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MIDWIFERY-RESEARCH  November 2018

MIDWIFERY-RESEARCH November 2018

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Subject:

AW: MIDWIFERY-RESEARCH Digest - 6 Nov 2018 to 7 Nov 2018 (#2018-197)

From:

"Dr. Christiane Schwarz" <[log in to unmask]>

Reply-To:

A forum for discussion on midwifery and reproductive health research." <[log in to unmask]>, Dr. Christiane Schwarz

Date:

Thu, 8 Nov 2018 09:21:27 +0000

Content-Type:

text/plain

Parts/Attachments:

Parts/Attachments

text/plain (1 lines)

Dear all,  
 
if there is anything I could contribute to support this initiative, I will gladly do so! 
 
best wishes,  
Christiane 
 
Prof. Dr. Christiane Schwarz 
Hebamme 
Studiengangsleitung Hebammenwissenschaft 
Universität zu Lübeck 
Ratzeburger Allee 160 
23562 Lübeck 
Haus 25, Raum 32a 
Tel: 0451/ 3101- 8560 
[log in to unmask] 
www.hewi.uni-luebeck.de 
 
 
 
 
-----Ursprüngliche Nachricht----- 
Von: A forum for discussion on midwifery and reproductive health research. <[log in to unmask]> Im Auftrag von Susan Crowther (snm) 
Gesendet: Donnerstag, 8. November 2018 09:32 
An: [log in to unmask] 
Betreff: Re: MIDWIFERY-RESEARCH Digest - 6 Nov 2018 to 7 Nov 2018 (#2018-197) 
 
Hi Gillian and all, 
 
What a good thread. I agree that a global reach initiative to reclaim the term ‘normal birth’ and provide strategies and structured teaching and assessing tools is needed.  Normal birth’ has not been demonised everywhere as it has been in the UK recently. Having just read the recent Lancet CS series it is absolutely time to do something to safeguard normal birth. The foundations of knowledge are there, we have the evidence. I suspect most of us on this list could list at least 10 points without much effort from the top of our heads!  There are various local and national initiatives/guidelines over the years but a proactive global reach would be inspiring. 
 
I would very much like to be involved. Perhaps to start a small group exploring global funding options? 
 
Go well 
Dr Susan Crowther 
Professor of Midwifery 
Faculty of Health and Social Care | Robert Gordon University | Garthdee Road|Aberdeen | AB10 7AQ 
T: +44(0)1224 263291<tel:+441224%20263291>| E mail: [log in to unmask]<mailto:[log in to unmask]> 
ORCID ID:  0000-0002-4133-2189 
Twitter: https://eur02.safelinks.protection.outlook.com/?url=https%3A%2F%2Ftwitter.com%2FSusanCrowtherMW&amp;data=02%7C01%7C%7C6fba978558a04990166308d64554b1eb%7C84df9e7fe9f640afb435aaaaaaaaaaaa%7C1%7C0%7C636772627416955262&amp;sdata=pt9hN0oz42vvCh%2FEHv8B3MuAxHqoZvtb27ngiUyjwXo%3D&amp;reserved=0 
New book 2017  https://eur02.safelinks.protection.outlook.com/?url=https%3A%2F%2Ftwitter.com&amp;data=02%7C01%7C%7C6fba978558a04990166308d64554b1eb%7C84df9e7fe9f640afb435aaaaaaaaaaaa%7C1%7C0%7C636772627416955262&amp;sdata=yDnRM6RY0hxD%2BUQrPvIbffV4LBFTwB0f2Eq6%2FXPB4cY%3D&amp;reserved=0<https://eur02.safelinks.protection.outlook.com/?url=https%3A%2F%2Ftwitter.com%2FSusanCrowtherMW&amp;data=02%7C01%7C%7C6fba978558a04990166308d64554b1eb%7C84df9e7fe9f640afb435aaaaaaaaaaaa%7C1%7C0%7C636772627416955262&amp;sdata=pt9hN0oz42vvCh%2FEHv8B3MuAxHqoZvtb27ngiUyjwXo%3D&amp;reserved=0>/spiritbirthbook 
Blog: DrSusanCrowther.com<x-apple-msg-load://FA94F0BC-AD61-470A-8F25-ECA235DFEB6B/DrSusanCrowther.wordpress.com> 
Those finding themselves at birth need to pause .. allow the profundity of its meaning to surface and inspire their actions 
 
On 8 Nov 2018, at 00:02, MIDWIFERY-RESEARCH automatic digest system <[log in to unmask]<mailto:[log in to unmask]>> wrote: 
 
There are 25 messages totaling 9024 lines in this issue. 
 
Topics of the day: 
 
 1. MIDWIFERY-RESEARCH Digest - 26 Oct 2018 to 28 Oct 2018 (#2018-190) (22) 
 2. purple line (2) 
 3. New Course - Advanced Qualitative Research Methods 
 
######################################################################## 
 
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---------------------------------------------------------------------- 
 
Date:    Wed, 7 Nov 2018 20:00:32 +1300 
From:    SHEENA BYROM <[log in to unmask]<mailto:[log in to unmask]>> 
Subject: Re: MIDWIFERY-RESEARCH Digest - 26 Oct 2018 to 28 Oct 2018 (#2018-190) 
 
Hello Gillian, 
 
I absolutely agree with you. And in a time when we are ‘not allowed’ to use the term ‘normal birth’ - a call to action similar to Unicef and BFI would seem sensible. I have debated this before with Francesca Entwistle. 
 
Soo Downe is working with the WHO on these matters, and may offer some insight. Soo and I are planning the development of something similar to the now abolished RCM's Ten Tops Tips (not using this phrase) for NB to support women and practitioners, but just in the early stages and any help welcomed. 
 
I would be more than happy to be part of a small team looking at developing standards etc - we have so much evidence and it would be good to pull it together. 
 
Something else, we are soon to launch a Normal Birth Repository of information - freely accessible to all - just making the final tweeks to the website, so this will be something else to contribute to a strategy… 
 
Thank you for raising this critical issue... 
 
 
 
With very best wishes, 
 
Sheena 
 
Website: sheenabyrom.com<https://eur02.safelinks.protection.outlook.com/?url=http%3A%2F%2Fsheenabyrom.com&amp;data=02%7C01%7C%7C6fba978558a04990166308d64554b1eb%7C84df9e7fe9f640afb435aaaaaaaaaaaa%7C1%7C0%7C636772627416955262&amp;sdata=ReTRJ7I5GuIpv9CUi5XuBa3x5iA72ft%2FTitg9RKG9%2BM%3D&amp;reserved=0> <https://eur02.safelinks.protection.outlook.com/?url=http%3A%2F%2Fwww.sheenabyrom.com%2F&amp;data=02%7C01%7C%7C6fba978558a04990166308d64554b1eb%7C84df9e7fe9f640afb435aaaaaaaaaaaa%7C1%7C0%7C636772627416955262&amp;sdata=q7WQIqi9fx5lihmalJ3%2BXreTAWX3s%2B4wRxW6wCFugug%3D&amp;reserved=0> 
 
Twitter: @SagefemmeSB <https://eur02.safelinks.protection.outlook.com/?url=https%3A%2F%2Ftwitter.com%2FSagefemmeSB&amp;data=02%7C01%7C%7C6fba978558a04990166308d64554b1eb%7C84df9e7fe9f640afb435aaaaaaaaaaaa%7C1%7C0%7C636772627416955262&amp;sdata=CVQEqaqLWCKV0s44bYpow9kxrzwSDt3w4wZNFjnwGvo%3D&amp;reserved=0> 
 
On 1 Nov 2018, at 02:17, Gillian Meldrum <[log in to unmask]<mailto:[log in to unmask]>> wrote: 
 
I think what is needed is an international & national normal birth strategy with a co-ordinating body. The UNICEF Baby Friendly Initiative, in partnership with WHO, is a good model to consider. 
They have made slow but steady progress over the last 27 years, with many challenges similar to normal birth. 
It has to start with an understanding of why normal birth matters - the increase in interventions is often lamented, but rarely do we see the negative impacts of this or it’s often weak rationales explicitly stated in the media or communicated to women. 
The importance of normal birth, and how to achieve it, may be taught to midwifery students, but not to doctors and most lay people are unaware. 
BFI at a local level means setting policies & guidelines for best evidence-based practice, training staff & auditing their skills, knowledge & understanding, and most importantly, auditing mothers’ experiences so that we hear their voices & find out if we are getting it right. 
Nationally, they co-ordinate a national network of infant feeding leads who link in to all maternity, neonatal, health visiting &  children’s centre staff in the country (except for some areas in England who are not signed up). They have established standards for universities training midwives & health visitors. 
Currently they are working on a medical student curriculum. 
They work together with other national bodies involved in 
https://eur02.safelinks.protection.outlook.com/?url=https%3A%2F%2Fukbreastfeeding.org%2F&amp;data=02%7C01%7C%7C6fba978558a04990166308d64554b1eb%7C84df9e7fe9f640afb435aaaaaaaaaaaa%7C1%7C0%7C636772627416955262&amp;sdata=BZFBv8lL3w7SHjMSKjzxFQSbdf338iYTA7n%2BDotDyKM%3D&amp;reserved=0 <https://eur02.safelinks.protection.outlook.com/?url=https%3A%2F%2Fukbreastfeeding.org%2F&amp;data=02%7C01%7C%7C6fba978558a04990166308d64554b1eb%7C84df9e7fe9f640afb435aaaaaaaaaaaa%7C1%7C0%7C636772627417111522&amp;sdata=UqAuQ7RNeLZUzzeRKHdPLbd7Yh%2By%2FBq6r8hjXZtN2jc%3D&amp;reserved=0> 
They are a tiny unit, but have clear aims and focus - we have never had any organisation promoting normal birth in such a structured way. 
Who of you has contacts with WHO? We need an Innocenti Declaration for normal birth and a an equivalent of the 10 steps framework to protect it. Then a UK organisation which exists for the purpose of implementing those standards. 
 
On a slightly different note, I think the improvements in induction rates in the 1990s can be partly attributed to the contribution of NCT & AIMS which encouraged women to expect more oppprtunities for informed choice & resulted in more women asking for less intervention, together with the publication in 1989 of Chalmers et al Effective Care in Pregnancy & Childbirth - this gave massive support to clinicians. 
 
Gillian Meldrum 
 
On Wed, 31 Oct 2018 at 10:43, Macfarlane, Alison <[log in to unmask]<mailto:[log in to unmask]> <mailto:[log in to unmask]>> wrote: 
We have a lot more research evidence since the early 1990s when the policies first changed and more recent robust research which has confirmed and extended the earlier more limited evidence on which the policies were based. Although research questions remain, I don’t think more research is the prime need now. An outside observer can see the majority of women giving birth in ever larger obstetric units with rocketing levels of intervention and a few midwifery units and private midwifery companies for the minority of women who manage to find out that they have a choice. I know you midwives are run off your feet, but it looks like you have a choice between letting it all happen and becoming the RCOG / RCN Faculty of Obstetric Nursing or taking some action. 
 
 
 
Alison Macfarlane 
 
 
 
From: MacVane Phipps Fiona [mailto:[log in to unmask] <mailto:[log in to unmask]>] 
Sent: 30 October 2018 12:56 
To: Macfarlane, Alison; A forum for discussion on midwifery and reproductive health research. 
Subject: Re: MIDWIFERY-RESEARCH Digest - 26 Oct 2018 to 28 Oct 2018 (#2018-190) 
 
 
 
Alison 
 
Thank you for this. I didn't see your graphs. were they circulated on this list?  I find your suggestion very chilling yet very credible, particularly if this government plan, as widely rumoured, to throw open NHS contracts to any US trade deal. I can't think of anything worse than the UK maternity service being influenced/comtrolled by US care providers (read 'Insurance conglomerates'). I find it very hard to understand why the large body of evidence supporting midwifery care and the midwifery model of birth has failed to alter this trend. I'm happy to be involved in any discussion about research that could be done to investigate. 
 
