Even while I was waiting for the bus to take me to the airport to fly home after the International Confederation of Midwives (ICM) 40th Triennial Congress in Prague (June 2014), the conversations continued. Ranging from politics to clinical care; discussions about the best way of conducting intermittent auscultation, to thinking about how a midwife might make a change to the highly invasive routine care in second stage of labour in her country, routine electronic fetal monitoring, compulsory supine position in bed, and the overuse of syntocinon augmentation.
I first attended an ICM Triennial Congress in 1986. I have always been humbled by the sheer courage and altruism of many of the midwives attending, who work powerfully against the odds to improve the quality of maternity care. The membership of midwifery associations in the ICM is important to the recognition of midwifery as a profession in regulation and education and with governments. Because of this, midwifery associations will go to great lengths to meet the criteria for membership and raise the fees required.
This year, a number of shifts in thinking and trends were apparent to me. One was the amount of high quality research and evaluation evident in many of the papers, and so many of the informal discussions.
But some of the shifts were related to broader views of midwifery, including an important basis in human rights. With the ICM being situated in Eastern Europe, the issue of human rights had a particular resonance this year. A number of the countries of Eastern Europe have excessive rates of intervention and lack alternatives, while there is criminalisation of out-of-hospital midwifery and home birth (Birthrights, 2014).
The human rights concurrent session drew a large attendance and following the panel discussion about human rights and the law, the importance of personal autonomy, dignity and respect for women, there was wide-ranging discussion.
One of the issues that has always presented difficulty at ICM has been the discomfort with how we talk about the problem of excessive intervention rates in much of what used to be called the First World, while being aware of the numbers of women and their babies without care, or dying or suffering severe morbidity in other parts of the world. This year the conversation seemed to take a different turn. There is growing awareness of the potential for unhelpful routine medical interventions to be exported to other countries, and awareness of rising intervention rates in much of the economically developed world and the emerging economies, and in private practice in many of the resource-poor countries.
Over recent years, with such widely available media, we have become more aware of the awful atrocities that occur during war and invasion and genocide. Many of the midwives I talked to had lived through events that I find unimaginable. During all of this, and sometimes while emerging from chaotic states, these leaders of midwifery associations and the midwifery profession had established associations, developed services and education programmes and systems of regulation for midwifery.
Many talked about developing a midwifery model. This is a step forward from the important but basic aim of saving lives, to a broader more social approach to midwifery: a view recognising that our care is also about supporting the mother–baby relationship and formation of family. Recognising our important contribution to society.
The most touching presentation for me was at a meeting of the Asian Associations, when the President of the Midwives Association of one of the countries most notable for the total subjugation of women, talked about the importance of midwifery to improving the status of women. I was struck by the sheer bravery of this work, in a part of the world where midwives and their families may be under threat of death just for being midwives and improving the lives of women and their families.
Given the harsh demands of such life it might seem that there would be a tendency to think only in terms of life saving. The higher aim, recognising the social function of midwives and midwifery, is admirable and will be far more effective in the long run. I couldn't help but think about how much we, in the well-resourced world, take for granted. These meetings, hearing at first hand what life can be like, witnessing the determination and commitment, took me beyond seeing the world though a television screen or the pages of newspapers, to a deeper understanding.
The Royal College of Midwives leads a twinning programme with Nepal, Uganda and Cambodia. Our twin associations were with us at the ICM and through their eyes I saw the importance of such global work for deeper understanding, mutual learning and solidarity.
Modern midwifery is developing as an evidence-based profession, with strong roots of working in relationship with women. But there are also values that drive midwifery. Starting with voices in the park and the rousing singing of thousands of midwives, and the celebration at the Congress party, we were never far, despite the awful circumstances that many of my colleagues face, from the joy and hope of new life that is so central to the work of midwives. While we do the politics of ensuring midwives and the midwifery profession are well placed to provide the most effective care and to make their full contribution to society, awareness of the values that bind us wherever we live, will help us move forward.