Presentations - European Midwives Association

Transcription

General Meeting 2014
Tallinn
Welcome!
Opening address and
welcome
Mervi Jokinen
President
European Midwives Association
Minutes of meeting
Zagreb GM 2013
Mervi Jokinen
President
Official opening of the
Pille Teesalu
President Estonian Midwives Association
"
EMA AGM 2014
TALLINN, ESTONIA
ACHIVEMENTS SINCE 2007
2007
1. Midwife as the profession was recognized
2. Midwifery in Estonia was and still is changing
rapidly
3. Lack of Legislation
Midwifery care 2014
• Midwife is recognized as the member of
primary health care system (2008, Primary
Health Care Masterplan)
• Since 1-st of april 2010 independent midwifery
care was legalised (incl. right to prescribe)
• 2014.01.08. Regulation of homebirth is included
in to legislation
Education
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2 Health Care Colleges in Tartu and in Tallinn
Competence based Midwifery programs since 2009
Institutional accreditation in 2013
Direct entry
Nominal length of studies 4,5 years, 270 EAP
National student places 25-30
Diploma of professional higher education
Midwifery master's level
Organisation 2014
• Since 2012 transition to the 8-level progressive
system of vocational qualifications
• 2014 EMA nominated as the main assessor of
qualifications
• Post-graduation courses - systematic since 2012
• ICM (Durban – 10, Praque – 17)
• EMA – AGM annually (1-2), 2013 – Maastricht (3)
• Elections 2014 (new president, vicepresident,
board, council)
WELCOME!
Official opening of the
Urmas Kruuse
Minister of Social Affairs, Estonia
"
Annual Report
2013-2014
Mervi Jokinen
President
Annual Report
2013-2014
-Financial Report 2013-2014
-Financial Committee verbal report
-Approval of the Financial Report
-Financial Committee 2014-2015
Annual Report
2013-2014
-CPD project - EAHC
-ICM
-Strengthening midwifery associations
-Partnerships
EMA Strategy 2013-2015
Pictures from last year
Coffee break
Midwifery in Estonia
EAHC/2013/Health/07
• Study concerning the review and mapping of
continuous professional development and lifelong
learning for health professionals in the EU
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Council of European Dentists (CED)
Standing Committee of European Doctors (CPME)
European Federation of Nurses Associations (EFN)
European Midwives Association (EMA)
European Public Health Alliance (EPHA)
Pharmaceutical Group of the European Union (PGEU)
OBJECTIVES OF THE STUDY
 Provide an accurate, comprehensive and comparative account
of CPD models, approaches and practices for health
professionals and how these are structured and financed in
the EU-28 and the EFTA/EEA countries
 Facilitate a discussion between organisations representing
health professionals and policy-makers, regulatory and
professional bodies to share information and practices on the
CPD of health professionals and to reflect on the benefits of
European cooperation in this area for the good of patients of
Europe
 Duration: October 2013 to October 2014
STUDY METHODOLOGY
 Literature review on CPD in Europe
 Survey
 Structure of questionnaire: Structures &
Governance/ Development & Implementation /
Accreditation / Financing & Transparency /
Content / Trends & Reflections
 Research on European-level initiatives on CPD
 Technical workshop
 Final report
ISSUES TO DEFINE
 Mandatory vs. voluntary CPD: predefined
requirement by a competent authority
 Formal vs. informal: is CPD recordable and verifiable?
 Conceptual context: continuous professional
development, continuing education, life-long
learning
SURVEY
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complex survey for many national associations
if national organisation tried to contact competent
authority
survey monkey missing answers
verification on the country profile level
constant changes and challenges ?political influence
•During this meeting I expect to discuss any questions
•Clarification required some countries
•Political fallout
Annual Report
2013-2014
Discussion on the annual report and
strategic plan
Evaluation of 4th EMA
Educational
conference
Maastricht 2013
Franka Cadee
Koninklijke Nederlandse Organisatie
van Verloskundigen
EMA
Education Conference
29+30 November 2013
Maastricht
an EMA-AVM-KNOV collaboration
Profiling midwifery
education by leadership &
Science
The essence of midwifery education, coaching
student midwives in their practical training,
curriculum development and assessments,
bringing research and education together,
educating midwifery leadership and last but
not least about EU education-regulation and funding.
Delegates
218 delegates
from 20+
countries
• 20 posters plus
poster tour
• 3 parallel
sessions: 34
workshops
EMA survey
Key note speakers:
Professor Cees van der Vleuten, Scientific Director
School of Health Professions Education: Assessment
Professor Soo Downe, Professor of Midwifery Studies.
complexity and leadership
Professor Raymond de Vries, Prof. medical school and
department of sociology University of Michigan, Academie
Verloskunde Maastricht/Zuyd University, School for Public
Health and Primary Care: The value of academic skills in
midwifery
Mr. Konstantinos Tomaras, Deputy Head of the Unit
"Free movement of professionals: What is up in the EU?