Best wishes, 
 
Fiona 
 
 
 
 
 
From: Macfarlane, Alison <[log in to unmask]<mailto:[log in to unmask]> <mailto:[log in to unmask]>> 
Sent: 30 October 2018 12:29:53 
To: A forum for discussion on midwifery and reproductive health research.; MacVane Phipps Fiona 
Subject: RE: MIDWIFERY-RESEARCH Digest - 26 Oct 2018 to 28 Oct 2018 (#2018-190) 
 
 
 
Dear all, 
 
I hope you don't mind me commenting on this from a statistical perspective. The graphs I circulated show that in England childbirth is changing but in a non-evidence-based direction that I think most people on this list think is wrong. 
 
How long before some hard-nosed finance person notices that fewer than half of births in England are spontaneous and proposes that a 'solution' to the shortage of midwives would be replacing a substantial number of midwifery posts with obstetric nursing assistants to help the obstetricians conduct an ever growing proportion of births? This reached 39 per cent in 2007-18. 
 
Good luck and I hope you do better than King Canute. 
 
Alison Macfarlane 
 
-----Original Message----- 
From: A forum for discussion on midwifery and reproductive health research. 
 
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######################################################################## 
 
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------------------------------ 
 
Date:    Wed, 7 Nov 2018 07:47:00 +0000 
From:    "Prins, Marianne" <[log in to unmask]<mailto:[log in to unmask]>> 
Subject: purple line 
 
Dear all, 
I am curious whether midwives ‘use’ the purple line in their care. Do you observe progression of the line and what do you do with the results? Do you for example postpone vaginal examinations in case the purple line is visible? 
Best Whishes 
Marianne 
 
From: A forum for discussion on midwifery and reproductive health research. <[log in to unmask]<mailto:[log in to unmask]>> On Behalf Of SHEENA BYROM 
Sent: woensdag 7 november 2018 08:01 
To: [log in to unmask]<mailto:[log in to unmask]> 
Subject: Re: MIDWIFERY-RESEARCH Digest - 26 Oct 2018 to 28 Oct 2018 (#2018-190) 
 
Hello Gillian, 
 
I absolutely agree with you. And in a time when we are ‘not allowed’ to use the term ‘normal birth’ - a call to action similar to Unicef and BFI would seem sensible. I have debated this before with Francesca Entwistle. 
 
Soo Downe is working with the WHO on these matters, and may offer some insight. Soo and I are planning the development of something similar to the now abolished RCM's Ten Tops Tips (not using this phrase) for NB to support women and practitioners, but just in the early stages and any help welcomed. 
 
I would be more than happy to be part of a small team looking at developing standards etc - we have so much evidence and it would be good to pull it together. 
 
Something else, we are soon to launch a Normal Birth Repository of information - freely accessible to all - just making the final tweeks to the website, so this will be something else to contribute to a strategy… 
 
Thank you for raising this critical issue... 
 
 
 
With very best wishes, 
 
Sheena 
 
Website: sheenabyrom.com<https://eur02.safelinks.protection.outlook.com/?url=http%3A%2F%2Fsheenabyrom.com&amp;data=02%7C01%7C%7C6fba978558a04990166308d64554b1eb%7C84df9e7fe9f640afb435aaaaaaaaaaaa%7C1%7C0%7C636772627417111522&amp;sdata=tSVs1BYBVndJXVrgYa3h5F6RXBNITlKSI9fp%2FA%2F7Nms%3D&amp;reserved=0><https://eur02.safelinks.protection.outlook.com/?url=http%3A%2F%2Fwww.sheenabyrom.com&amp;data=02%7C01%7C%7C6fba978558a04990166308d64554b1eb%7C84df9e7fe9f640afb435aaaaaaaaaaaa%7C1%7C0%7C636772627417111522&amp;sdata=6ZUm%2Fvpd70mA3RVolKytbGz%2FM9ehrh%2F2BHQ8JhWfuGM%3D&amp;reserved=0> 
 
Twitter: @SagefemmeSB<https://eur02.safelinks.protection.outlook.com/?url=https%3A%2F%2Ftwitter.com%2FSagefemmeSB&amp;data=02%7C01%7C%7C6fba978558a04990166308d64554b1eb%7C84df9e7fe9f640afb435aaaaaaaaaaaa%7C1%7C0%7C636772627417111522&amp;sdata=XqyrdHbyZLU7OwK8loz%2BGpd5Mv2hoUYeSqVpCBsFk6o%3D&amp;reserved=0> 
 
 
On 1 Nov 2018, at 02:17, Gillian Meldrum <[log in to unmask]<mailto:[log in to unmask]><mailto:[log in to unmask]>> wrote: 
 
I think what is needed is an international & national normal birth strategy with a co-ordinating body. The UNICEF Baby Friendly Initiative, in partnership with WHO, is a good model to consider. 
They have made slow but steady progress over the last 27 years, with many challenges similar to normal birth. 
It has to start with an understanding of why normal birth matters - the increase in interventions is often lamented, but rarely do we see the negative impacts of this or it’s often weak rationales explicitly stated in the media or communicated to women. 
The importance of normal birth, and how to achieve it, may be taught to midwifery students, but not to doctors and most lay people are unaware. 
BFI at a local level means setting policies & guidelines for best evidence-based practice, training staff & auditing their skills, knowledge & understanding, and most importantly, auditing mothers’ experiences so that we hear their voices & find out if we are getting it right. 
Nationally, they co-ordinate a national network of infant feeding leads who link in to all maternity, neonatal, health visiting &  children’s centre staff in the country (except for some areas in England who are not signed up). They have established standards for universities training midwives & health visitors. 
Currently they are working on a medical student curriculum. 
They work together with other national bodies involved in 
https://eur02.safelinks.protection.outlook.com/?url=https%3A%2F%2Fukbreastfeeding.org%2F&amp;data=02%7C01%7C%7C6fba978558a04990166308d64554b1eb%7C84df9e7fe9f640afb435aaaaaaaaaaaa%7C1%7C0%7C636772627417111522&amp;sdata=UqAuQ7RNeLZUzzeRKHdPLbd7Yh%2By%2FBq6r8hjXZtN2jc%3D&amp;reserved=0 
They are a tiny unit, but have clear aims and focus - we have never had any organisation promoting normal birth in such a structured way. 
Who of you has contacts with WHO? We need an Innocenti Declaration for normal birth and a an equivalent of the 10 steps framework to protect it. Then a UK organisation which exists for the purpose of implementing those standards. 
 
On a slightly different note, I think the improvements in induction rates in the 1990s can be partly attributed to the contribution of NCT & AIMS which encouraged women to expect more oppprtunities for informed choice & resulted in more women asking for less intervention, together with the publication in 1989 of Chalmers et al Effective Care in Pregnancy & Childbirth - this gave massive support to clinicians. 
 
Gillian Meldrum 
 
On Wed, 31 Oct 2018 at 10:43, Macfarlane, Alison <[log in to unmask]<mailto:[log in to unmask]><mailto:[log in to unmask]>> wrote: 
We have a lot more research evidence since the early 1990s when the policies first changed and more recent robust research which has confirmed and extended the earlier more limited evidence on which the policies were based. Although research questions remain, I don’t think more research is the prime need now. An outside observer can see the majority of women giving birth in ever larger obstetric units with rocketing levels of intervention and a few midwifery units and private midwifery companies for the minority of women who manage to find out that they have a choice. I know you midwives are run off your feet, but it looks like you have a choice between letting it all happen and becoming the RCOG / RCN Faculty of Obstetric Nursing or taking some action. 
 
Alison Macfarlane 
 
From: MacVane Phipps Fiona [mailto:[log in to unmask]<mailto:[log in to unmask]>] 
Sent: 30 October 2018 12:56 
To: Macfarlane, Alison; A forum for discussion on midwifery and reproductive health research. 
Subject: Re: MIDWIFERY-RESEARCH Digest - 26 Oct 2018 to 28 Oct 2018 (#2018-190) 
 
Alison 
Thank you for this. I didn't see your graphs. were they circulated on this list?  I find your suggestion very chilling yet very credible, particularly if this government plan, as widely rumoured, to throw open NHS contracts to any US trade deal. I can't think of anything worse than the UK maternity service being influenced/comtrolled by US care providers (read 'Insurance conglomerates'). I find it very hard to understand why the large body of evidence supporting midwifery care and the midwifery model of birth has failed to alter this trend. I'm happy to be involved in any discussion about research that could be done to investigate. 
Best wishes, 
Fiona 
 
 
________________________________ 
From: Macfarlane, Alison <[log in to unmask]<mailto:[log in to unmask]><mailto:[log in to unmask]>> 
Sent: 30 October 2018 12:29:53 
To: A forum for discussion on midwifery and reproductive health research.; MacVane Phipps Fiona 
Subject: RE: MIDWIFERY-RESEARCH Digest - 26 Oct 2018 to 28 Oct 2018 (#2018-190) 
 
Dear all, 
 
I hope you don't mind me commenting on this from a statistical perspective. The graphs I circulated show that in England childbirth is changing but in a non-evidence-based direction that I think most people on this list think is wrong. 
 
How long before some hard-nosed finance person notices that fewer than half of births in England are spontaneous and proposes that a 'solution' to the shortage of midwives would be replacing a substantial number of midwifery posts with obstetric nursing assistants to help the obstetricians conduct an ever growing proportion of births? This reached 39 per cent in 2007-18. 
 
Good luck and I hope you do better than King Canute. 
 
Alison Macfarlane 
 
-----Original Message----- 
From: A forum for discussion on midwifery and reproductive health research. 
________________________________ 
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------------------------------ 
 
Date:    Wed, 7 Nov 2018 08:15:01 +0000 
From:    "Page, Lesley" <[log in to unmask]<mailto:[log in to unmask]>> 
Subject: Re: MIDWIFERY-RESEARCH Digest - 26 Oct 2018 to 28 Oct 2018 (#2018-190) 
 
I would be very much in support of this 
 
 
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://eur02.safelinks.protection.outlook.com/?url=https%3A%2F%2Fwww.all4maternity.com%2Fauthor%2Flesleypage%2F&amp;data=02%7C01%7C%7C6fba978558a04990166308d64554b1eb%7C84df9e7fe9f640afb435aaaaaaaaaaaa%7C1%7C0%7C636772627417111522&amp;sdata=6WSlANhRFYhaDG9%2FFlrRDbeOmiUtIWzAacKfx674Pow%3D&amp;reserved=0 
 
<https://eur02.safelinks.protection.outlook.com/?url=https%3A%2F%2Fwww.all4maternity.com%2Fauthor%2Flesleypage%2F&amp;data=02%7C01%7C%7C6fba978558a04990166308d64554b1eb%7C84df9e7fe9f640afb435aaaaaaaaaaaa%7C1%7C0%7C636772627417111522&amp;sdata=6WSlANhRFYhaDG9%2FFlrRDbeOmiUtIWzAacKfx674Pow%3D&amp;reserved=0>twitter: lesleypageCBE@humanisingbirth 
 
 
 
 
 
 
 
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------------------------------ 
 
Date:    Wed, 7 Nov 2018 08:28:33 +0000 
From:    MacVane Phipps Fiona <[log in to unmask]<mailto:[log in to unmask]>> 
Subject: Re: MIDWIFERY-RESEARCH Digest - 26 Oct 2018 to 28 Oct 2018 (#2018-190) 
 
I very much support any  initiative in support of physiological labour and birth and would like to be included in any group working on this 
 
Kind regards, 
 
Fiona Macvane Phipps 
 
 
________________________________ 
From: A forum for discussion on midwifery and reproductive health research. 
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------------------------------ 
 
Date:    Wed, 7 Nov 2018 08:47:46 +0000 
From:    "Scamell, Mandie" <[log in to unmask]<mailto:[log in to unmask]>> 
Subject: Re: MIDWIFERY-RESEARCH Digest - 26 Oct 2018 to 28 Oct 2018 (#2018-190) 
 
This is a really exciting opportunity. Every cloud and all that. I would be happy to be involved if I can help at all. 
 
