'Motivation for our work is the health and well-being of women and families in Central Europe': ICM Board member Andrea Stiefel writes about the midwives' associations and recent advances for midwifery in 'Central Europe--an active region within ICM'.

In January 2005 the former Central European Region held a Pan-European meeting (see IM March/April 2005; p 16-17) to prepare for the Brisbane Congress and to discuss a new structure for the European regions. Our proposal of three instead of live regions was adopted in Council and on February 18, 2006, our first Central European Meeting was opened in the Vivantes Klinikum Berlin Neukolln by Andrea Stiefel from BDH e.V. (German Midwives Association), who was elected a Board member at the Brisbane Council.

Of 18 member associations in the region, 15 sent delegates to work on an action plan for the Triennium. Member associations from Poland, Hungary and Romania did not respond to the invitation, but we will strengthen efforts to contact and keep the associations informed. We also have to clarify whether the midwives from Israel or the Lebanon want to belong to our region. Political influences make it difficult for them to stay in the Mediterranean region together.

Country reports

Our two days were filled with ICM business and strategic development. The most interesting part were the country reports. We learned a great deal about the policy within our member associations and how to address future needs for midwives, women and families in our countries. Although we come from countries with a diversity of health care systems, we understood the common issues and we recognised the vital importance of networking. Central Europe has a tradition of strong associations and we would like to highlight a few of our activities, developments and future plans.

Austria: The President of Osterreichisches Hebammen Gremium, Renate Grossbichler-Ulrich and Maria Spernbauer, former ICM President, informed us that in 2005 Austria established education for midwives at tertiary level. Future plans include: a higher salary for midwives especially when they have a higher qualification; paid consultations during pregnancy and access to primary midwife care for pregnant women; negotiating a new contract with health insurers.

Belgium: Serena Debonnet reported that midwives in Belgium have been very active since they celebrated the 10th anniversary of Vlaamse Organisatie van Vroedvrouwen in 2004. Special groups work on issues such as: basic and ongoing midwifery education; independent midwifery; scientific research; childbirth education; profile of midwifery in society; and the midwifery magazine. Each group has a coordinator, who is also a member of the Board. As well as many achievements, the Belgium midwives have numerous items on their agenda for the future, including: prescription rights for midwives; midwifery competencies; bachelor's and master's degrees in education; and strengthening co-operation with other professional groups and consumer groups.

Bosnia-Herzegovina: We welcomed our colleague Adisa Hotic for the first time since the Association of Midwives of Bosnia Herzegovinia joined ICM. Adisa and her colleagues have organised training programmes and workshops for 140 midwives and nurses on 'Supportive care in pregnancy and childbirth'; some also qualified as a trainers. They aim to get accreditation for the programme by the Ministry of Health. Adisa has also organised a round table conference to promote breastfeeding. Among future plans are: basic and ongoing education workshops for 2006; presentation of the programme in public together with representatives from the Ministry of Health; strengthening the midwifery association; and a national conference with international speakers from Europe.

A particular aim is to strengthen the FENIX-Centre for the numerous women and families who still suffer from war trauma: this is a place where people listen to them and their needs. Adisa and her friends offer services such as social support, food supply, a club for mothers, a children's play group and the FENIX gardening project.

Croatia: Barbara Finderle, Vice President, informed us that the Croatian Association of Midwives is facing a hard time because of lack of money and many midwives leaving the association. Some were forced by their employers to join the Chamber of Nursing and could not afford membership of two associations. Despite these problems, the Croatian midwives held a symposium in April and have plans for the future: an event called 'Your midwife is remembered all your life' will be organised in co-operation with the Association of Parents to inform the public and media about the importance of midwifery; and in October, during the Croatian Perinatal Days, there will be a workshop about alternative birthing methods. They also aim to improve their midwifery journal.

Czech Republic: Zuzana Stromerova wrote in her report that the former Czech Association of Midwives is reorganised, has a new name--the Czech Confederation of Midwives (CKPA)--and a new president, Vera Vranova. Stabilisation of the Confederation, politically and financially, is the first aim, as well as gaining recognition of an autonomous midwifery profession, with midwives working in primary care. The European Perinatal Conference is to be held May 24-27 in Prague with a programme for midwives; Czech midwives look forward to meeting colleagues from all over the world.

Germany: A new President of BDH, Helga Albrecht, was introduced, together with new delegate Ute Lange. Susanne Ratz described concerns about the education of midwives. Expert groups are working on plans for tertiary level midwifery education, but the progress is slow, due to lack of money and minimal support from the government. Despite this, BDH is trying to implement a quality management system for midwifery schools. A pilot project with seven schools will start soon under supervision of either a university or a professional advisory group. On May 5, International Day of the Midwife, BDH will launch an expert hearing and will present a blueprint of the situation of midwifery in Germany, called 'Geburtshilfe neu denken'. This will be a milestone towards professionalism.