Opinion on speakers:
EMA social programme
• The Welcome reception at
the Maastricht City Hall
• Conference dinner at
“Museum aan het Vrijthof”
Opinion on logistics
Finances
Investment KNOV & VA-M €10.000 each.
Net RESULT € 14.398,14 (€7.200 each)
Take home message!
Next EMA conference?
Where next?
EMA Education Conference
2016
Patricia Gillen, Chair, RCM Board
Suzanne Tyler, Director, Services to Members
RCM Strategic Objectives
2014
• To promote high quality maternity services, professional
standards and to lead the future of midwifery
• To influence on behalf of our members and in the interest of the
women and families for whom they care
• To ensure products and services meet the particular needs of
members
• To support and represent our members individually and
collectively in their respective countries
• To ensure our future growth and sustainability as an innovative,
adaptive and responsive organisation
• To be an exemplary organisation and employer
Education Conference
Objectives
• To challenge and disseminate current
midwifery education knowledge and research
• To provide a platform for discussion,
networking and collaboration
• To keep abreast with contemporary EU
directives and education frameworks
• To enable host country to address country
specific issues gaining EU support
Programme
• 3 main themes
– Regulation
– Education
– Midwifery practice
• Call for abstracts
– Concurrent sessions
– Posters
• Exhibitors
– Masterclasses
RCM Conferences
Extensive experience of staging
large-scale educational
conferences and events in the
UK. Expertise covers:
• Sound financial
management
• Working with sponsors and
partners
• Managing media relations
and publicity
• Prominent speakers and
ground-breaking content
Conference venue
Accommodation
Visit London
Midwifery in London
Thank you
Please put your name on the
flip-board which workgroup you
like to attend
(2 sessions/person)
Homebirth
Developing midwifery practice standards
Changing maternity policies
IT tools for E-learning and professional
communication
Lunch
Budget 2013-2014
Eva Matintupa
Treasurer
EMA and social media
Anita Prelec
Board member
In beginning of 2014
Facebook
https://www.facebook.com/europeanmidwives
Twitter
@Emidwives
Website
www.europeanmidwives.com
www.europeanmidwives.net
Most reached news
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Evidence of water birth 690
Vitamin D and nursing mother 872
Labour ward „not for regular birth“ 1252
Cosleeping and Biological Imperatives 3646
PLEASE, SEND INPUTS about
National and international conferences and
events, link to video, interviews, information
Twin2twin
EU Project proposal
Franka Cadee
Koninklijke Nederlandse Organisatie
van Verloskundigen
TWINNING in EUROPE
East <> West
North<>South
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Method twin2twin
Phase one: placing the persons midwifery in the context.
formulate joint organizational goals
assess joint capacity
create a project structure
foster relationships based on equality
pairing of twins
create joint communication channels
Phase two: work on joint projects to gain experience in roject
planning etc.
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create joint stories
set evaluation moments
create joint products
celebrate together
Projected impact of project
• A better understanding among beneficiaries of a
variety of midwifery issues within the EU
• Empowered midwives who can become change
agents in their own countries
• Improved cultural understanding
• Small ‘pilot’ projects will have been developed
and tested. These can be scaled up.
• Incited change in education, registration
procedures, organization of professional body
Cont.
• Virtual learning platform to promote and support
twin2twin (including forum, blog, etc)
• Network of twins
• Physical exchanges, long-lasting relationships
beyond individual level
• A sustainable platform of midwives that will be
connected after the end of the project
Participants per country:
• midwifery education,
• the professional association,
• registration body?
Countries interested
• The Independent Midwives Association (AMI) of
Romania,
• Ecole de sages-femmes de Bordeaux,
• Alliance of Bulgarian Midwives,
• CYNMA (Cyprus),
• Lithuania Midwives Association,
• Estonian Midwives Association,
• KNOV, The Netherlands,
Way forward?
Election of the
Treasurer, Secretary
and Vice-President
Presentations and
confirmation of venue GM
2015
Alliance of Bulgarian Midwives
(ABM) is a voluntary,
independent, non-political and
non-partisan organization
whose main goal is to work
towards introducing the
midwifery model of care. It is
an association of midwives.
Midwifery education in
Bulgaria is provided by
Medical Colleges affiliated
with Medical Universities in
Bachelor - level programmes.
Midwifery education in Bulgaria is still
subordinated to the medical model of care
for pregnant women. The emphasis on
prevantiv medicine and consulting skills is
missing.
The Alliance supports
respecting women’s rights
in childbirth !
Our annual meeting
and training in
European standards
for midwifery model of
care !
Our hope - midwifery
model of care in Bulgaria
and in all over the
WORLD.
An invitation to Bucharest, Romania
Independent Midwives Association
TALLINN, SEPTEMBER 2014
MELANIA TUDOSE
ADINA PAUN
INDEPENDENT MIDWIVES ASSOCIATION, ROMANIA
WHY BUCHAREST?