BW 
 
Mandie 
 
Sent from my iPhone 
 
On 7 Nov 2018, at 07:01, SHEENA BYROM <[log in to unmask]<mailto:[log in to unmask]><mailto:[log in to unmask]>> wrote: 
 
Hello Gillian, 
 
I absolutely agree with you. And in a time when we are ‘not allowed’ to use the term ‘normal birth’ - a call to action similar to Unicef and BFI would seem sensible. I have debated this before with Francesca Entwistle. 
 
Soo Downe is working with the WHO on these matters, and may offer some insight. Soo and I are planning the development of something similar to the now abolished RCM's Ten Tops Tips (not using this phrase) for NB to support women and practitioners, but just in the early stages and any help welcomed. 
 
I would be more than happy to be part of a small team looking at developing standards etc - we have so much evidence and it would be good to pull it together. 
 
Something else, we are soon to launch a Normal Birth Repository of information - freely accessible to all - just making the final tweeks to the website, so this will be something else to contribute to a strategy… 
 
Thank you for raising this critical issue... 
 
 
 
With very best wishes, 
 
Sheena 
 
Website: sheenabyrom.com<https://eur02.safelinks.protection.outlook.com/?url=http%3A%2F%2Fsheenabyrom.com&amp;data=02%7C01%7C%7C6fba978558a04990166308d64554b1eb%7C84df9e7fe9f640afb435aaaaaaaaaaaa%7C1%7C0%7C636772627417111522&amp;sdata=tSVs1BYBVndJXVrgYa3h5F6RXBNITlKSI9fp%2FA%2F7Nms%3D&amp;reserved=0><https://eur02.safelinks.protection.outlook.com/?url=http%3A%2F%2Fwww.sheenabyrom.com&amp;data=02%7C01%7C%7C6fba978558a04990166308d64554b1eb%7C84df9e7fe9f640afb435aaaaaaaaaaaa%7C1%7C0%7C636772627417111522&amp;sdata=6ZUm%2Fvpd70mA3RVolKytbGz%2FM9ehrh%2F2BHQ8JhWfuGM%3D&amp;reserved=0> 
 
Twitter: @SagefemmeSB<https://eur02.safelinks.protection.outlook.com/?url=https%3A%2F%2Ftwitter.com%2FSagefemmeSB&amp;data=02%7C01%7C%7C6fba978558a04990166308d64554b1eb%7C84df9e7fe9f640afb435aaaaaaaaaaaa%7C1%7C0%7C636772627417111522&amp;sdata=XqyrdHbyZLU7OwK8loz%2BGpd5Mv2hoUYeSqVpCBsFk6o%3D&amp;reserved=0> 
 
On 1 Nov 2018, at 02:17, Gillian Meldrum <[log in to unmask]<mailto:[log in to unmask]><mailto:[log in to unmask]>> wrote: 
 
I think what is needed is an international & national normal birth strategy with a co-ordinating body. The UNICEF Baby Friendly Initiative, in partnership with WHO, is a good model to consider. 
They have made slow but steady progress over the last 27 years, with many challenges similar to normal birth. 
It has to start with an understanding of why normal birth matters - the increase in interventions is often lamented, but rarely do we see the negative impacts of this or it’s often weak rationales explicitly stated in the media or communicated to women. 
The importance of normal birth, and how to achieve it, may be taught to midwifery students, but not to doctors and most lay people are unaware. 
BFI at a local level means setting policies & guidelines for best evidence-based practice, training staff & auditing their skills, knowledge & understanding, and most importantly, auditing mothers’ experiences so that we hear their voices & find out if we are getting it right. 
Nationally, they co-ordinate a national network of infant feeding leads who link in to all maternity, neonatal, health visiting &  children’s centre staff in the country (except for some areas in England who are not signed up). They have established standards for universities training midwives & health visitors. 
Currently they are working on a medical student curriculum. 
They work together with other national bodies involved in 
https://eur02.safelinks.protection.outlook.com/?url=https%3A%2F%2Fukbreastfeeding.org%2F&amp;data=02%7C01%7C%7C6fba978558a04990166308d64554b1eb%7C84df9e7fe9f640afb435aaaaaaaaaaaa%7C1%7C0%7C636772627417111522&amp;sdata=UqAuQ7RNeLZUzzeRKHdPLbd7Yh%2By%2FBq6r8hjXZtN2jc%3D&amp;reserved=0 
They are a tiny unit, but have clear aims and focus - we have never had any organisation promoting normal birth in such a structured way. 
Who of you has contacts with WHO? We need an Innocenti Declaration for normal birth and a an equivalent of the 10 steps framework to protect it. Then a UK organisation which exists for the purpose of implementing those standards. 
 
On a slightly different note, I think the improvements in induction rates in the 1990s can be partly attributed to the contribution of NCT & AIMS which encouraged women to expect more oppprtunities for informed choice & resulted in more women asking for less intervention, together with the publication in 1989 of Chalmers et al Effective Care in Pregnancy & Childbirth - this gave massive support to clinicians. 
 
Gillian Meldrum 
 
On Wed, 31 Oct 2018 at 10:43, Macfarlane, Alison <[log in to unmask]<mailto:[log in to unmask]><mailto:[log in to unmask]>> wrote: 
We have a lot more research evidence since the early 1990s when the policies first changed and more recent robust research which has confirmed and extended the earlier more limited evidence on which the policies were based. Although research questions remain, I don’t think more research is the prime need now. An outside observer can see the majority of women giving birth in ever larger obstetric units with rocketing levels of intervention and a few midwifery units and private midwifery companies for the minority of women who manage to find out that they have a choice. I know you midwives are run off your feet, but it looks like you have a choice between letting it all happen and becoming the RCOG / RCN Faculty of Obstetric Nursing or taking some action. 
 
Alison Macfarlane 
 
From: MacVane Phipps Fiona [mailto:[log in to unmask]<mailto:[log in to unmask]>] 
Sent: 30 October 2018 12:56 
To: Macfarlane, Alison; A forum for discussion on midwifery and reproductive health research. 
Subject: Re: MIDWIFERY-RESEARCH Digest - 26 Oct 2018 to 28 Oct 2018 (#2018-190) 
 
 
Alison 
 
Thank you for this. I didn't see your graphs. were they circulated on this list?  I find your suggestion very chilling yet very credible, particularly if this government plan, as widely rumoured, to throw open NHS contracts to any US trade deal. I can't think of anything worse than the UK maternity service being influenced/comtrolled by US care providers (read 'Insurance conglomerates'). I find it very hard to understand why the large body of evidence supporting midwifery care and the midwifery model of birth has failed to alter this trend. I'm happy to be involved in any discussion about research that could be done to investigate. 
 
Best wishes, 
 
Fiona 
 
 
 
________________________________ 
From: Macfarlane, Alison <[log in to unmask]<mailto:[log in to unmask]><mailto:[log in to unmask]>> 
Sent: 30 October 2018 12:29:53 
To: A forum for discussion on midwifery and reproductive health research.; MacVane Phipps Fiona 
Subject: RE: MIDWIFERY-RESEARCH Digest - 26 Oct 2018 to 28 Oct 2018 (#2018-190) 
 
Dear all, 
 
I hope you don't mind me commenting on this from a statistical perspective. The graphs I circulated show that in England childbirth is changing but in a non-evidence-based direction that I think most people on this list think is wrong. 
 
How long before some hard-nosed finance person notices that fewer than half of births in England are spontaneous and proposes that a 'solution' to the shortage of midwives would be replacing a substantial number of midwifery posts with obstetric nursing assistants to help the obstetricians conduct an ever growing proportion of births? This reached 39 per cent in 2007-18. 
 
Good luck and I hope you do better than King Canute. 
 
Alison Macfarlane 
 
-----Original Message----- 
From: A forum for discussion on midwifery and reproductive health research. 
________________________________ 
 
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------------------------------ 
 
Date:    Wed, 7 Nov 2018 16:04:07 +0700 
From:    Sophie Goyet <[log in to unmask]<mailto:[log in to unmask]>> 
Subject: Re: MIDWIFERY-RESEARCH Digest - 26 Oct 2018 to 28 Oct 2018 (#2018-190) 
 
Me too! And congratulations for the repository. I am excited to see it. 
Kind regards, 
Sophie G. 
 
-----Original Message----- 
From: A forum for discussion on midwifery and reproductive health research. 
[mailto:[log in to unmask]] On Behalf Of MacVane Phipps Fiona 
Sent: Wednesday, November 07, 2018 03:29 PM 
To: [log in to unmask]<mailto:[log in to unmask]> 
Subject: Re: MIDWIFERY-RESEARCH Digest - 26 Oct 2018 to 28 Oct 2018 
(#2018-190) 
 
I very much support any  initiative in support of physiological labour and 
birth and would like to be included in any group working on this 
 
Kind regards, 
 
Fiona Macvane Phipps 
 
 
________________________________ 
From: A forum for discussion on midwifery and reproductive health research. 
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------------------------------ 
 
Date:    Wed, 7 Nov 2018 11:33:42 +0200 
From:    Hilde Agema <[log in to unmask]<mailto:[log in to unmask]>> 
Subject: Re: MIDWIFERY-RESEARCH Digest - 26 Oct 2018 to 28 Oct 2018 (#2018-190) 
 
Hi all! 
 
 
 
This sounds like a good idea.  One could call it the “MotherFriendlyInitiative” (promoting normal/vaginal birth) where the “BabyFriendlyInitiative” promotes breastfeeding. 
 
 
 
Have a good day. 
 
 
 
Hilde Agema 
 
 
 
From: A forum for discussion on midwifery and reproductive health research. [mailto:[log in to unmask]] On Behalf Of Scamell, Mandie 
Sent: Wednesday, November 7, 2018 10:48 AM 
To: [log in to unmask]<mailto:[log in to unmask]> 
Subject: Re: MIDWIFERY-RESEARCH Digest - 26 Oct 2018 to 28 Oct 2018 (#2018-190) 
 
 
 
This is a really exciting opportunity. Every cloud and all that. I would be happy to be involved if I can help at all. 
 
 
 
BW 
 
 
 
Mandie 
 
Sent from my iPhone 
 
 
On 7 Nov 2018, at 07:01, SHEENA BYROM <[log in to unmask]<mailto:[log in to unmask]>> wrote: 
 
Hello Gillian, 
 
 
 
I absolutely agree with you. And in a time when we are ‘not allowed’ to use the term ‘normal birth’ - a call to action similar to Unicef and BFI would seem sensible. I have debated this before with Francesca Entwistle. 
 
