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Fabulous to hear Susan. We really need to collect positive stories of good quality care (for women, families, and care providers). All the best Soo ________________________________ From: The normal birth research list <[log in to unmask]> on behalf of Susan Crowther <[log in to unmask]> Sent: Thursday, March 26, 2020 8:55 PM To: [log in to unmask] <[log in to unmask]> Subject: Re: Situation in Slovakia - grim Agree Lesley, what can we do for regions where sensitive community relational care is threatened. It seems that this is the time for more compassion and sensitivity not institutional uncaring dictates. What can we do – perhaps ICM could release some guidance to all regions? The risk and childbirth discourse appears to be escalating in some regions in the face of Covid 19. We all need practical solutions not fear based knee jerk reactions. NZ has its own issues at this time but CoCer and maintaining women’s rights to choose continues to be central to the partnership model. I am truly impressed on how New Zealand midwives, both hospital based and the continuity of carer midwives, are addressing the needs of their communities and supporting each other to practice proactively to do so. It is heart-warming. Go well Susan From: The normal birth research list <[log in to unmask]> On Behalf Of Page, Lesley Sent: Friday, 27 March 2020 5:14 am To: [log in to unmask] Subject: Re: Situation in Slovakia - grim I am so disturbed to hear what is happening in Slovakia. Why is the humanisation of birth so difficult? Lesley Professor Lesley Page CBE Visiting Professor in Midwifery KCL Adjunct Professor UTS Australia Griffith University Australia Honorary research fellow Oxford Brookes University mobile +44(o)7747708630 https://www.all4maternity.com/humanising-birth-hope-for-the-future-even-in-war/ https://www.all4maternity.com/author/lesleypage/ twitter: lesleypageCBE@humanisingbirth ________________________________ From: The normal birth research list <[log in to unmask]<mailto:[log in to unmask]>> on behalf of Soo Downe <[log in to unmask]<mailto:[log in to unmask]>> Sent: 26 March 2020 15:35 To: [log in to unmask]<mailto:[log in to unmask]> <[log in to unmask]<mailto:[log in to unmask]>> Subject: Situation in Slovakia - grim ________________________________ From: Zuzana Kriskova <[log in to unmask]<mailto:[log in to unmask]>> Sent: Thursday, March 26, 2020 3:33 PM To: Soo Downe <School of Community Health & Midwifery> <[log in to unmask]<mailto:[log in to unmask]>> Cc: Brenda Dmello <[log in to unmask]<mailto:[log in to unmask]>>; Rebecca Brown <[log in to unmask]<mailto:[log in to unmask]>>; Jennifer Stevens <[log in to unmask]<mailto:[log in to unmask]>>; Elena Skoko <[log in to unmask]<mailto:[log in to unmask]>>; [log in to unmask]<mailto:[log in to unmask]> <[log in to unmask]<mailto:[log in to unmask]>> Subject: Re: Thinking out of the box - an alternative covid approach for birth Dear all, in Slovakia, we hear disturbing news. Some hospitals decided to follow protocols from China (enclosed) and decided that - no companions, forceps birth or ceaserians section are mandatory for women with COVID-19, mandatory 14 days separation of the baby. Some women need to wear the mask non-stop, during birth and after birth (even in sleep). In another hospital epidurals are postponed (we are not in crises, only 2 people are officialy in critical condition). As visits are banned parents of premature children are not allowed to see them. From Czech rep. we heard that some women are allowed to be with their baby in room, but the baby needs to be 2m from mother. We are afraid that more and more "creative" directives would be forced upon women. I understand that you as midwifes and other healthcare professional are in front lines, risking your own health. And many of you are in the risk group. I understand the need of protection and we see that in many countries and hospitals personnel doesn't have sufficient protection - we are missing masks, respirators, gloves.... But still as human rights activist I call for your help. Pregnant women are in very vulnerable position, they can not wait until the pandemic is over. We need to hear that even the time of crisis respectful maternity care is not a luxury. We need to call out those who use this time as opportunity to bully and mistreat women. Zuzana Kriskova Women's circles NGO from Slovakia št 26. 