Le Petit Paris
The European Midwives
Association Assembly of
2014
The statistics
Romania has:
• the highest rate of infant mortality: 9,8 per thousand
• the highest neonatal mortality : 5,5 per thousand
• highest rate of under 20-mother mortality: 10,6 per thousand
• second place in terms of maternal mortality: 21 per 100,000
• third place in percentage of cesarean sections in the total
number of births: 36,9%
• lowest rate of exclusive breastfeeding in the first 6 months of
life : 12,6% in 2012.
• in some areas, up to 25% women do not receive any
healthcare until the moment they are in labor
Source: European Perinatal Health Report 2010
Romania’s midwives
• Almost in-name only
• No real implementation norms for the
midwifery profession
• International curriculum university programs
with no real hands on experience
• No jobs, no independent practice, no
protection
• More than 800 licensed midwives, out of
which approximately 300 work as such
The Independent Midwives Association
• In contact with all relevant authorities
• Partnerships with women’s organizations
• Working towards partnerships with embassies
of midwifery friendly countries
• Recently petitioned the European Commission
to take up our cause
Thank you and see you in Bucharest!
All pictures credit of Mr. Vlad Parfenie,
with our many thanks
Melania Tudose, president AMI
+40 0722 751 540 / tudose_melania@yahoo.com
Irina Popescu, vicepresident AMI
+40 0722 658 054 / popescuirina@gmail.com
Adina Păun, vicepreşedinte AMI
+40 0722 272 270/ paunadina@gmail.com
Anca Belu, secretary AMI
+40 0758 983 061/ cyucy_afm@yahoo.com
Candidates for venue GM
2016
Matters arising from
Member Associations
Closure of meeting
Tallinn
Welcome!
Opening
Matters arising from
yesterday
Website for expecting
mothers, managed by
the Estonian Midwives
Association
Maret Voites, Board member
Estonian Midwives Association
Website for expecting mothers
and families with children
Maret Voites
Estonian Midwives Association
Perekool.ee
 www.perekool.ee is created by
Estonian Midwives Association in
1999
 The goal is to provide access to
quality health information and
trustworthy advice in the
internet environment
Team
 Manager
 Editor/administrator
 Project manager/administrator
 IT-specialist
 5-8 voluntary forum moderators
 ~10-15 specialists for “Ask advice” section
 No office, everybody work from home
Target group
 Expecting mothers or families with young children
 ~ 50 000 registered users
 80 000 - 100 000 unique visits per week
 Statistics
Webpage sections
 Articles
 “Ask advice”
 Videos
 FAQ
 Pregnancy calendar
 Marketplace
 Forum
 Database
Articles
 ~50 % are original articles by specialists
 Pregnancy
 Schoolchild
 Birth
 Fathers
 Postpartum time
 Work, money, law
 Breastfeeding
 Health
 Baby and toddler
Pregnancy calendar
Videos
 We started publishing and producing videos in 2012
 By now we have 55 educational videos in 5 categories:
 Pregnancy
 Birth
 Baby and toddler
 Breastfeeding
 Other
 2014 project – Baby Diary
“Ask Advice”
 Since 1999
 2013 – 1555 questions-answers + 249 replies to forum
 2014 target - 1800 questions
 Funding
 2001-2011 Estonian Health Incurance Fund
 2012-2014 Social Ministry projects
“Ask Advice”
 Most questions about:
 Baby’s health, baby care and feeding
 Pregnancy
 Health incurance, financial support and legal issues
 14 specialists:
 6 midwives
 2 paediatritians
 1 gynaecologist
 3 breastfeeding counsellors
 1 speech therapist, child psychologist
 1 lawyer
 Co-operation with other associations (family therapy, breastfeeding
counsellors, lawyers etc)
Frequently Asked Questions
 336 questions and answers
 FAQ and answers throughout the years from “Ask Advice”
 Constantly updating the database
Forum
 Most popular part of Perekool.ee
 Appr. 3000 new posts daily
 Most popular sections:
 Leisure time
 Baby
 Toddler
 Pregnancy
Marketplace and advertisement
 Marketplace – for private and commercial users
 Advertisement spaces in Perekool.ee – banners, active
textlinks, etc.
 Advertisement contract with Adnet Media
 Profit will be used for members additional education and
training
Value for midwives
 Patient education tools
 Reliable source of information
 Surveys and research (target group!)
 Income from advertisement
THANK YOU!