 
 
Soo Downe is working with the WHO on these matters, and may offer some insight. Soo and I are planning the development of something similar to the now abolished RCM's Ten Tops Tips (not using this phrase) for NB to support women and practitioners, but just in the early stages and any help welcomed. 
 
 
 
I would be more than happy to be part of a small team looking at developing standards etc - we have so much evidence and it would be good to pull it together. 
 
 
 
Something else, we are soon to launch a Normal Birth Repository of information - freely accessible to all - just making the final tweeks to the website, so this will be something else to contribute to a strategy… 
 
 
 
Thank you for raising this critical issue... 
 
 
 
 
 
 
 
With very best wishes, 
 
Sheena 
 
Website: sheenabyrom.com<https://eur02.safelinks.protection.outlook.com/?url=http%3A%2F%2Fsheenabyrom.com&amp;data=02%7C01%7C%7C6fba978558a04990166308d64554b1eb%7C84df9e7fe9f640afb435aaaaaaaaaaaa%7C1%7C0%7C636772627417111522&amp;sdata=tSVs1BYBVndJXVrgYa3h5F6RXBNITlKSI9fp%2FA%2F7Nms%3D&amp;reserved=0> <https://eur02.safelinks.protection.outlook.com/?url=http%3A%2F%2Fwww.sheenabyrom.com&amp;data=02%7C01%7C%7C6fba978558a04990166308d64554b1eb%7C84df9e7fe9f640afb435aaaaaaaaaaaa%7C1%7C0%7C636772627417111522&amp;sdata=6ZUm%2Fvpd70mA3RVolKytbGz%2FM9ehrh%2F2BHQ8JhWfuGM%3D&amp;reserved=0> 
 
Twitter: @SagefemmeSB <https://eur02.safelinks.protection.outlook.com/?url=https%3A%2F%2Ftwitter.com%2FSagefemmeSB&amp;data=02%7C01%7C%7C6fba978558a04990166308d64554b1eb%7C84df9e7fe9f640afb435aaaaaaaaaaaa%7C1%7C0%7C636772627417111522&amp;sdata=XqyrdHbyZLU7OwK8loz%2BGpd5Mv2hoUYeSqVpCBsFk6o%3D&amp;reserved=0> 
 
 
 
 
 
On 1 Nov 2018, at 02:17, Gillian Meldrum <[log in to unmask]<mailto:[log in to unmask]>> wrote: 
 
 
 
I think what is needed is an international & national normal birth strategy with a co-ordinating body. The UNICEF Baby Friendly Initiative, in partnership with WHO, is a good model to consider. 
 
They have made slow but steady progress over the last 27 years, with many challenges similar to normal birth. 
 
It has to start with an understanding of why normal birth matters - the increase in interventions is often lamented, but rarely do we see the negative impacts of this or it’s often weak rationales explicitly stated in the media or communicated to women. 
 
The importance of normal birth, and how to achieve it, may be taught to midwifery students, but not to doctors and most lay people are unaware. 
 
BFI at a local level means setting policies & guidelines for best evidence-based practice, training staff & auditing their skills, knowledge & understanding, and most importantly, auditing mothers’ experiences so that we hear their voices & find out if we are getting it right. 
 
Nationally, they co-ordinate a national network of infant feeding leads who link in to all maternity, neonatal, health visiting &  children’s centre staff in the country (except for some areas in England who are not signed up). They have established standards for universities training midwives & health visitors. 
 
Currently they are working on a medical student curriculum. 
 
They work together with other national bodies involved in 
 
https://eur02.safelinks.protection.outlook.com/?url=https%3A%2F%2Fukbreastfeeding.org%2F&amp;data=02%7C01%7C%7C6fba978558a04990166308d64554b1eb%7C84df9e7fe9f640afb435aaaaaaaaaaaa%7C1%7C0%7C636772627417111522&amp;sdata=UqAuQ7RNeLZUzzeRKHdPLbd7Yh%2By%2FBq6r8hjXZtN2jc%3D&amp;reserved=0 
 
They are a tiny unit, but have clear aims and focus - we have never had any organisation promoting normal birth in such a structured way. 
 
Who of you has contacts with WHO? We need an Innocenti Declaration for normal birth and a an equivalent of the 10 steps framework to protect it. Then a UK organisation which exists for the purpose of implementing those standards. 
 
 
 
On a slightly different note, I think the improvements in induction rates in the 1990s can be partly attributed to the contribution of NCT & AIMS which encouraged women to expect more oppprtunities for informed choice & resulted in more women asking for less intervention, together with the publication in 1989 of Chalmers et al Effective Care in Pregnancy & Childbirth - this gave massive support to clinicians. 
 
 
 
Gillian Meldrum 
 
 
 
On Wed, 31 Oct 2018 at 10:43, Macfarlane, Alison <[log in to unmask]<mailto:[log in to unmask]>> wrote: 
 
We have a lot more research evidence since the early 1990s when the policies first changed and more recent robust research which has confirmed and extended the earlier more limited evidence on which the policies were based. Although research questions remain, I don’t think more research is the prime need now. An outside observer can see the majority of women giving birth in ever larger obstetric units with rocketing levels of intervention and a few midwifery units and private midwifery companies for the minority of women who manage to find out that they have a choice. I know you midwives are run off your feet, but it looks like you have a choice between letting it all happen and becoming the RCOG / RCN Faculty of Obstetric Nursing or taking some action. 
 
 
 
Alison Macfarlane 
 
 
 
From: MacVane Phipps Fiona [mailto:[log in to unmask]] 
Sent: 30 October 2018 12:56 
To: Macfarlane, Alison; A forum for discussion on midwifery and reproductive health research. 
Subject: Re: MIDWIFERY-RESEARCH Digest - 26 Oct 2018 to 28 Oct 2018 (#2018-190) 
 
 
 
Alison 
 
Thank you for this. I didn't see your graphs. were they circulated on this list?  I find your suggestion very chilling yet very credible, particularly if this government plan, as widely rumoured, to throw open NHS contracts to any US trade deal. I can't think of anything worse than the UK maternity service being influenced/comtrolled by US care providers (read 'Insurance conglomerates'). I find it very hard to understand why the large body of evidence supporting midwifery care and the midwifery model of birth has failed to alter this trend. I'm happy to be involved in any discussion about research that could be done to investigate. 
 
Best wishes, 
 
Fiona 
 
 
 
 
 
 
 _____ 
 
 
From: Macfarlane, Alison <[log in to unmask]<mailto:[log in to unmask]>> 
Sent: 30 October 2018 12:29:53 
To: A forum for discussion on midwifery and reproductive health research.; MacVane Phipps Fiona 
Subject: RE: MIDWIFERY-RESEARCH Digest - 26 Oct 2018 to 28 Oct 2018 (#2018-190) 
 
 
 
Dear all, 
 
I hope you don't mind me commenting on this from a statistical perspective. The graphs I circulated show that in England childbirth is changing but in a non-evidence-based direction that I think most people on this list think is wrong. 
 
How long before some hard-nosed finance person notices that fewer than half of births in England are spontaneous and proposes that a 'solution' to the shortage of midwives would be replacing a substantial number of midwifery posts with obstetric nursing assistants to help the obstetricians conduct an ever growing proportion of births? This reached 39 per cent in 2007-18. 
 
Good luck and I hope you do better than King Canute. 
 
Alison Macfarlane 
 
-----Original Message----- 
From: A forum for discussion on midwifery and reproductive health research. 
 
 
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------------------------------ 
 
Date:    Wed, 7 Nov 2018 11:33:59 +0000 
From:    Trixie McAree <[log in to unmask]<mailto:[log in to unmask]>> 
Subject: Re: MIDWIFERY-RESEARCH Digest - 26 Oct 2018 to 28 Oct 2018 (#2018-190) 
 
I think this is key, having a key strategy will enhance success at re-normalising a normal physiological function. 
The strategy will need to encompass targeted research, briefing papers and something practical. Working in a joint clinical academic post my time is accounted for and costed therefore maybe collaborating more widly on a few big projects may be the way forward. 
Best wishes 
Trixie 
 
 
From: A forum for discussion on midwifery and reproductive health research. [mailto:[log in to unmask]] On Behalf Of SHEENA BYROM 
Sent: 07 November 2018 07:01 
To: [log in to unmask]<mailto:[log in to unmask]> 
Subject: Re: MIDWIFERY-RESEARCH Digest - 26 Oct 2018 to 28 Oct 2018 (#2018-190) 
 
Hello Gillian, 
 
I absolutely agree with you. And in a time when we are ‘not allowed’ to use the term ‘normal birth’ - a call to action similar to Unicef and BFI would seem sensible. I have debated this before with Francesca Entwistle. 
 
Soo Downe is working with the WHO on these matters, and may offer some insight. Soo and I are planning the development of something similar to the now abolished RCM's Ten Tops Tips (not using this phrase) for NB to support women and practitioners, but just in the early stages and any help welcomed. 
 
I would be more than happy to be part of a small team looking at developing standards etc - we have so much evidence and it would be good to pull it together. 
 
Something else, we are soon to launch a Normal Birth Repository of information - freely accessible to all - just making the final tweeks to the website, so this will be something else to contribute to a strategy… 
 
Thank you for raising this critical issue... 
 
 
 
With very best wishes, 
 
Sheena 
 
Website: sheenabyrom.com<https://eur02.safelinks.protection.outlook.com/?url=http%3A%2F%2Fsheenabyrom.com&amp;data=02%7C01%7C%7C6fba978558a04990166308d64554b1eb%7C84df9e7fe9f640afb435aaaaaaaaaaaa%7C1%7C0%7C636772627417111522&amp;sdata=tSVs1BYBVndJXVrgYa3h5F6RXBNITlKSI9fp%2FA%2F7Nms%3D&amp;reserved=0><https://eur02.safelinks.protection.outlook.com/?url=http%3A%2F%2Fwww.sheenabyrom.com&amp;data=02%7C01%7C%7C6fba978558a04990166308d64554b1eb%7C84df9e7fe9f640afb435aaaaaaaaaaaa%7C1%7C0%7C636772627417111522&amp;sdata=6ZUm%2Fvpd70mA3RVolKytbGz%2FM9ehrh%2F2BHQ8JhWfuGM%3D&amp;reserved=0> 
 
Twitter: @SagefemmeSB<https://eur02.safelinks.protection.outlook.com/?url=https%3A%2F%2Ftwitter.com%2FSagefemmeSB&amp;data=02%7C01%7C%7C6fba978558a04990166308d64554b1eb%7C84df9e7fe9f640afb435aaaaaaaaaaaa%7C1%7C0%7C636772627417111522&amp;sdata=XqyrdHbyZLU7OwK8loz%2BGpd5Mv2hoUYeSqVpCBsFk6o%3D&amp;reserved=0> 
 
 
On 1 Nov 2018, at 02:17, Gillian Meldrum <[log in to unmask]<mailto:[log in to unmask]><mailto:[log in to unmask]>> wrote: 
 
I think what is needed is an international & national normal birth strategy with a co-ordinating body. The UNICEF Baby Friendly Initiative, in partnership with WHO, is a good model to consider. 
They have made slow but steady progress over the last 27 years, with many challenges similar to normal birth. 
It has to start with an understanding of why normal birth matters - the increase in interventions is often lamented, but rarely do we see the negative impacts of this or it’s often weak rationales explicitly stated in the media or communicated to women. 
The importance of normal birth, and how to achieve it, may be taught to midwifery students, but not to doctors and most lay people are unaware. 
BFI at a local level means setting policies & guidelines for best evidence-based practice, training staff & auditing their skills, knowledge & understanding, and most importantly, auditing mothers’ experiences so that we hear their voices & find out if we are getting it right. 
Nationally, they co-ordinate a national network of infant feeding leads who link in to all maternity, neonatal, health visiting &  children’s centre staff in the country (except for some areas in England who are not signed up). They have established standards for universities training midwives & health visitors. 
Currently they are working on a medical student curriculum. 
They work together with other national bodies involved in 
https://eur02.safelinks.protection.outlook.com/?url=https%3A%2F%2Fukbreastfeeding.org%2F&amp;data=02%7C01%7C%7C6fba978558a04990166308d64554b1eb%7C84df9e7fe9f640afb435aaaaaaaaaaaa%7C1%7C0%7C636772627417111522&amp;sdata=UqAuQ7RNeLZUzzeRKHdPLbd7Yh%2By%2FBq6r8hjXZtN2jc%3D&amp;reserved=0 
They are a tiny unit, but have clear aims and focus - we have never had any organisation promoting normal birth in such a structured way. 
Who of you has contacts with WHO? We need an Innocenti Declaration for normal birth and a an equivalent of the 10 steps framework to protect it. Then a UK organisation which exists for the purpose of implementing those standards. 
 