3. 2020 o 14:40 Soo Downe <[log in to unmask]<mailto:[log in to unmask]>> napísal(a): And maybe some good news about an alternative approach, where this is possible?: From: Nieuwenhuijze M (AV-M) <[log in to unmask]<mailto:[log in to unmask]>> Subject: RE: CORONAVIRUS - COST activities Women in the Netherlands are still giving birth at home. Actually, low risk women in certain areas are more often choosing a home birth to avoid the hospital or because some hospital restrict admittance as much as possible. Additionally, they are setting up birth units (e.g. in hotels) very close to the hospital to avoid delay in time and still keep women outside the hospital. If women need to be admitted for medical reasons, they are allowed one person to accompany them during birth. Met vriendelijke groet | Kind regards, Marianne Nieuwenhuijze PhD MPH RM Professor of Midwifery Lectoraat Midwifery Science | Research Centre for Midwifery Science Academie Verloskunde Maastricht Zuyd University +31(0)43 388 54 11 [log in to unmask]<mailto:[log in to unmask]>, MailScanner has detected a possible fraud attempt from "eur03.safelinks.protection.outlook.com" claiming to be www.av-m.nl<https://eur03.safelinks.protection.outlook.com/?url=http%3A%2F%2Fwww.av-m.nl%2F&data=01%7C01%7Clesley.page%40KCL.AC.UK%7C80f93327c7dd459c47c508d7d19b53c2%7C8370cf1416f34c16b83c724071654356%7C0&sdata=s77jNrUTvEcLLtHsXjHdAuDQP82IIB0pkBTRHLe0mOk%3D&reserved=0> Universiteitssingel 60, 6229 ER Maastricht ________________________________ From: Brenda Dmello <[log in to unmask]<mailto:[log in to unmask]>> Sent: Thursday, March 26, 2020 7:39 AM To: Rebecca Brown <[log in to unmask]<mailto:[log in to unmask]>> Cc: Soo Downe <School of Community Health & Midwifery> <[log in to unmask]<mailto:[log in to unmask]>>; Jennifer Stevens <[log in to unmask]<mailto:[log in to unmask]>>; Elena Skoko <[log in to unmask]<mailto:[log in to unmask]>>; [log in to unmask]<mailto:[log in to unmask]> <[log in to unmask]<mailto:[log in to unmask]>> Subject: Re: ITALY: COVID-19 & RMC Position statement Hello, May I share a few thoughts on respectful care at childbirth in the time of COVID 19. It is indeed a tough time- a novel virus - overwhelming health systems- the world is in panic. The scientific community has not had the time to really determine the facts - it is a time of transition - we can expect multiple changes in protocols as new evidence emerges. It will take us some time to figure out what is best for mum and baby and the community at large. We do not yet know enough about the interaction between COVID19 and pregnancy- how to manage a patient that is infected and how to manage a patient that is not infected. We may need to be gracious and patient but not complacent. To allow birth companions or not- that is the question...separate mum and baby- we have had a similar scenario before when we had to decide to breastfeed or not to breastfeed in the time of HIV. Are we making decisions on what is best and convenient for the health care provider- like we do here in Tanzania or what is best for the client? While we do not know everything about how to handle pregnancy in the time of COVID, we know for SURE what the woman needs and wants and, what keeps her and her baby safe. For centuries we have know, but the progress to give the woman what is 'RIGHT' has been hard fought and gains have been slow...and that is why this group exists. We need to recognize that pregnancy management is not an individual sport- it requires a team approach and is a family/community affair.We have managed TB and HIV in pregnancy in the past.Maybe there are lessons we can learn. My hunch is that time will tell us that we should prioritise