EU level session
Mervi Jokinen
President
Global policy and practice environment
‘The First’ - Lancet series on Midwifery 23rd June 2014 A set of papers http://www.thelancet.com/series/midwifery
Global policy and practice environment
• Improvement of maternal and newborn health
through midwifery
• The projected effect of scaling up midwifery
• Country experience with strengthening of health
systems and deployment of midwives in countries
with high maternal mortality
• Midwifery and quality care: findings from a new
evidence-informed framework for maternal and
newborn care
Figure 1
Diagram of the multimethod approach used in this study
Figure 2
The framework for quality maternal and newborn care: maternal and newborn health components of a health system needed by childbearing
women and newborn infants
*Examples of education, information, and health promotion include maternal nutrition, family planning, and breastfeeding promotion. †Examples
of assessment, screening, and care planning include planning for transfer to other services as needed, screening for sexually transmitted
diseases, diabetes, HIV, pre-eclampsia, mental health problems, and assessment of labour progress. ‡Examples of promoting normal processes
and preventing complications include prevention of mother-to-child transmission of HIV, encouraging mobility in labour, clinical, emotional, and
psychosocial care during uncomplicated labour and birth, immediate care of the newborn baby, skin-to-skin contact, and support for
breastfeeding. §Examples of first-line management of complications include treatment of infections in pregnancy, anti-D administration in
pregnancy for rhesus-negative women, external cephalic version for breech presentation, and basic and emergency obstetric and newborn baby
care (WHO 2009 monitoring emergency care), such as management of pre-eclampsia, post-partum iron deficiency anaemia, and post-partum
haemorrhage. ¶Examples of management of serious complications include elective and emergency caesarean section, blood transfusion, care
for women with multiple births and medical complications such as HIV and diabetes, and services for preterm, small for gestational age, and sick
neonates.
Open Discussion re any EMA action points and
strategies activities
Coffee break
Homebirths in four
Nordic countries
Preliminary results from
the Nordic Homebirth
Study
Ellen Blix, Norway
Homebirths in four Nordic
countries (dk, is, no, se)
Preliminary results from the
Nordic Homebirth Study
Ellen Blix, DrPH, MPH, RNM
Professor in Maternal and Reproductive Health
Faculty of Health Sciences
The research field
• Researchers may have very strong opinions
about home births – which again may bias
results
• Important exception: The England
Birthplace study 2011
Homebirths in four Nordic
countries
Lindgren H, Kjærgaard H,
Olafsdóttir ÓA, Blix E.
Praxis and guidelines for planned home
births in the Nordic countries – an
overwiew. Sex Reprod Healthc 2014;5:3-8
• 20.5 mill inhabitants
• 220 000 births annually
• Midwives attend all births
• Welfare states
• Similar historic and cultural
background
• Similar socio-economic
background
• But there are differences…
Denmark
• ~60 000 births
• 7-800 planned home births (12/1000)
• Homebirths attended by centre
midwives and independent midwives
• Some regions/hospitals provide
homebirths with midwives who are
specially affiliated the homebirth
service
• Midwives can prescribe necessary
medicaments
Denmark
• The woman has the right to be attended by a
midwife at home – also when home birth is not
recommended
• National guidelines support choice of birthplace
• Home births a part of midwifery training
• Home births are free of charge (except if the woman
chooses a private midwife)
• No midwifery-led units, 22 obstetric units
• CS rate 22.1%
Iceland
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~ 4900 births
~ 90 planned homebirths (18/1000)
Homebirths attended by independent midwives
Nearly all midwifery students attend one homebirth
National guidelines support choice of birthplace
Home births are funded by the health authorities
The woman must find a midwife willing to attend
homebirth
Iceland
• Iceland‘s association of midwives provides
equipment and medicaments for homebirths
• Decentralized care
• Midwifery led units in smaller hospitals and health
centres and at the University hospital in Reykjavik, 3
obstetric units
• CS rate 14.8 % (lowest in Europe)
Norway
~60 000 births
90-100 planned home births (1.7/1000)
Usually not a part of midwifery training
National guidelines for homebirths support choice of
birthplace
• Home births are partly funded by the authorities
• The woman must find a midwife willing to attend
homebirth
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Norway
• Midwives do not have the right to
prescribe medicaments
• Decentralized and differentiated care
• 49 birth institutions, including 10 freestanding midwifery-led units
• 5 alongside units in big hospitals
• ~8% of all births in midwifery-led
units
• CS rate 16.8%
Sweden
106 000 births
~60-70 planned home births (0.6/1000)
Not a part of midwifery training
No national guidelines on homebirths
Homebirths are funded only in the county of
Stockholm and under certain premises
• The woman has to pay herself (except in Stockholm)
• The woman must find a midwife willing to attend
homebirth
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Sweden
• Midwives do not have the right to
prescribe medicaments
• One alongside midwifery-led unit,
obstetric units
• CS rate 17.1%
Developing midwifery
practice standards
Ute Wronn, Germany
Miriam Wille, Swiss
A story of success:
Midwives define the quality of midwifery care –
First National Midwifery Expert Standard
for the Promotion of Normal Birth
Annual Grand Meeting, Tallinn, Estonia
26th /27th September 2014
Ute Wronn
International Delegate
German Association of Midwives (DHV)
Overview
First National Midwifery Expert Standard for the
Promotion of Normal Birth
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Background
What‘s so special
Definition and core functions
Structure
Methodology
Prerequisites
EMA AGM 2014 Tallinn Ute Wronn DHV
146
National Midwifery Expert Standard on the
University of Applied Sciences
Osnabrueck
• German Network for Quality
Development in Nursing,
DNQP
head: Prof. Andreas Buescher
• Network of Midwifery
Research
head: Prof. Friederike zu SaynWittgenstein
Information in English:
http://www.dnqp.de/38413.html
http://www.hebammenforschung.de/ne
tworkmidwiferyresearch.html
147
How it all started
• team of midwifery researchers committed to work on
practice-relevant midwifery issues
• research project: „Midwifery Care during pregnancy,
childbirth and postpartum period – tools to develop crosssectoral quality“ (IsQua)
• concerns
– rising C-section rates
– rising intervention rates
– staff shortages in clinical settings  working conditions and
procedures impact on childbirth
• need for scientific evidence on midwifery practice
 research proposal (by midwifery research network)
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Why is this Expert Standard so special?