On a slightly different note, I think the improvements in induction rates in the 1990s can be partly attributed to the contribution of NCT & AIMS which encouraged women to expect more oppprtunities for informed choice & resulted in more women asking for less intervention, together with the publication in 1989 of Chalmers et al Effective Care in Pregnancy & Childbirth - this gave massive support to clinicians. 
 
Gillian Meldrum 
 
On Wed, 31 Oct 2018 at 10:43, Macfarlane, Alison <[log in to unmask]<mailto:[log in to unmask]><mailto:[log in to unmask]>> wrote: 
We have a lot more research evidence since the early 1990s when the policies first changed and more recent robust research which has confirmed and extended the earlier more limited evidence on which the policies were based. Although research questions remain, I don’t think more research is the prime need now. An outside observer can see the majority of women giving birth in ever larger obstetric units with rocketing levels of intervention and a few midwifery units and private midwifery companies for the minority of women who manage to find out that they have a choice. I know you midwives are run off your feet, but it looks like you have a choice between letting it all happen and becoming the RCOG / RCN Faculty of Obstetric Nursing or taking some action. 
 
Alison Macfarlane 
 
From: MacVane Phipps Fiona [mailto:[log in to unmask]<mailto:[log in to unmask]>] 
Sent: 30 October 2018 12:56 
To: Macfarlane, Alison; A forum for discussion on midwifery and reproductive health research. 
Subject: Re: MIDWIFERY-RESEARCH Digest - 26 Oct 2018 to 28 Oct 2018 (#2018-190) 
 
Alison 
Thank you for this. I didn't see your graphs. were they circulated on this list?  I find your suggestion very chilling yet very credible, particularly if this government plan, as widely rumoured, to throw open NHS contracts to any US trade deal. I can't think of anything worse than the UK maternity service being influenced/comtrolled by US care providers (read 'Insurance conglomerates'). I find it very hard to understand why the large body of evidence supporting midwifery care and the midwifery model of birth has failed to alter this trend. I'm happy to be involved in any discussion about research that could be done to investigate. 
Best wishes, 
Fiona 
 
 
________________________________ 
From: Macfarlane, Alison <[log in to unmask]<mailto:[log in to unmask]><mailto:[log in to unmask]>> 
Sent: 30 October 2018 12:29:53 
To: A forum for discussion on midwifery and reproductive health research.; MacVane Phipps Fiona 
Subject: RE: MIDWIFERY-RESEARCH Digest - 26 Oct 2018 to 28 Oct 2018 (#2018-190) 
 
Dear all, 
 
I hope you don't mind me commenting on this from a statistical perspective. The graphs I circulated show that in England childbirth is changing but in a non-evidence-based direction that I think most people on this list think is wrong. 
 
How long before some hard-nosed finance person notices that fewer than half of births in England are spontaneous and proposes that a 'solution' to the shortage of midwives would be replacing a substantial number of midwifery posts with obstetric nursing assistants to help the obstetricians conduct an ever growing proportion of births? This reached 39 per cent in 2007-18. 
 
Good luck and I hope you do better than King Canute. 
 
Alison Macfarlane 
 
-----Original Message----- 
From: A forum for discussion on midwifery and reproductive health research. 
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------------------------------ 
 
Date:    Wed, 7 Nov 2018 12:27:08 +0000 
From:    University of Oxford CPD Centre <[log in to unmask]<mailto:[log in to unmask]>> 
Subject: New Course - Advanced Qualitative Research Methods 
 
Qualitative Research Methods 
 
1 – 5 April 2019 
Rewley House, Oxford, UK 
 
Register here:  https://eur02.safelinks.protection.outlook.com/?url=https%3A%2F%2Fwww.conted.ox.ac.uk%2Fcourses%2Fadvanced-qualitative-research-methods&amp;data=02%7C01%7C%7C6fba978558a04990166308d64554b1eb%7C84df9e7fe9f640afb435aaaaaaaaaaaa%7C1%7C0%7C636772627417111522&amp;sdata=eXYrUEKWB5X7H19QR%2Fhz%2Fe0vKVrjV2EZuAoxbMion18%3D&amp;reserved=0 
 
Advancing skills and knowledge of complex issues in qualitative research 
 
Led by experienced qualitative experts, this module will provide students with knowledge, insights and techniques relating to the more advanced aspects of qualitative research. This will include providing students with a comprehensive understanding of the theoretical perspectives within qualitative research designs, specific qualitative methodologies and analyses, advanced data collection methods and complex issues in qualitative research (e.g. critical appraisal). Students will be taught the knowledge and skills needed to critically engage with complex concepts relevant to the more advanced aspects of qualitative research. 
 
Full details and information on how to apply can be found on the course webpage - https://eur02.safelinks.protection.outlook.com/?url=https%3A%2F%2Fwww.conted.ox.ac.uk%2Fcourses%2Fadvanced-qualitative-research-methods&amp;data=02%7C01%7C%7C6fba978558a04990166308d64554b1eb%7C84df9e7fe9f640afb435aaaaaaaaaaaa%7C1%7C0%7C636772627417111522&amp;sdata=eXYrUEKWB5X7H19QR%2Fhz%2Fe0vKVrjV2EZuAoxbMion18%3D&amp;reserved=0 
 
 
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------------------------------ 
 
Date:    Wed, 7 Nov 2018 12:35:19 +0000 
From:    Elizabeth Newnham <[log in to unmask]<mailto:[log in to unmask]>> 
Subject: Re: MIDWIFERY-RESEARCH Digest - 26 Oct 2018 to 28 Oct 2018 (#2018-190) 
 
I agree, 
 
I remember being struck at the time the way that BFHI policy affected practice change. 
 
Would also be happy to be involved in any work/discussion in this area. 
 
 
Warm regards, 
Liz Newnham 
 
 
 
 
From: A forum for discussion on midwifery and reproductive health research. [mailto:[log in to unmask]] On Behalf Of SHEENA BYROM 
Sent: Wednesday 7 November 2018 07:01 
To: [log in to unmask]<mailto:[log in to unmask]> 
Subject: Re: MIDWIFERY-RESEARCH Digest - 26 Oct 2018 to 28 Oct 2018 (#2018-190) 
 
Hello Gillian, 
 
I absolutely agree with you. And in a time when we are ‘not allowed’ to use the term ‘normal birth’ - a call to action similar to Unicef and BFI would seem sensible. I have debated this before with Francesca Entwistle. 
 
Soo Downe is working with the WHO on these matters, and may offer some insight. Soo and I are planning the development of something similar to the now abolished RCM's Ten Tops Tips (not using this phrase) for NB to support women and practitioners, but just in the early stages and any help welcomed. 
 
I would be more than happy to be part of a small team looking at developing standards etc - we have so much evidence and it would be good to pull it together. 
 
Something else, we are soon to launch a Normal Birth Repository of information - freely accessible to all - just making the final tweeks to the website, so this will be something else to contribute to a strategy… 
 
Thank you for raising this critical issue... 
 
 
 
With very best wishes, 
 
Sheena 
 
Website: sheenabyrom.com<https://eur02.safelinks.protection.outlook.com/?url=http%3A%2F%2Fsheenabyrom.com&amp;data=02%7C01%7C%7C6fba978558a04990166308d64554b1eb%7C84df9e7fe9f640afb435aaaaaaaaaaaa%7C1%7C0%7C636772627417111522&amp;sdata=tSVs1BYBVndJXVrgYa3h5F6RXBNITlKSI9fp%2FA%2F7Nms%3D&amp;reserved=0><https://eur02.safelinks.protection.outlook.com/?url=http%3A%2F%2Fwww.sheenabyrom.com&amp;data=02%7C01%7C%7C6fba978558a04990166308d64554b1eb%7C84df9e7fe9f640afb435aaaaaaaaaaaa%7C1%7C0%7C636772627417111522&amp;sdata=6ZUm%2Fvpd70mA3RVolKytbGz%2FM9ehrh%2F2BHQ8JhWfuGM%3D&amp;reserved=0> 
 
Twitter: @SagefemmeSB<https://eur02.safelinks.protection.outlook.com/?url=https%3A%2F%2Ftwitter.com%2FSagefemmeSB&amp;data=02%7C01%7C%7C6fba978558a04990166308d64554b1eb%7C84df9e7fe9f640afb435aaaaaaaaaaaa%7C1%7C0%7C636772627417111522&amp;sdata=XqyrdHbyZLU7OwK8loz%2BGpd5Mv2hoUYeSqVpCBsFk6o%3D&amp;reserved=0> 
 
 
On 1 Nov 2018, at 02:17, Gillian Meldrum <[log in to unmask]<mailto:[log in to unmask]><mailto:[log in to unmask]>> wrote: 
 
I think what is needed is an international & national normal birth strategy with a co-ordinating body. The UNICEF Baby Friendly Initiative, in partnership with WHO, is a good model to consider. 
They have made slow but steady progress over the last 27 years, with many challenges similar to normal birth. 
It has to start with an understanding of why normal birth matters - the increase in interventions is often lamented, but rarely do we see the negative impacts of this or it’s often weak rationales explicitly stated in the media or communicated to women. 
The importance of normal birth, and how to achieve it, may be taught to midwifery students, but not to doctors and most lay people are unaware. 
BFI at a local level means setting policies & guidelines for best evidence-based practice, training staff & auditing their skills, knowledge & understanding, and most importantly, auditing mothers’ experiences so that we hear their voices & find out if we are getting it right. 
Nationally, they co-ordinate a national network of infant feeding leads who link in to all maternity, neonatal, health visiting &  children’s centre staff in the country (except for some areas in England who are not signed up). They have established standards for universities training midwives & health visitors. 
Currently they are working on a medical student curriculum. 
They work together with other national bodies involved in 
https://eur02.safelinks.protection.outlook.com/?url=https%3A%2F%2Fukbreastfeeding.org%2F&amp;data=02%7C01%7C%7C6fba978558a04990166308d64554b1eb%7C84df9e7fe9f640afb435aaaaaaaaaaaa%7C1%7C0%7C636772627417111522&amp;sdata=UqAuQ7RNeLZUzzeRKHdPLbd7Yh%2By%2FBq6r8hjXZtN2jc%3D&amp;reserved=0 
They are a tiny unit, but have clear aims and focus - we have never had any organisation promoting normal birth in such a structured way. 
Who of you has contacts with WHO? We need an Innocenti Declaration for normal birth and a an equivalent of the 10 steps framework to protect it. Then a UK organisation which exists for the purpose of implementing those standards. 
 