what the mother wants, she knows what is best for her and her baby. A few more thoughts and an advocacy pitch for a birth companion.... Birth companion is not a soft science- it is the single most important intervention to ensure Right care which includes respectful birth. More importantly the management of the psyche in a pregnant woman is critical during labour. It is one of the four pillar in labour management- along with the other 'P's - Passage (the pelvis), the Passenger(the baby size and position) and Power(the strength of uterine contractions). It will be sad for our fellow pregnant mums in the developed world to move backwards and now experience the trauma of labouring alone or with strangers. It is too painful and sad to hear women scream 'nursi'...'nursi'- mostly out of panic and fear in her loneliness. It kills the joy that should be there at childbirth. Sometimes it kills more than that. I understand we need to be wise in this new era- but a few more thoughts... Who is the birth companion ban protecting? The companion ? - who most likely lives with the woman. The health care provider ? - who is highly trained to deal with COVID cases, infectious disease and is fully kitted with IPC gear (that could be stepped up to ebola prevention levels) or The pregnant woman? who irrespective whether she has COVID or not needs urgent and right delivery care with access to emergency management/PPH/blood transfusion/ and a few other unpredictable emergencies etc Once we decide that both the clinical provision of care and the experience of care are of equal and non negotiable priority- then the health specialists should tell us what to do to keep the various participants in the delivery process safe without withholding any basic rights. I agree maybe the companion will need extra training - we may need to clarify and ensure no vulnerable groups selected as companions and include training on how not to acquire and how not to spread infection. I am sure that is possible. I am believing that together we will come up with a best way forward with public health specialists, virologists, nurse midwives, mothers and partners engaged in decision making.Together we will make the right decision. We always have. Warmest regards Brenda Dr. Brenda Sequeira D'mello,MD, MMed (OBGYN) Technical Advisor & Project Manager, Capacity Building Project Maternal and Newborn Health program CCBRT phone 255 754295465 On Wed, Mar 25, 2020 at 8:05 PM 'Rebecca Brown' via Global RMC Council <[log in to unmask]<mailto:[log in to unmask]>> wrote: Hi All, In New York, so far two large hospital systems (New York Presbyterian and Mt Sinai) have instituted a policy allowing no additional support into the labor and delivery units – no spouses, doulas or family. It’s causing outrage here and petitions have been launched. Best, Rebecca [cid:image002.jpg@01D6041D.E080D2F0] REBECCA BROWN* (she/her/hers) Senior Director of Global Advocacy [log in to unmask]<mailto:[log in to unmask]> 199 Water Street, 22nd Floor New York NY 10038 Tel 917 6373606 Fax 917 637 3666 Skype rbrown_crr Website<https://eur03.safelinks.protection.outlook.com/?url=http%3A%2F%2Fwww.reproductiverights.org%2F&data=01%7C01%7Clesley.page%40KCL.AC.UK%7C80f93327c7dd459c47c508d7d19b53c2%7C8370cf1416f34c16b83c724071654356%7C0&sdata=RP5MyXRyBolqJB7YbWHIPpjP9mvQBaFZhoeXWHSzoy8%3D&reserved=0> | Facebook<https://eur03.safelinks.protection.outlook.com/?url=https%3A%2F%2Fwww.facebook.com%2Freproductiverights&data=01%7C01%7Clesley.page%40KCL.AC.UK%7C80f93327c7dd459c47c508d7d19b53c2%7C8370cf1416f34c16b83c724071654356%7C0&sdata=ghe0faj%2BsypJvMwnYs117OTAr9dS0y0RZQ4%2F9XEb%2FSs%3D&reserved=0> | Twitter<https://eur03.safelinks.protection.outlook.com/?url=https%3A%2F%2Ftwitter.com%2Freprorights&data=01%7C01%7Clesley.page%40KCL.AC.UK%7C80f93327c7dd459c47c508d7d19b53c2%7C8370cf1416f34c16b83c724071654356%7C0&sdata=gx%2Bg1xp1eLwKxTRmuTukzvnjJ62h5Zou7eGEAw%2F6xOY%3D&reserved=0> *JD, admitted in New York (active status) This message may contain confidential or privileged information. If you are not the intended