• first midwifery standard in the history of German midwifery
• developed by midwives (researchers and clinical midwives)
for midwives (supported by experienced nursing researchers,
DNQP)
• aim: offer every childbearing woman the midwifery support
she needs and requires for a normal birth
• does not exclude women who are going to have a C-section
(e. g. on demand); counseling and guidance is open to
pregnant women during scheduled midwifery consultation
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Definition
(credit: DNQP)
Expert standards (nursing)
• reflect a determined level of professional performance
matching the needs of a target population and imply
evaluation criteria
• provide guidance and alternatives for professional action and
decision-making
• are suited for nursing/midwifery care problems requiring a
considerable level of attention and assessment and are
characterized by a highly interactive nature
• are not: guidelines or clinical decision rules
150
Core functions and purpose of Expert Standards
(credit: DNQP)
Core functions
• define professional accountability
• initiate innovative thinking
• promote evidence-based practice and professional identity
• initiate a constructive interdisciplinary dialogue on quality of
care/midwifery care
Purpose
• bridge theory and practice
• impact on professional responsibility
• serve as quality assurance tools
• serve as expert evidence accepted by legal judgement
151
Structure of an Expert Standard
(credit: DNQP)
Scope and purpose: aim of the standard, target population
Structure: ressources,
organisational structure
Process: what is actually done
Outcome: planned results
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The midwife:
• assesses
• plans
• carries out
• evaluates
The client is…
The client can…
The client says, that…
The client seems to…
There is …
Environment
Infrastructure
Personal ressources
Equipment
„National Midwifery Expert Standard for the Promotion of Normal Birth“
S1a: The hospital has regular
midwifery consultation times for
pregnant women in order to plan
and advise.
The hospital provides adequate
rooms, staff and euipment for
midwifery consultation.
S1b: The midwife is competent to
counsel pregnant women with
regards to normal birth.
P1 : The midwife enquires the woman‘s
expectations, needs, concerns and fears.
The midwife provides the woman with
comprehensive counseling and
information. She/he offers ways to
identify expectations and how to best
obtain assistance within the delivery unit
on ways how to realize expectations and
to have support in the delivery unit.
E1 The woman is fully
informed about the
support of normal birth.
There is an adequate
documentation about the
counselling and planning
An appropriate
documentation on the
counselling and planning
process in place.
152
Methodological approach (following RCN, UK)
(credit: DNQP)
topic selection (by midwifery expert group)
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convening an independent panel of experts (researchers, practicing
professionels, civil society,…)
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literature review (findings commented by expert group, „evidence meets
experience“)
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development of an evidence-based standard
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consensus conference
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implementation in model projects (training, adaptation to specific needs):
several stages
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public presentation, monitoring and update
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final version, introduction of national standard
153
Prerequisites for the development of
professional guidelines, standards and tools
• strong will to develop an autonomous profession: Midwives
define quality of midwifery care!
• strong will to define explicit and transparent criteria for
professional midwifery practice
• strong commitment to midwifery research
• close cooperation between midwifery
association/chamber/stakeholders and midwifery researchers
• engagement in complex debates about needs, requirements
and quality of midwifery care (intra- and interprofessional
level)
154
National Midwifery Expert Standard for the
Who else but midwives can define the contents of
midwifery?...
Thank you for your kind attention
Thanks to DNQP for support and sharing conference slides!
• www.hebammenforschung.de/networkmidwiferyresearch.html
• www.dnqp.de/38413.html
Ute Wronn
International Delegate DHV
German Association of Midwives
www.hebammenverband.de
wronn@hebammenverband.de
155
Interdisciplinary Ceasarean
Section Brochure
Miriam Wille
Swiss Federation of Midwives, SHV
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6.
