknowledged. However, the challenge will now be how interventions are getting scaled-up and if they actually have an impact on our caesarian section rate. The problem is multifaceted and other structural problems of maternity service provision need to be acknowledged in order to create change, e.g. overstretched maternity services, inadequate staffing levels go along with difficult working conditions for midwives, an increase of complex pregnancies and the change in demographics. Therefore, the vision needs to be clear, ambitious and should have a strong focus on sustainability, so that paradigms can be shifted and create a platform for change.

In Germany, women can choose if they want to give birth at home, in a birth centre or in hospital. Homebirths and Midwifery-led Units are operated through community midwives on an independent basis. There are all registered midwives and submit their claims to health insurance companies. Independent midwives need to ensure quality of care in service provision to women and their babies and so there are certain criteria for them to fulfil regularly.

What could be improved by Governments and the public to save more lives of women and newborns? Morbidity rates – better working conditions, one to one, education and regulation

The shift from vocational midwifery training to degree level can definitely improve morbidity rates in Germany. It has not yet been finally decided if midwifery education in Germany should be shifted completely to a university degree. We need a high-educated workforce in order to challenge current practice, to implement evidence-based care and effective midwifery-led working models in order to improve outcomes and ensure women and their babies a good start to life.

Furthermore, we don’t have a mandatory one-to-one care for employed midwives in hospital. Midwives often care for up to 4 women in labor at the same time. We already know about the benefits of one-to-one care and so it’s essential to ensure patient safety, ensure good working conditions for midwives to practice respectful care, reduce unnecessary interventions and improve maternal and newborn child health outcomes.

What could be improved by Governments and the public to support midwives in delivering high-quality, respectful maternity care? Education and regulation

The shift from vocational training to a single-system midwifery education program at university level can ensure high standards of midwifery-care. Therefore, it is important that we don’t create different cadres of midwives and that all midwives are taken on board and are supported during this transformation process.

With regards to respectful maternity care it is essential to raise awareness about the topic under midwives, to create an enabling environment to provide midwifery care, be reflective and have regular discussions with peers and as well within the multidisciplinary team of maternity care professionals.

In Germany, midwifery is regulated but the next step needs to be a self-regulation mechanism through the profession itself - and not through other professionals.

What do you love most about being a midwife?

I love to support families during the transition process of parenthood, strengthen their confidence, empower them towards informed-choice and decision making and to create an enabling environment for children, so that they have the best start into life and fulfil their whole potential.

Furthermore, I love that midwifery is so complex. I can work close with women but also have the opportunity to share my expertise with the next generation of midwives, being an advocate for women and child rights and to strengthen midwifery due to global engagement.

What progress is happening in your country, region, community or even just in your own professional life that excites you about the future of midwifery?

The German Association of Midwives is currently making strong advocacy work in order to shift midwifery education from vocation schools to university level. Therefore, our midwifery association is promoting a universal single-system shift towards an university degree with a dual-system study approach, which should ensure that the practical component is maintained adequately. We are raising awareness about all benefits of midwifery education at degree level, including how it can improve quality of care, get the job attractive and produce new research. This can introduce new midwifery-led working models and initiate a structural change of maternity services.

Our association has started proactive communication with all stakeholders involved in order to create a system change. As of now, the decision has not yet been made. That’s why we are working on a high strategic level in order to convince decision-makers of the benefits of a university degree for midwives. The concept of our midwifery association includes how education can be shifted to university level, which financing concept are practicable and offers options of how midwives without a degree can top-up to a degree and be taken on board.

That’s a very interesting time for midwifery in Germany. We have a strong profession but we want to improve further. Nobody should be left behind and that’s why we stand in for excellent education, which is the cornerstone of a strong midwifery workforce. The German Association of Midwives is delighted of setting the scene towards this transformation process and will do its very best to strengthen midwifery and shift midwifery care to the next level.

Lisa Welcland 2 blog 2018

Lisa Welcland , International Representative for Deutscher Hebammenverband (DHV) - German Association of Midwives

ICM is increasing its advocacy capacity for midwives at country, regional and global levels. As a member, what would you like to see ICM do to support advocacy efforts in your Association, community or country?

I would be grateful if ICM could support the German Association of Midwives towards the transformation process of midwifery education to degree level. We could benefit from ICM’s expertise and explore how this shift in education could also help to change maternity services in Germany. Midwifery in Germany needs to be strengthened and empowered so that we can step in for high-quality education, promote self-regulation of our profession and implement integrated midwifery-led working models with good working conditions for midwives.

A regional or international congress in Germany could raise awareness to our government, society and midwives at individual level, which could help a lot to reduce barriers, understand the importance and get inspired of being a change-maker. Together we can do it!