Midwives in the Americas Region achieve communication, collaboration and celebration: the ICM Americas Regional Conference, Port of Spain, Trinidad, April 23-24, 2004, broke new ground in bringing together 450 midwives from across two continents.
The conference and its associated events provided an action-packed week in all, and this short report aims to describe only some of the many highlights, but future issues of IM will include more details of some of the ICM activities.
Traditional midwifery in the Americas
The vivid presence of a number of traditional midwives at the conference was a reminder of those countries whose existence rarely impacts on inhabitants of the industrialised world, among them El Salvador, Guatemala, Honduras and Nicaragua. The world's media do not report on famines, conflicts and disasters in these countries: their populations are small so numbers of deaths do not grab the headlines. Nevertheless, the maternal mortality ratios are 183, 267, 221 and 246 (for every, 100,000 births) for these countries respectively. They have large families so the risks for women are high. There is no national midwifery service, and doctors are few and far between--effectively unreachable for most families in rural areas. The thinly stretched network of traditional midwives is the only source of care mad support for these women.
Alicia Huete Diaz, known as 'Mama Licha', a traditional midwife in Nicaragua, spoke movingly of the lives of herself and her colleagues. The traditional midwives in general do not receive state funding. They are dependent on what their clients can pay which may be little or literally nothing. Most midwives practise another trade or craft, often pottery or basket-weaving, to help provide an income. This profound poverty shared by cater and families is the root of the prevailing poor health outcomes in childbirth, rather than the ignorance or inadequate skill of the traditional midwife, as is sometimes suggested. Alicia stated that 97% of traditional midwives in her country have received basic training which they make full use of, and most have abandoned any harmful practices. However they still lack equipment, drugs and any form of transport to enable either access to their clients or transfer to hospital when necessary.
Lisa Mills from Carleton University, USA, presented on 'Facilitating a dialogue between professional and traditional midwifery in Mexico'. She emphasised strongly the urgent need for such dialogue taking place in a context of mutual respect. By enabling student midwives at the CASA school in San Miguel de Allende to spend a community-based apprenticeship period with a traditional midwife, the latter retains her position of authority, but the skills, knowledge and learning needs of both may be identified and debated within the setting.
Midwifery education in Trinidad
Dr Jean Grayson, chair of the Midwifery Committee of the Nursing Council of Trinidad & Tobago memorably tracked the development of midwifery education in Trinidad. It was a grim reminder of the Caribbean's colonial history when we heard that the seeds of midwifery education were actually sown by the slave-owning plantation masters. In the 18th century, the sugar barons found to their dismay that many of the women in the cargoes brought over from Africa later died in childbirth along with their babies. Instead of breeding new generations of workers, the slave populations started to dwindle. Driven by profit motive rather than humanitarian feeling, the slave-owners identified women among the groups who had fulfilled the function of midwife in their home countries and allowed them to receive basic instruction from the local doctors; alongside their memories of traditional practices this began to improve the outcomes for the women.
As the system of slavery slowly disintegrated and the people achieved some independence, these women continued to work as midwives and to demand--and receive--appropriate education, which eventually grew into the programmes of today.
Dr Grayson went on to discuss the 'tomorrow' of midwifery education: she would like to see educational support geared more specifically to midwifery in the appropriate geographical context. The textbooks and other resources currently used in Trinidad are usually based on either the UK or the US model, neither of which is suitable for local practice. She also looked forward to a time when students could experience attendance at a home birth and encourage women to take up this option, which is very rarely available at the moment.
Safe Motherhood and the midwifery model of care
Joyce Thompson, Director of the ICM and co-chair of the Partnership for Safe Motherhood and Newborn Health (PSMNH), presented the opening session on the second day of the conference. She explained how the PSMNH will take forward the drive towards achievement of the UN Millennium Development Goals for reduction of maternal and infant mortality by use of a midwifery model of care. Joyce urged midwives to bear in mind not only the goals specific to midwifery, but also those relating to poverty and hunger; education for girls; and equality and women's rights. All these advances will contribute to the reduction of maternal deaths.
Sandra Land from the Pan American Health Organization (PAHO) tracked the success of midwifery in reducing maternal deaths in countries across the globe and, more locally, midwifery successes in Chile and some of the Caribbean islands. Currently her team at PAHO is mapping and reviewing midwifery in the whole region to provide a proper baseline for subsequent strengthening. Partners in the initiative include ministries of health, universities and professional associations.
Universities collaborate to promote midwifery
Recent political troubles in Haiti have affected the health of mothers and children so that infant mortality is at 100 deaths per 1,000 live births and maternal mortality at 523 per 100,000. The 'Rebirth and development of midwifery in Haiti' is a university-based collaborative project between Canadian and Haitian midwives. The presenter, Nadine Duhil-Enns from McMaster University, Hamilton, Ontario, described this much-needed endeavour to bridge the economic gap across the Americas, in aid of midwifery. Mdwifery education disappeared in Haiti in 1982, and ted in 2001. The project enables exchanges of students between the McMaster University and the university in Haiti. Another objective is to help develop monitoring tools and evaluation indicators so that the impact of the rebirth of midwifery can be measured.
Disciplines collaborate to reduce maternal deaths
The ICM/FIGO joint statement on active management of the third stage of labour to prevent postpartum haemorrhage received its regional launch during the conference. The ICM and TTAM were delighted to welcome Canadian obstetrician Dr Andre Lalonde who enthusiastically joined in the conference, the launch of the statement and the post-conference workshop. Representatives of midwifery associations were invited to sign a giant-size copy of the statement, declaring their intent to implement the action points.
University of Columbia awards for midwives
Dr Deborah Maine came to present this award--a prize designed to honour midwives who have demonstrated the potential to act as change agents in their country in the reduction of maternal and neonatal death and disability. It is given every year, initially for the period 2002-2004, and there is one award per ICM region. The award is to be used to strengthen the activities and effectiveness of the midwives' association with the ultimate goal to reduce maternal death and disability.
The four award winners were Nery Alba Rapoport, from Argentina; Ma Setha, from Cambodia; Zuzana Stromerova, from the Czech Republic; and Mnembere Meherete Ayele, from Ethiopia (seen below with Kathy Herschderfer and Deborah Maine).
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|Date:||May 1, 2004|
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