7.
How it all began
How the brochure came into being
The interdisciplinary working group
Difficulties in the process
The final product
Purpose of the brochure
Publication and distribution
Interdisciplinary Ceasarean Section Brochure, Swiss Federation of Midwives SHV, 2014 157
1. How it all began
The Cesarean section rate in
Switzerland is continuously rising
1998= 22.7%- 2007 = 32.2%
Interdisciplinary Ceasarean Section Brochure, Swiss Federation of Midwives SHV, 2014
158
159
This rising trend arouses no immediate
interest neither from the media, nor health
insurance companies, nor medical
stakeholders nor the government.
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2. How the brochure came into being
• Actions initiated by the Swiss Federation of
Midwives (SHV)
• Position paper including catalogue of measures is
adopted
• Parliamentary intervention is submitted to the plenary
• Scoop press release was issued
• Letter sent to Santésuisse to safeguard the WZW- Law
• Cooperation with expert associations is aimed at
161
•
Parliamentary intervention
Motion by Liliane Maury Pasquier (18 December 2008),Member of the
National Council and President of the Swiss Federation of
Midwives 2009-2013
Submitted text
The Federal Council is required to examine the reasons for and
consequences of the high cesarean section rate in Switzerland as
well as identify possibilities how to counteract the negative effects
on mother and child and on the health care system.
Grounds
The Swiss Federal Law on Health Insurance (KVG) obliges the
Federal Council to examine the economic efficiency, expediency
and effectiveness of medical interventions. Several factors indicate
that in the sector of obstetrics, medical interventions that do not
comply with these criteria are carried out and financed by
mandatory health insurance.
162
• How the SHV looked for interdisciplinary
cooperation and found it
There is a demand for extensive information on the
advantages and disadvantages of the ceasarean section
among pregnant women.
The Swiss societies for neonatology, gynecology,
pediatrics and midwives are committed to develop an
interdisciplinary patient information brochure to enable an
informed choice for a ceasarean section.
163
3. Work within the interdisciplinary group
• Phase 1
• Project design and drafting of the text, April 2011- May
2012
• Funding secured, by the foundation; Health Promotion
Switzerland
• Set target: publication in 2012
164
• Phase 2
• Draft review by specialist associations, May 2012 November 2012
• The Society of Anesthesiologists joins the working
Interdisciplinary Ceasarean Section Brochure, Swiss Federation of Midwives SHV, April 2014
165
4. Difficulties in the course of the drafting process
Search for consensus between expert associations blocks
the process
November 2012- September 2013:
• Difficult phase, as an agreement on contents cannot be
reached
• Personnel changes within the working group
• Absence due to illness results in delays
• Various media reports lead to a debate on principles
about the purpose of the brochure among gynecologists
September 2013:
• The association for gynecology pulls out of the project
166
Federal Council finally reacts to political initiative
• The high rate of Cesarean sections in Switzerland
cannot be explained with simple cause-effect
relationships
•
A review and update of established guidelines for
supporting decision making processes is proposed
•
Hence, the Federal Council in its reply supports the joint
purpose of the expert societies to compile a brochure
on Cesarean sections
167
September 2013 – February
2014:
In spite of the pullout of the
society for gynecology the
other expert associations
continue the project
The brochure is completed,
edited and translated into
three national languages
168
5. The final product
Content
1. Cesarean section: the facts
2. The process of a ceasarean section
3. How mother and child feel afterwards
4. Frequently asked questions concerning
ceasarean sections
5. The publishers of this brochure
169
6. Purpose of the brochure
Midwives, pediatricians, neonatologists and
anesthesiologists collectively provide comprehensive
information on the topic of Cesarean sections in this
brochure
In order for mothers to be/couples to make an informed
decision, they need a thorough understanding of what
happens during this procedure and what possible
consequences need to be taken into consideration
170
• This brochure serves as a basis to then discuss the
individual situation with a midwife and/or gynecologist
and make an individual decision
171
7. Publication and promotion
• Publication of the brochure at the end of March 2014
• Distribution within the expert associations to all members
• Distribution to counseling centers and medical practices
• Publication in professional journals
• Brochures can be ordered from the expert societies
172
• Media relations work has happend
• Core message: The topic of ceasarean sections
is relevant. It is worth looking at it in detail!
173
Questions
174
Expert Associations
• www.hebamme.ch
• www.sgar-ssar.ch
• www.neonet.ch
• www.swiss-paediatrics.org
175
Changing maternity
policies
Maria Cutajar, Malta
Permanthia Panani, Greece
Changing Maternity Services
MARIA CUTAJAR
MALTA
INTRODUCTION
• During this presentation insight will be given to
describe the process of improving maternity care
through initiatives conducive to change in maternity
services in Malta.
MIDWIFERY IN MALTA
 One General Hospital – Obstetrics & Gynaecology
Department cater for 98% of all births
 Midwifery input during Antenatal period
* Antenatal Education Programme
* Booking Visit
* Care for hospitalised pregnant women.