On a slightly different note, I think the improvements in induction rates in the 1990s can be partly attributed to the contribution of NCT & AIMS which encouraged women to expect more oppprtunities for informed choice & resulted in more women asking for less intervention, together with the publication in 1989 of Chalmers et al Effective Care in Pregnancy & Childbirth - this gave massive support to clinicians. 
 
Gillian Meldrum 
 
On Wed, 31 Oct 2018 at 10:43, Macfarlane, Alison <[log in to unmask]<mailto:[log in to unmask]><mailto:[log in to unmask]>> wrote: 
We have a lot more research evidence since the early 1990s when the policies first changed and more recent robust research which has confirmed and extended the earlier more limited evidence on which the policies were based. Although research questions remain, I don’t think more research is the prime need now. An outside observer can see the majority of women giving birth in ever larger obstetric units with rocketing levels of intervention and a few midwifery units and private midwifery companies for the minority of women who manage to find out that they have a choice. I know you midwives are run off your feet, but it looks like you have a choice between letting it all happen and becoming the RCOG / RCN Faculty of Obstetric Nursing or taking some action. 
 
Alison Macfarlane 
 
From: MacVane Phipps Fiona [mailto:[log in to unmask]<mailto:[log in to unmask]>] 
Sent: 30 October 2018 12:56 
To: Macfarlane, Alison; A forum for discussion on midwifery and reproductive health research. 
Subject: Re: MIDWIFERY-RESEARCH Digest - 26 Oct 2018 to 28 Oct 2018 (#2018-190) 
 
Alison 
Thank you for this. I didn't see your graphs. were they circulated on this list?  I find your suggestion very chilling yet very credible, particularly if this government plan, as widely rumoured, to throw open NHS contracts to any US trade deal. I can't think of anything worse than the UK maternity service being influenced/comtrolled by US care providers (read 'Insurance conglomerates'). I find it very hard to understand why the large body of evidence supporting midwifery care and the midwifery model of birth has failed to alter this trend. I'm happy to be involved in any discussion about research that could be done to investigate. 
Best wishes, 
Fiona 
 
 
________________________________ 
From: Macfarlane, Alison <[log in to unmask]<mailto:[log in to unmask]><mailto:[log in to unmask]>> 
Sent: 30 October 2018 12:29:53 
To: A forum for discussion on midwifery and reproductive health research.; MacVane Phipps Fiona 
Subject: RE: MIDWIFERY-RESEARCH Digest - 26 Oct 2018 to 28 Oct 2018 (#2018-190) 
 
Dear all, 
 
I hope you don't mind me commenting on this from a statistical perspective. The graphs I circulated show that in England childbirth is changing but in a non-evidence-based direction that I think most people on this list think is wrong. 
 
How long before some hard-nosed finance person notices that fewer than half of births in England are spontaneous and proposes that a 'solution' to the shortage of midwives would be replacing a substantial number of midwifery posts with obstetric nursing assistants to help the obstetricians conduct an ever growing proportion of births? This reached 39 per cent in 2007-18. 
 
Good luck and I hope you do better than King Canute. 
 
Alison Macfarlane 
 
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From: A forum for discussion on midwifery and reproductive health research. 
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------------------------------ 
 
Date:    Wed, 7 Nov 2018 12:36:52 +0000 
From:    MacVane Phipps Fiona <[log in to unmask]<mailto:[log in to unmask]>> 
Subject: Re: purple line 
 
I am not currently in clinical practice as I am an educator and research midwife at present. However in my experience and what i tell students is that nothing should be used in isolation. Observe, listen, use all your senses, and yes, seeing a purple line develop may well be part of that but it is understanding the whole picture of labour that will make reliance on staged VEs unnecessary. A VE is a tool and may well be useful if you need to act on information that can only be confirmed by VE but as an holistic art, midwifery uses all senses and all observations. An abdominal examination can tell you a lot about descent and rotation as well. 
 
 
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------------------------------ 
 
Date:    Wed, 7 Nov 2018 13:10:47 +0000 
From:    Katherine Hales <[log in to unmask]<mailto:[log in to unmask]>> 
Subject: Re: MIDWIFERY-RESEARCH Digest - 26 Oct 2018 to 28 Oct 2018 (#2018-190) 
 
Yes indeed I have received notice today that our local induction of labour 
rate reached 47% in September this year. Given that our C Section rate has 
been up to 38% lately that would suggest that our spontaneous normal birth 
rate must regularly be lower than 20%. I am very disheartened by this and 
feel almost powerless to be a "proper" midwife at times! 
Glad to help in any way I can. 
 
 
 
 
Katherine Hales 
National Coordinator 
 
Association of Radical Midwives 
Because Midwifery Matters 
https://eur02.safelinks.protection.outlook.com/?url=www.midwifery.org.uk&amp;data=02%7C01%7C%7C6fba978558a04990166308d64554b1eb%7C84df9e7fe9f640afb435aaaaaaaaaaaa%7C1%7C0%7C636772627417111522&amp;sdata=vKrNgCLwkPNomx13LS0tood2ICtH3qR1f2vTHBnmChw%3D&amp;reserved=0<https://eur02.safelinks.protection.outlook.com/?url=http%3A%2F%2Fwww.midwifery.org.uk&amp;data=02%7C01%7C%7C6fba978558a04990166308d64554b1eb%7C84df9e7fe9f640afb435aaaaaaaaaaaa%7C1%7C0%7C636772627417111522&amp;sdata=qoc4%2BORDA%2Fj5NyyFhICd9iQ6e9HI3PhZ4XHyD%2F8wAbo%3D&amp;reserved=0>:[log in to unmask]<mailto:[log in to unmask]> 
[log in to unmask]<mailto:[log in to unmask]>:07810665733. 
 
 
On Wed, 7 Nov 2018, 07:01 SHEENA BYROM < 
[log in to unmask]<mailto:[log in to unmask]> wrote: 
 
Hello Gillian, 
 
I absolutely agree with you. And in a time when we are ‘not allowed’ to 
use the term ‘normal birth’ - a call to action similar to Unicef and BFI 
would seem sensible. I have debated this before with Francesca Entwistle. 
 
Soo Downe is working with the WHO on these matters, and may offer some 
insight. Soo and I are planning the development of something similar to the 
now abolished RCM's Ten Tops Tips (not using this phrase) for NB to support 
women and practitioners, but just in the early stages and any help 
welcomed. 
 
I would be more than happy to be part of a small team looking at 
developing standards etc - we have so much evidence and it would be good to 
pull it together. 
 
Something else, we are soon to launch a *Normal Birth Repository* of 
information - freely accessible to all - just making the final tweeks to 
the website, so this will be something else to contribute to a strategy… 
 
Thank you for raising this critical issue... 
 
 
 
With very best wishes, 
 
Sheena 
 
Website: sheenabyrom.com<https://eur02.safelinks.protection.outlook.com/?url=http%3A%2F%2Fsheenabyrom.com&amp;data=02%7C01%7C%7C6fba978558a04990166308d64554b1eb%7C84df9e7fe9f640afb435aaaaaaaaaaaa%7C1%7C0%7C636772627417111522&amp;sdata=tSVs1BYBVndJXVrgYa3h5F6RXBNITlKSI9fp%2FA%2F7Nms%3D&amp;reserved=0> <https://eur02.safelinks.protection.outlook.com/?url=http%3A%2F%2Fwww.sheenabyrom.com&amp;data=02%7C01%7C%7C6fba978558a04990166308d64554b1eb%7C84df9e7fe9f640afb435aaaaaaaaaaaa%7C1%7C0%7C636772627417111522&amp;sdata=6ZUm%2Fvpd70mA3RVolKytbGz%2FM9ehrh%2F2BHQ8JhWfuGM%3D&amp;reserved=0> 
 
Twitter: @SagefemmeSB <https://eur02.safelinks.protection.outlook.com/?url=https%3A%2F%2Ftwitter.com%2FSagefemmeSB&amp;data=02%7C01%7C%7C6fba978558a04990166308d64554b1eb%7C84df9e7fe9f640afb435aaaaaaaaaaaa%7C1%7C0%7C636772627417111522&amp;sdata=XqyrdHbyZLU7OwK8loz%2BGpd5Mv2hoUYeSqVpCBsFk6o%3D&amp;reserved=0> 
 
On 1 Nov 2018, at 02:17, Gillian Meldrum <[log in to unmask]<mailto:[log in to unmask]>> wrote: 
 
I think what is needed is an international & national normal birth 
strategy with a co-ordinating body. The UNICEF Baby Friendly Initiative, in 
partnership with WHO, is a good model to consider. 
They have made slow but steady progress over the last 27 years, with many 
challenges similar to normal birth. 
It has to start with an understanding of why normal birth matters - the 
increase in interventions is often lamented, but rarely do we see the 
negative impacts of this or it’s often weak rationales explicitly stated in 
the media or communicated to women. 
The importance of normal birth, and how to achieve it, may be taught to 
midwifery students, but not to doctors and most lay people are unaware. 
BFI at a local level means setting policies & guidelines for best 
evidence-based practice, training staff & auditing their skills, knowledge 
& understanding, and most importantly, auditing mothers’ experiences so 
that we hear their voices & find out if we are getting it right. 
Nationally, they co-ordinate a national network of infant feeding leads 
who link in to all maternity, neonatal, health visiting &  children’s 
centre staff in the country (except for some areas in England who are not 
signed up). They have established standards for universities training 
midwives & health visitors. 
Currently they are working on a medical student curriculum. 
They work together with other national bodies involved in 
https://eur02.safelinks.protection.outlook.com/?url=https%3A%2F%2Fukbreastfeeding.org%2F&amp;data=02%7C01%7C%7C6fba978558a04990166308d64554b1eb%7C84df9e7fe9f640afb435aaaaaaaaaaaa%7C1%7C0%7C636772627417111522&amp;sdata=UqAuQ7RNeLZUzzeRKHdPLbd7Yh%2By%2FBq6r8hjXZtN2jc%3D&amp;reserved=0 
They are a tiny unit, but have clear aims and focus - we have never had 
any organisation promoting normal birth in such a structured way. 
Who of you has contacts with WHO? We need an Innocenti Declaration for 
normal birth and a an equivalent of the 10 steps framework to protect it. 
Then a UK organisation which exists for the purpose of implementing those 
standards. 
 
On a slightly different note, I think the improvements in induction rates 
in the 1990s can be partly attributed to the contribution of NCT & AIMS 
which encouraged women to expect more oppprtunities for informed choice & 
resulted in more women asking for less intervention, together with the 
publication in 1989 of Chalmers et al Effective Care in Pregnancy & 
Childbirth - this gave massive support to clinicians. 
 
Gillian Meldrum 
 
On Wed, 31 Oct 2018 at 10:43, Macfarlane, Alison < 
[log in to unmask]<mailto:[log in to unmask]>> wrote: 
 
We have a lot more research evidence since the early 1990s when the 
policies first changed and more recent robust research which has confirmed 
and extended the earlier more limited evidence on which the policies were 
based. Although research questions remain, I don’t think more research is 
the prime need now. An outside observer can see the majority of women 
giving birth in ever larger obstetric units with rocketing levels of 
intervention and a few midwifery units and private midwifery companies for 
the minority of women who manage to find out that they have a choice. I 
know you midwives are run off your feet, but it looks like you have a 
choice between letting it all happen and becoming the RCOG / RCN Faculty of 
Obstetric Nursing or taking some action. 
 