recipient, please advise the sender immediately by reply e-mail and delete this message and any attachments without retaining a copy. From: [log in to unmask]<mailto:[log in to unmask]> <[log in to unmask]<mailto:[log in to unmask]>> On Behalf Of Soo Downe Sent: Wednesday, March 25, 2020 12:03 PM To: Jennifer Stevens <[log in to unmask]<mailto:[log in to unmask]>>; Elena Skoko <[log in to unmask]<mailto:[log in to unmask]>> Cc: [log in to unmask]<mailto:[log in to unmask]> Subject: Re: ITALY: COVID-19 & RMC Position statement This is a recommendation from the WHO intrapartum guidelines Jennifer, that has applied to all settings since the guidelines were published: Companionship during labour and childbirth 3. A companion of choice is recommended for all women throughout labour and childbirth. Recommended I think the idea is that the lack of privacy and etc should not be used as an excuse to limit companionship - rather that the human right of companionship should lead to a change in hospital design/ward set up so that it can be provided. I know there is debate about this in the light of covid-19 for some settings in Europe - but in others it is still absolutely seen as a right, and, indeed, as a way of minimising cross-infection for staff, as, if a woman has a birth companion she is better able to labour without the need for constant staff support, is less likely to need an epidural (so to need an anaesthetist) and is less likely to need a CS (and so, again, less likely to occupy a theatre and need theatre staff, and more likely to be able to leave hospital quicker). My understanding, by the way, is that healthy pregnant women are the social group of adults least likely to be infected with C-19/to experience severe disease once infected - the theory being that, paradoxically, because they are immune suppressed they dont mount the catastrophic auto-immune response that characterises the worst effects of the disease -but Im not sure where I got that information from (it could be mis-information!). Can anyone enlighten me on this? Many thanks soo Many thanks Soo ________________________________ From: [log in to unmask]<mailto:[log in to unmask]> <[log in to unmask]<mailto:[log in to unmask]>> on behalf of Jennifer Stevens <[log in to unmask]<mailto:[log in to unmask]>> Sent: Wednesday, March 25, 2020 2:58 PM To: Elena Skoko <[log in to unmask]<mailto:[log in to unmask]>> Cc: [log in to unmask]<mailto:[log in to unmask]> <[log in to unmask]<mailto:[log in to unmask]>> Subject: Re: ITALY: COVID-19 & RMC Position statement Thank you for sharing this. I was surprised to see a companion of choice listed on the info graphic. Although a right I fully support during normal circumstances, I have some concerns around it now during the COVID outbreak, especially in LMIC where often inadequate screening and privacy is available. What are others thoughts on this? Also, is this supported in current WHO recommendations? Thank you! Jennifer Stevens On Tue, Mar 24, 2020 at 9:40 PM Elena Skoko <[log in to unmask]<mailto:[log in to unmask]>> wrote: Dear colleagues, as Italian users' rappresentatives, we have issued a Position statement on COVID-19 and respectful maternity care. MailScanner has detected a possible fraud attempt from "eur03.safelinks.protection.outlook.com" claiming to be https://ovoitalia.wordpress.com/2020/03/24/position-statement-emergenza-codiv-19-e-assistenza-rispettosa-alla-maternita-e-nascita/<https://eur03.safelinks.protection.outlook.com/?url=https%3A%2F%2Fovoitalia.wordpress.com%2F2020%2F03%2F24%2Fposition-statement-emergenza-codiv-19-e-assistenza-rispettosa-alla-maternita-e-nascita%2F&data=01%7C01%7Clesley.page%40KCL.AC.UK%7C80f93327c7dd459c47c508d7d19b53c2%7C8370cf1416f34c16b83c724071654356%7C0&sdata=UogMxJmw6tanwXx2woH9nPzHQoS3NF4fP2ZnItyV%2F54%3D&reserved=0> Thank you for sharing. If you feel like it, you can endorse the statement with your organisation or association by replying to me. Thank you! Sorry for not having a translation in English yet. 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