 Intrapartum Care
 Postnatal Care
 Community Care
Background
• The Maltese maternity care is fragmented and is more
medically oriented rather than women-centred.
• As stated during the EMA AGM held in Malta in 2008, Antenatal
care is mainly provided by the obstetricians, rates of induction of
labour and caesarean sections are still high.
• Reports on the factors that influence the service users and service
providers, the organisation and the nation recommend
widespread reform in the way services are organised, all
heralding a state of massive change.
Midwifery Initiatives
• Such initiatives were also CATALYST for the introduction of
new services:
 (Midwifery community care, Hospital based assisted
reproductive technology clinic, Female Genital Mutilation
Bill and awareness)
 improvement of other services (Normalising Childbirth,
Breast feeding baby friendly initiative)
This happened through collaboration between:
 service users, policy makers, midwives, paediatricians,
obstetricians, other health care professionals and NGO’s.
CHANGE was based on education, evidence and
experiences adapted to the local needs:
• Research findings and training needs analysis
• CPD activities
• Experience
of professionals working both in a local and international setting
(education supported by EU funds):
• Normalising Childbirth & Breastfeeding Baby Friendly Mobility
Project 2009 – 2011 (23 Midwives – 2 weeks experience in Midwifery Led Unit UK)
• Normalising Childbirth Training Module
(Malta – UK – Malta, 68 Midwives
followed 92 hours programme – study week University of West England Bristol & visit to
MLU).
• Discharge Liason Midwives postnatal community services
for 1 month in a Hospital in Ireland)
(5 midwives
This change:
• Raised the profile and status of the midwifery
profession.
• Provided avenues to explore constraints and
opportunities.
• Understanding of the occupational and
professional relationships necessary to face the
challenges encountered.
WHY CHANGE WAS NEEDED?
• High rates of unnecessary intervention during pregnancy and childbirth
• Fragmentation of care
• Under utilisation of midwifery skills
• Professional development of midwives
• Unsatisfied service users
• Lack of job satisfaction and demotivation due to difficulty in maintaining high
quality maternity services
• Shortage of hospital beds
• Research findings
• Midwives’ experiences abroad
• Sustainable services – awareness of wastage of resources
• Successful experiences
How this Happened?
• Change
was
possible
through
CONSULTATION AND COLLABORATIVE
APPROACH from all stake holders.
• Change is happening gradually
consistent, though still long way to go
but
• Move from a Hospital-focused and Medical
oriented model of care, to a women centred
care approach.
POLICY MAKERS
Minister of Health
Minister of Social Policy
Parlamentary Secretary / Health
Shadow Minister for Health
MEPs
Hospital Management
BE THE
VOICE
NGO’s, Unions &
Organisations
Media
Expectant & New Parents
& General Public
CONSULTATION
DOCUMENTS
POSITION
STATEMENT
Strategic Direction for Strengthening
Midwifery in Malta 2011
Breastfeeding Policy 2014
National Health Strategy 2014 – 2020
Become a Regulated Practice
offered in Public Health System
implantation of two fertilised ovum
POSITION
STATEMENT
IVF
BE THE
VOICE
FGM
Seminars / Conference on Topic
Increase Awareness
Improve Service
RESOLUTIONS
NCW
Normalising Childbirth
Breastfeeding
FGM
Perinatal Mental Health
Sexual Assault Clinic
OBSTACLES/ BARRIERS:
• Process was not easy and there where barriers which could have
hindered the process to improve midwifery care. Some of the
problems were:
•Interdisciplinary/professional Conflicts
•Political professional power
•Organisational Culture (Highly medical oriented model of care)
•Increasing shortfalls in numbers of midwives
•Limited budget/funds
•Limitations of regulation and standards and their comparability at a
national level
•Lack of resources
•Resistance to change
Through collaboration:
•Set up a focus group at Ministry level
•Analyse the service delivery, models of care and
organisation of services
•Formulation of midwifery guidelines
•Practice skills that promote normality (more doctors are
cooperating and slowly coming on board)
•Improve recognition of the midwife (limited role during
the antenatal period)
•Set up a strategic direction and a way forward
•Set up a strategy for future education of midwives (as
regards specialisation areas and continuation of further
education)
•Get all concerned on board – to minimise resistance to
change
•Put forward recommendations for policy and the
regulation of midwives
•Improve communication across sectors
•Promote organisational links and cohesive leadership
•Improve inter-sectoral collaboration in the long-term
•Strengthen Midwife / mother relationship
Conclusion:
This 'rethink' of the systems and organisation of health care
delivery in Malta needs to:
• address priorities for care and safety
• meet the needs of consumers
• be guided by evidence and demonstrate cost
effectiveness
• be mindful of the need to maintain and develop a skilled
health workforce
Put simply, these developments should occur within a
framework of three basic principles: choice, control and
continuity.