 
 
Alison Macfarlane 
 
 
 
*From:* MacVane Phipps Fiona [mailto:[log in to unmask]] 
*Sent:* 30 October 2018 12:56 
*To:* Macfarlane, Alison; A forum for discussion on midwifery and 
reproductive health research. 
*Subject:* Re: MIDWIFERY-RESEARCH Digest - 26 Oct 2018 to 28 Oct 2018 
(#2018-190) 
 
 
 
Alison 
 
Thank you for this. I didn't see your graphs. were they circulated on 
this list?  I find your suggestion very chilling yet very credible, 
particularly if this government plan, as widely rumoured, to throw open NHS 
contracts to any US trade deal. I can't think of anything worse than the UK 
maternity service being influenced/comtrolled by US care providers (read 
'Insurance conglomerates'). I find it very hard to understand why the large 
body of evidence supporting midwifery care and the midwifery model of birth 
has failed to alter this trend. I'm happy to be involved in any discussion 
about research that could be done to investigate. 
 
Best wishes, 
 
Fiona 
 
 
 
 
------------------------------ 
 
*From:* Macfarlane, Alison <[log in to unmask]<mailto:[log in to unmask]>> 
*Sent:* 30 October 2018 12:29:53 
*To:* A forum for discussion on midwifery and reproductive health 
research.; MacVane Phipps Fiona 
*Subject:* RE: MIDWIFERY-RESEARCH Digest - 26 Oct 2018 to 28 Oct 2018 
(#2018-190) 
 
 
 
Dear all, 
 
I hope you don't mind me commenting on this from a statistical 
perspective. The graphs I circulated show that in England childbirth is 
changing but in a non-evidence-based direction that I think most people on 
this list think is wrong. 
 
How long before some hard-nosed finance person notices that fewer than 
half of births in England are spontaneous and proposes that a 'solution' to 
the shortage of midwives would be replacing a substantial number of 
midwifery posts with obstetric nursing assistants to help the obstetricians 
conduct an ever growing proportion of births? This reached 39 per cent in 
2007-18. 
 
Good luck and I hope you do better than King Canute. 
 
Alison Macfarlane 
 
-----Original Message----- 
From: A forum for discussion on midwifery and reproductive health 
research. 
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------------------------------ 
 
Date:    Wed, 7 Nov 2018 13:18:24 +0000 
From:    MacVane Phipps Fiona <[log in to unmask]<mailto:[log in to unmask]>> 
Subject: Re: MIDWIFERY-RESEARCH Digest - 26 Oct 2018 to 28 Oct 2018 (#2018-190) 
 
What concerns me is the possible loss of midwifery to obstetric nursing when the UK standards of midwifery and the fact that all women in the UK have a midwife have been held up as standards around the world for so many years. I was interviewing one of my own research participants recently and was very sad to hear that in the postnatal period she felt unable to ask a midwife for advice as she perceived them as very 'task orientated' and never saw the same midwife twice, or her 'named midwife' at all. As a community midwife 20 years ago, one of the best parts of the job was developing a relationship with the women in my caseload, and feeling that we could just sit down and have a chat about how things were going. 
 
 
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------------------------------ 
 
Date:    Wed, 7 Nov 2018 15:03:38 +0000 
From:    "Page, Lesley" <[log in to unmask]<mailto:[log in to unmask]>> 
Subject: Re: MIDWIFERY-RESEARCH Digest - 26 Oct 2018 to 28 Oct 2018 (#2018-190) 
 
Have just been in email communication with Liz. 
 
 
I wonder if the Humanization of birth would be a good framework to use? WHO might be interested? 
 
 
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://eur02.safelinks.protection.outlook.com/?url=https%3A%2F%2Fwww.all4maternity.com%2Fauthor%2Flesleypage%2F&amp;data=02%7C01%7C%7C6fba978558a04990166308d64554b1eb%7C84df9e7fe9f640afb435aaaaaaaaaaaa%7C1%7C0%7C636772627417111522&amp;sdata=6WSlANhRFYhaDG9%2FFlrRDbeOmiUtIWzAacKfx674Pow%3D&amp;reserved=0 
 
<https://eur02.safelinks.protection.outlook.com/?url=https%3A%2F%2Fwww.all4maternity.com%2Fauthor%2Flesleypage%2F&amp;data=02%7C01%7C%7C6fba978558a04990166308d64554b1eb%7C84df9e7fe9f640afb435aaaaaaaaaaaa%7C1%7C0%7C636772627417111522&amp;sdata=6WSlANhRFYhaDG9%2FFlrRDbeOmiUtIWzAacKfx674Pow%3D&amp;reserved=0>twitter: lesleypageCBE@humanisingbirth 
 
 
 
 
 
 
 
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------------------------------ 
 
Date:    Wed, 7 Nov 2018 15:09:41 +0000 
From:    "Kay, Lesley" <[log in to unmask]<mailto:[log in to unmask]>> 
Subject: Re: MIDWIFERY-RESEARCH Digest - 26 Oct 2018 to 28 Oct 2018 (#2018-190) 
 
Hi there, 
Sounds like a great idea - I would be interested in any work/discussion. 
Regards 
 
Lesley 
 
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------------------------------ 
 
Date:    Wed, 7 Nov 2018 15:16:47 +0000 
From:    Soo Downe <[log in to unmask]<mailto:[log in to unmask]>> 
Subject: Re: MIDWIFERY-RESEARCH Digest - 26 Oct 2018 to 28 Oct 2018 (#2018-190) 
 
definitely 
 
 
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------------------------------ 
 
Date:    Wed, 7 Nov 2018 17:37:09 +0100 
From:    Sophie Alexander <[log in to unmask]<mailto:[log in to unmask]>> 
Subject: Re: MIDWIFERY-RESEARCH Digest - 26 Oct 2018 to 28 Oct 2018 (#2018-190) 
 
Yes, but "humanisation" is a bit like the "baby friendly" wording which 
looks as if all other units are "baby unfriendly" and here the opposite 
would be "unhuman birth"?...And all this gets under the skin of some people. 
 
I would vote for something which includes the "positive experience of WHO" 
and NO UNNECESSARY ACTION (if it's not broken why mend it?), and promotion 
of salutogenesis and empowerment... 
 
 
Sophie Alexander MD, PhD 
PERU (Perinatal Epidemiology and Reproductive health Unit) 
Ecole de Santé Publique 
Universite Libre de Bruxelles 
808 route de Lennik 
1070 Brussels 
Belgium 
Tel +32 2555 4063 
 
-----Message d'origine----- 
De : A forum for discussion on midwifery and reproductive health research. 
[mailto:[log in to unmask]] De la part de Page, Lesley 
Envoyé : mercredi 7 novembre 2018 16:04 
À : [log in to unmask]<mailto:[log in to unmask]> 
Objet : Re: MIDWIFERY-RESEARCH Digest - 26 Oct 2018 to 28 Oct 2018 
(#2018-190) 
 
Have just been in email communication with Liz. 
 
 
I wonder if the Humanization of birth would be a good framework to use? WHO 
might be interested? 
 
 
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 
 
 
 
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Date:    Wed, 7 Nov 2018 13:39:41 +0000 
From:    Yvonne McGrath <[log in to unmask]<mailto:[log in to unmask]>> 
Subject: Re: MIDWIFERY-RESEARCH Digest - 26 Oct 2018 to 28 Oct 2018 (#2018-190) 
 
Hi all, 
 
I agree totally. I am new consultant midwife and would be very keen to 
being involved in setting standards/strategy to move these discussions 
forward and pull all of the evidence together. 
 
Best wishes 
Yvonne 
 
On Wed, 7 Nov 2018, 12:36 pm Elizabeth Newnham <[log in to unmask]<mailto:[log in to unmask]> wrote: 
 
I agree, 
 
 
 
I remember being struck at the time the way that BFHI policy affected 
practice change. 
 
 
 
Would also be happy to be involved in any work/discussion in this area. 
 
 
 
 
 
Warm regards, 
Liz Newnham 
 
 
 
 
 
 
 
*From:* A forum for discussion on midwifery and reproductive health 
research. [mailto:[log in to unmask]] *On Behalf Of *SHEENA 
BYROM 
*Sent:* Wednesday 7 November 2018 07:01 
*To:* [log in to unmask]<mailto:[log in to unmask]> 
*Subject:* Re: MIDWIFERY-RESEARCH Digest - 26 Oct 2018 to 28 Oct 2018 
(#2018-190) 
 
 
 
Hello Gillian, 
 
 
 
I absolutely agree with you. And in a time when we are ‘not allowed’ to 
use the term ‘normal birth’ - a call to action similar to Unicef and BFI 
would seem sensible. I have debated this before with Francesca Entwistle. 
 
 
 
Soo Downe is working with the WHO on these matters, and may offer some 
insight. Soo and I are planning the development of something similar to the 
now abolished RCM's Ten Tops Tips (not using this phrase) for NB to support 
women and practitioners, but just in the early stages and any help 
welcomed. 
 
 
 
I would be more than happy to be part of a small team looking at 
developing standards etc - we have so much evidence and it would be good to 
pull it together. 
 
 
 
Something else, we are soon to launch a *Normal Birth Repository* of 
information - freely accessible to all - just making the final tweeks to 
the website, so this will be something else to contribute to a strategy… 
 
 
 
Thank you for raising this critical issue... 
 
 
 
 
 
 
 
With very best wishes, 
 
Sheena 
 
Website: sheenabyrom.com<https://eur02.safelinks.protection.outlook.com/?url=http%3A%2F%2Fsheenabyrom.com&amp;data=02%7C01%7C%7C6fba978558a04990166308d64554b1eb%7C84df9e7fe9f640afb435aaaaaaaaaaaa%7C1%7C0%7C636772627417267769&amp;sdata=Ta%2FR14PNCja5zy5%2Bq%2BlRvVfoc4YFr%2Fbi33Wts3Qx1Vk%3D&amp;reserved=0> <https://eur02.safelinks.protection.outlook.com/?url=http%3A%2F%2Fwww.sheenabyrom.com&amp;data=02%7C01%7C%7C6fba978558a04990166308d64554b1eb%7C84df9e7fe9f640afb435aaaaaaaaaaaa%7C1%7C0%7C636772627417267769&amp;sdata=6GuFXwfEcrfyUUxPWf4cWXsedcMHkwX4leFeKdWL0XU%3D&amp;reserved=0> 
 
Twitter: @SagefemmeSB <https://eur02.safelinks.protection.outlook.com/?url=https%3A%2F%2Ftwitter.com%2FSagefemmeSB&amp;data=02%7C01%7C%7C6fba978558a04990166308d64554b1eb%7C84df9e7fe9f640afb435aaaaaaaaaaaa%7C1%7C0%7C636772627417267769&amp;sdata=9pwTxLbVVuvBfygTt1uNwmYDDEvohTVrc9DHRNamO1U%3D&amp;reserved=0> 
 
 
 
On 1 Nov 2018, at 02:17, Gillian Meldrum <[log in to unmask]<mailto:[log in to unmask]>> wrote: 
 
 
 
I think what is needed is an international & national normal birth 
strategy with a co-ordinating body. The UNICEF Baby Friendly Initiative, in 
partnership with WHO, is a good model to consider. 
 
They have made slow but steady progress over the last 27 years, with many 
challenges similar to normal birth. 
 
It has to start with an understanding of why normal birth matters - the 
increase in interventions is often lamented, but rarely do we see the 
negative impacts of this or it’s often weak rationales explicitly stated in 
the media or communicated to women. 
 
The importance of normal birth, and how to achieve it, may be taught to 
midwifery students, but not to doctors and most lay people are unaware. 
 