Gisela Carreras of BfHD (Association of Independent Midwives of Germany) also introduced a new President, Susanne Schafer. In 2005 BfHD organised a very successful two-day conference called 'Homebirth Days'. BfHD also supports the report about midwifery in Germany. A prenatal care conference in Frankfurt is among future plans, as is work on a liability insurance contract for out-of-hospital birth.

Ireland." Rhona O'Connell from the Midwives Association of Ireland sent apologies, but Deirdre Daly and Mary Higgins (Midwives Section, Irish Nurses Organisation) announced with great pleasure that direct entry midwifery education will commence in the Republic of Ireland in 2006. There will be a four-year honours degree in midwifery offered at five universities. Deirdre was elected President of the European Midwifery Association (EMA) in October 2005 and this will intensify the contacts between EMA and ICM. Despite repeated lobbying, the legislation governing midwifery practice has not changed. The Irish midwives will continue with their efforts to get legislation which recognises the separate and distinct nature of the midwifery profession.

The Netherlands: Greta Rijninks-van Driel, newly elected Vice President of the Royal Dutch Organisation of Midwives (KNOV) and Marian van Huis, former President, highlighted the emphasis on a market system and competition within the Dutch health service. Continuing activities are: empowering midwifery by strengthening the role as primary care gate-keeper and co-operation with other health professionals; quality management; and quality systems for midwifery practices. They also discussed broadening of midwives' role to include prenatal screening, external cephalic version and preconceptional consultations. Topics related to professional development are installation of a quality register; co-operation to improve perinatal registration of obstetrical data; and a new MSc in midwifery.

Slovenia: Anita Prelec, Vice President of the Nurse and Midwifery Association of Slovenia, Section of Midwives also told of a very active year in 2005. In October midwives implemented an important document with new competencies for midwives, in accordance with changes in midwifery education, based on EU directives. The midwifery section established a website in October 2005 (www.sekcija-babic.si) and organised the ICM Young Midwifery Leaders Workshop in March 2006 combined with the National Conference. For the future the work is currently focused on gaining competencies for midwives in antenatal and postnatal care.

Switzerland: Jocelyne Bonnet from Francophone Switzerland could not attend, but Zuzka Hofstetter reported from the Swiss Federation of Midwives who are busy with many projects. From 2008 two universities at Bern and Winterthur will offer tertiary level programmes in midwifery education. By 2012 all new midwives will have a higher education degree. A media campaign by Swiss midwives has raised public awareness concerning the increase of Caesarean section rates. In 2005 Switzerland started a data collection from all independent working midwives. SHV also published a position statement concerning doulas, as they believe that in Switzerland the work of a doula is not meeting the needs of childbearing women. Midwives are working for government acceptance of birth centres, prescription rights and payment for complementary therapy.

United Kingdom: Four UK organisations participated. The Royal College of Midwives (RCM) was represented by Karlene Davis, Frances Day-Stirk, Maggie Elliott and Ruth Clark. They focused on the three issues identified in Brisbane--normality of birth, recruitment and retention, and education of midwives. Health ministers have been lobbied on recruitment and retention of midwives, with a student hardship campaign to achieve a bursary for students in order to stem the attrition rate. RCM organised a 'midwifery week' May 1-7, around the IDM, to raise the profile of midwifery. Activities for the week included a joint conference with RCN, Voluntary Service Overseas and Medecins Sans Frontieres.

From the Association of Radical Midwives (ARM), Pam Dorling informed us that ARM has contributed to a wide range of consultations and is active on bodies including the Maternity Care Working Party, Breastfeeding Law Group and EMA. One project was thought by all of us to be a brilliant idea! ARM has a festival tent and travels to festivals like Glastonbury and The Big Chill to offer a space for women to relax or get a massage. This is a very communicative way to get in contact with women and promote midwifery.

The Association of Supervisors of Midwives (ASM) was represented by Sandra Arthur, President. Sandra told us that currently membership is declining, which may become a problem. ASM is involved in many activities, especially work with the Nursing and Midwifery Council and has been invited to join the preparations for the ICM Glasgow Congress 2008. In April the Annual General Meeting was held and the annual journal was published in February 2006.

The report from the Royal College of Nursing (RCN) Midwifery Society was given by Carolyn Basak, Midwifery and Women's Health Adviser, and Donna Kirwan, who focused on activities of: stopping violence against women; helping vulnerable women; and promotion of diversity awareness in midwifery. The RCN Midwifery Society published an excellent paper in April about female genital mutilation to bring this to the attention of the public and health care professionals.In September 2005 the RCN Midwifery Society joined the Partnership for Maternal, Newborn and Child Health, the new global health partnership.

I would like to thank the midwives from our region for their active participation, enthusiasm and warm atmosphere at our meeting. Motivation for our work is the health and wellbeing of women, children and families in Central Europe and worldwide. In the long term we will continue until every woman in childbirth has access to a midwife.