'Normalising childbirth through authentic collaboration': the international evidence.

The new mission of the International Confederation of Midwives (ICM) includes reference to the midwife's responsibility in promoting normal birth, and clearly this encompasses research around normal birth to ensure a strong evidence base for the practice. The availability of such research was robustly demonstrated at the 4th Research Conference on Normal Labour and Birth, held at the attractive venue of Grange-over-Sands in the UK's Lake District.

The American College of Nurse Midwives, the Canadian Midwives Association, the Midwives Alliance of North America and the Royal College of Midwives (RCM) of the UK--all ICM members--were associate hosts with the University of Central Lancashire's Research in Childbirth & Health (ReaCH) group. This popular event attracted participants from Australia, Brazil, Canada, China, Egypt, Germany, Ireland, Japan, Lebanon, the Netherlands, New Zealand, Nigeria, Norway, Sweden, Taiwan, the UK and USA.

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Cathy Warwick, General Secretary of the RCM, greeted delegates and welcomed the theme of collaboration and partnership--'together we are strong', she asserted. Cathy then introduced Hannah Dahlen of the Australian College of Midwives, and the University of Sydney, who gave the first keynote address.

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Hannah asked, are we 'undone by fear?' or 'deluded by trust?' and explored these concepts in a rollercoaster presentation that was moving, humorous and inspiring. She kept faith with 'audience expectations of any Australian speaker' by introducing sharks (the object of more fear than anything else, ever) and kangaroos (to be avoided on a road-trip undertaken as an alternative to safer but fear-ridden flying). She iterated that the worst fear is often of fear itself, and cited De Becker's view that 'worry will buckle under vigorous interrogation'. However, fear should not be denied as it can tell you something useful; Darwin noted that the most fearful may be those who survive. She closed with the comment that courage is not the absence of fear but the triumph over it, and a typically Australian metaphor: 'if the surfers always fear the sharks, they will never swim with the dolphins!'.

Frances Day-Stirk, ICM Vice-President, titled her keynote 'Defining, debating, directing: where do we go from here?'. She conveyed greetings from the ICM executive, and asked delegates to consider how relevant normal birth is in the four ICM regions of the world. She quoted Aristotle's definition of 'natural labour', based on a pregnancy at full term, the fetus in the right position, a speedy labour and 'the child alive'; the WHO definition from its Care in Normal Birth document; and the current ICM definition of 'A unique dynamic process in which fetal and maternal physiologies and psychosocial contexts interact ... the woman commences, continues and completes labour with the infant being born spontaneously at term ... without surgical, medical, or pharmaceutical intervention, but the possibility of referral when needed'.

Another keynote came from medical anthropologist Robbie Davis-Floyd, who gave a 'gallop through' the crucial points of her forthcoming book on birth models that work. All such models must demonstrate sustainability, replicability and financial viability. Aspects of Dutch midwifery and the New Zealand and Canadian systems were highlighted, along with pioneering models such the Albany practice in London, UK, with its 48% home birth rate; the set-up at the St George's Hospital in Sydney, Australia, established by Pat Brodie and Caroline Homer; and an exemplar of partnership between traditional and professional midwives in Samoa.

Elizabeth Duff, ICM Communications Manager, reports on he 4th Norman Birth Research Conference, held in Grange-over-Sands, UK, June 2009