CHANGING MATERNITY SERVICES
IN GREECE
PERMANTHIA PANANI
President of Hellenic Midwives Association
EMA Annual Meeting, Tallin, Esthonia 2014
• The midwifery role in primary health
care is autonomous, discrete and
necessary.
THE ROLE OF
THE MIDWIFE
IN PRIMARY
HEALTH CARE
*(PRIORITY
FOR HELLENIC
MIDWIVES
ASSOCIATION)
• Within her competences, a midwife,
takes action and interferes
supportively, aiming women’s and their
families health.
• The care that a midwife provides to the
community is holistic and of proven
effectiveness to the quality
improvement of health services
provided to a woman and her family.
Women must have access to a supportive
and high quality network of health
services which has to be developed for
their individual needs and the needs of
their families.
Our vision is:
1.VISION
 Healthy families
 Individualized care, according to their
own needs
 Normal pregnancy and natural birth
 Care that will will have a positive impact
on good clinical and psychological
results for the woman and her child.
The framework of the midwifery activities in the Primary
Health Care unit is based in four priority axes:
2. ORGANIZATION
OF MIDWIFERY
ACTIVITIES
FRAMEWORK IN
THE COMMUNITY
• Prevention (gynaecological cancer screening,
prevention of Sexually Transmitted Diseases)
• Provision of midwifery care at home
(antenatal/ postnatal care, breastfeeding
promotion)
• Health Education (Family planning,
educational presentations at schools,
preparation and education for transition to
parenthood)
• Protection and promotion (protection of safe
motherhood, promotion of natural birth)
1)
3.PROPOSALS
FOR THE
MINIMUM
SET OF
SERVICES OF
A MIDWIFE IN
THE
COMMUNITY
Promoting physical and mental health of the
mother, the infant and the family as a unit of
the society
2) Holistic perinatal care in the community
(pregnancy, childbirth, postpartum) with a
vision to promote safe motherhood and
meeting the specific needs of the family.
3) Implementation of international protocols and
guidelines for monitoring / evaluation of
pregnancy, childbirth and postpartum and
improving the quality of network services and
health indicators of perinatal morbidity and
mortality, reducing the Caesarean Section
rates, increasing breastfeeding rates etc.
4) Prenatal screening and early identification of
deviations from the normal physical and
mental progress and direct reference, if
necessary.
3.PROPOSALS
FOR THE
MINIMUM
SET OF
SERVICES OF
A MIDWIFE IN
THE
COMMUNITY
5) Preparation for parenthood, promotion of
natural childbirth and encourage scientifically
acceptable methods for neonatal care and
breastfeeding, promotion of the development
of a healthy parent-infant relationship.
6) Prescription (diagnostic tests, drugs) during
pregnancy, childbirth and the puerperium
7) Home visits by the Community midwife during
the perinatal period (pregnancy, childbirth,
postpartum)
3.PROPOSALS
FOR THE
MINIMUM SET
OF SERVICES
OF A MIDWIFE
IN THE
COMMUNITY
8)
Breastfeeding Counselling (support, promotion,
protection of breastfeeding) at individual -group
level and community level
9)
Promotion of women's health in all life periods
(adolescence, reproductive age, menopause)
10) Screening tests (test-pap, mastography, etc.)
11) Prevention of Sexual Transmitted Diseases, vaginal
fluid culture
12) Health Education in schools and community
agencies
13) Recordkeeping / Research in Women's Health
1) Improvement of the quality in midwifery
care services
2) Strengthening midwifery practice in our
country
3) Organization of seminars
4) Evaluation of midwifery practice every 3
4.ACTIONS years
5) Communication & collaboration with
women’s organizations. Their power forces
the Ministry of Health to accept our
proposals and make all the necessary
changes.
6) Our collaborations are the result of the
advertisement of our work in the media.
4.ACTIONS
The first action from the Ministry of Health
have already started:
In collaboration with Hellenic Midwives
Association, three programmes have been
designed to be initiated in 2015:
• Family Planning
• Care of mother and baby
• Community Midwifery
ANY
Any questions
Lunch
Workgroups
Homebirth (M. Carroll, Ireland-Ellen Blix, Norway,
Mervi Jokinen, UK)
Developing midwifery practice standards (Ute
Wronn, Germany- Miriam Wille, Swiss, Eva
Matintupa, Finland)
Changing maternity policies (Maria Cutajar,
Malta-Permanthia Panani, Greece, Agnes Simon,
France)
IT tools for E-learning and professional
communication (Marge Mahla, Estonia, Joeri
Vermeulen, Belgium, Anita Prelec, Slovenia)
Coffee break
Feedback from the
workgroups
Release of press statement
Summary and identification of
overall actions 2014-2015
Summary of meeting
Thanks and closure of
the meeting

Presentations - European Midwives Association

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