BFI at a local level means setting policies & guidelines for best 
evidence-based practice, training staff & auditing their skills, knowledge 
& understanding, and most importantly, auditing mothers’ experiences so 
that we hear their voices & find out if we are getting it right. 
 
Nationally, they co-ordinate a national network of infant feeding leads 
who link in to all maternity, neonatal, health visiting &  children’s 
centre staff in the country (except for some areas in England who are not 
signed up). They have established standards for universities training 
midwives & health visitors. 
 
Currently they are working on a medical student curriculum. 
 
They work together with other national bodies involved in 
 
https://eur02.safelinks.protection.outlook.com/?url=https%3A%2F%2Fukbreastfeeding.org%2F&amp;data=02%7C01%7C%7C6fba978558a04990166308d64554b1eb%7C84df9e7fe9f640afb435aaaaaaaaaaaa%7C1%7C0%7C636772627417267769&amp;sdata=5PQLCmNcwZ61bx6z0ZAUAQAlUKLF5PJjCK29j7Imb6Y%3D&amp;reserved=0 
 
They are a tiny unit, but have clear aims and focus - we have never had 
any organisation promoting normal birth in such a structured way. 
 
Who of you has contacts with WHO? We need an Innocenti Declaration for 
normal birth and a an equivalent of the 10 steps framework to protect it. 
Then a UK organisation which exists for the purpose of implementing those 
standards. 
 
 
 
On a slightly different note, I think the improvements in induction rates 
in the 1990s can be partly attributed to the contribution of NCT & AIMS 
which encouraged women to expect more oppprtunities for informed choice & 
resulted in more women asking for less intervention, together with the 
publication in 1989 of Chalmers et al Effective Care in Pregnancy & 
Childbirth - this gave massive support to clinicians. 
 
 
 
Gillian Meldrum 
 
 
 
On Wed, 31 Oct 2018 at 10:43, Macfarlane, Alison < 
[log in to unmask]<mailto:[log in to unmask]>> wrote: 
 
We have a lot more research evidence since the early 1990s when the 
policies first changed and more recent robust research which has confirmed 
and extended the earlier more limited evidence on which the policies were 
based. Although research questions remain, I don’t think more research is 
the prime need now. An outside observer can see the majority of women 
giving birth in ever larger obstetric units with rocketing levels of 
intervention and a few midwifery units and private midwifery companies for 
the minority of women who manage to find out that they have a choice. I 
know you midwives are run off your feet, but it looks like you have a 
choice between letting it all happen and becoming the RCOG / RCN Faculty of 
Obstetric Nursing or taking some action. 
 
 
 
Alison Macfarlane 
 
 
 
*From:* MacVane Phipps Fiona [mailto:[log in to unmask]] 
*Sent:* 30 October 2018 12:56 
*To:* Macfarlane, Alison; A forum for discussion on midwifery and 
reproductive health research. 
*Subject:* Re: MIDWIFERY-RESEARCH Digest - 26 Oct 2018 to 28 Oct 2018 
(#2018-190) 
 
 
 
Alison 
 
Thank you for this. I didn't see your graphs. were they circulated on this 
list?  I find your suggestion very chilling yet very credible, particularly 
if this government plan, as widely rumoured, to throw open NHS contracts to 
any US trade deal. I can't think of anything worse than the UK maternity 
service being influenced/comtrolled by US care providers (read 'Insurance 
conglomerates'). I find it very hard to understand why the large body of 
evidence supporting midwifery care and the midwifery model of birth has 
failed to alter this trend. I'm happy to be involved in any discussion 
about research that could be done to investigate. 
 
Best wishes, 
 
Fiona 
 
 
 
 
------------------------------ 
 
*From:* Macfarlane, Alison <[log in to unmask]<mailto:[log in to unmask]>> 
*Sent:* 30 October 2018 12:29:53 
*To:* A forum for discussion on midwifery and reproductive health 
research.; MacVane Phipps Fiona 
*Subject:* RE: MIDWIFERY-RESEARCH Digest - 26 Oct 2018 to 28 Oct 2018 
(#2018-190) 
 
 
 
Dear all, 
 
I hope you don't mind me commenting on this from a statistical 
perspective. The graphs I circulated show that in England childbirth is 
changing but in a non-evidence-based direction that I think most people on 
this list think is wrong. 
 
How long before some hard-nosed finance person notices that fewer than 
half of births in England are spontaneous and proposes that a 'solution' to 
the shortage of midwives would be replacing a substantial number of 
midwifery posts with obstetric nursing assistants to help the obstetricians 
conduct an ever growing proportion of births? This reached 39 per cent in 
2007-18. 
 
Good luck and I hope you do better than King Canute. 
 
Alison Macfarlane 
 
-----Original Message----- 
From: A forum for discussion on midwifery and reproductive health research. 
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------------------------------ 
 
Date:    Wed, 7 Nov 2018 16:19:44 +0000 
From:    Julie Watson <[log in to unmask]<mailto:[log in to unmask]>> 
Subject: Re: MIDWIFERY-RESEARCH Digest - 26 Oct 2018 to 28 Oct 2018 (#2018-190) 
 
Dear All 
I agree with the theme of this conversation and would be very happy to get involved 
 
Best wishes Julie 
 
[cid:[log in to unmask]] 
 
Julie Watson 
Midwife, SCPHN-HV, RGN, FiHV, PgCTLHE, MscAPPCP 
Lecturer /Senior Fellow HEA 
Research active: Maternal & child health 
School of Health and Social Work 
Dearne 232 
University of Hull 
Kingston Upon Hull, 
HU6 7RX, UK 
 
[log in to unmask]<mailto:[log in to unmask]><mailto:[log in to unmask]> | 01482 463225 
 
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From: Yvonne McGrath [mailto:[log in to unmask]] 
Sent: 07 November 2018 13:40 
To: [log in to unmask]<mailto:[log in to unmask]> 
Subject: Re: MIDWIFERY-RESEARCH Digest - 26 Oct 2018 to 28 Oct 2018 (#2018-190) 
 
Hi all, 
 
I agree totally. I am new consultant midwife and would be very keen to being involved in setting standards/strategy to move these discussions forward and pull all of the evidence together. 
 
Best wishes 
Yvonne 
 
On Wed, 7 Nov 2018, 12:36 pm Elizabeth Newnham <[log in to unmask]<mailto:[log in to unmask]><mailto:[log in to unmask]> wrote: 
I agree, 
 
I remember being struck at the time the way that BFHI policy affected practice change. 
 
Would also be happy to be involved in any work/discussion in this area. 
 
 
Warm regards, 
Liz Newnham 
 
 
 
From: A forum for discussion on midwifery and reproductive health research. [mailto:[log in to unmask]<mailto:[log in to unmask]>] On Behalf Of SHEENA BYROM 
Sent: Wednesday 7 November 2018 07:01 
To: [log in to unmask]<mailto:[log in to unmask]><mailto:[log in to unmask]> 
Subject: Re: MIDWIFERY-RESEARCH Digest - 26 Oct 2018 to 28 Oct 2018 (#2018-190) 
 
Hello Gillian, 
 
I absolutely agree with you. And in a time when we are ‘not allowed’ to use the term ‘normal birth’ - a call to action similar to Unicef and BFI would seem sensible. I have debated this before with Francesca Entwistle. 
 
Soo Downe is working with the WHO on these matters, and may offer some insight. Soo and I are planning the development of something similar to the now abolished RCM's Ten Tops Tips (not using this phrase) for NB to support women and practitioners, but just in the early stages and any help welcomed. 
 
I would be more than happy to be part of a small team looking at developing standards etc - we have so much evidence and it would be good to pull it together. 
 
Something else, we are soon to launch a Normal Birth Repository of information - freely accessible to all - just making the final tweeks to the website, so this will be something else to contribute to a strategy… 
 
Thank you for raising this critical issue... 
 
 
 
With very best wishes, 
 
Sheena 
 
Website: sheenabyrom.com<https://eur02.safelinks.protection.outlook.com/?url=http%3A%2F%2Fsheenabyrom.com&amp;data=02%7C01%7C%7C6fba978558a04990166308d64554b1eb%7C84df9e7fe9f640afb435aaaaaaaaaaaa%7C1%7C0%7C636772627417267769&amp;sdata=Ta%2FR14PNCja5zy5%2Bq%2BlRvVfoc4YFr%2Fbi33Wts3Qx1Vk%3D&amp;reserved=0><https://eur02.safelinks.protection.outlook.com/?url=http%3A%2F%2Fwww.sheenabyrom.com&amp;data=02%7C01%7C%7C6fba978558a04990166308d64554b1eb%7C84df9e7fe9f640afb435aaaaaaaaaaaa%7C1%7C0%7C636772627417267769&amp;sdata=6GuFXwfEcrfyUUxPWf4cWXsedcMHkwX4leFeKdWL0XU%3D&amp;reserved=0> 
 
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On 1 Nov 2018, at 02:17, Gillian Meldrum <[log in to unmask]<mailto:[log in to unmask]><mailto:[log in to unmask]>> wrote: 
 
I think what is needed is an international & national normal birth strategy with a co-ordinating body. The UNICEF Baby Friendly Initiative, in partnership with WHO, is a good model to consider. 
They have made slow but steady progress over the last 27 years, with many challenges similar to normal birth. 
It has to start with an understanding of why normal birth matters - the increase in interventions is often lamented, but rarely do we see the negative impacts of this or it’s often weak rationales explicitly stated in the media or communicated to women. 
The importance of normal birth, and how to achieve it, may be taught to midwifery students, but not to doctors and most lay people are unaware. 
BFI at a local level means setting policies & guidelines for best evidence-based practice, training staff & auditing their skills, knowledge & understanding, and most importantly, auditing mothers’ experiences so that we hear their voices & find out if we are getting it right. 
Nationally, they co-ordinate a national network of infant feeding leads who link in to all maternity, neonatal, health visiting &  children’s centre staff in the country (except for some areas in England who are not signed up). They have established standards for universities training midwives & health visitors. 
Currently they are working on a medical student curriculum. 
They work together with other national bodies involved in 
https://eur02.safelinks.protection.outlook.com/?url=https%3A%2F%2Fukbreastfeeding.org%2F&amp;data=02%7C01%7C%7C6fba978558a04990166308d64554b1eb%7C84df9e7fe9f640afb435aaaaaaaaaaaa%7C1%7C0%7C636772627417267769&amp;sdata=5PQLCmNcwZ61bx6z0ZAUAQAlUKLF5PJjCK29j7Imb6Y%3D&amp;reserved=0 
They are a tiny unit, but have clear aims and focus - we have never had any organisation promoting normal birth in such a structured way. 
Who of you has contacts with WHO? We need an Innocenti Declaration for normal birth and a an equivalent of the 10 steps framework to protect it. Then a UK organisation which exists for the purpose of implementing those standards. 
 
On a slightly different note, I think the improvements in induction rates in the 1990s can be partly attributed to the contribution of NCT & AIMS which encouraged women to expect more oppprtunities for informed choice & resulted in more women asking for less intervention, together with the publication in 1989 of Chalmers et al Effective Care in Pregnancy & Childbirth - this gave massive support to clinicians. 
 
Gillian Meldrum 
 
On Wed, 31 Oct 2018 at 10:43, Macfarlane, Alison <[log in to unmask]<mailto:[log in to unmask]><mailto:[log in to unmask]>> wrote: 
We have a lot more research evidence since the early 1990s when the policies first changed and more recent robust research which has confirmed and extended the earlier more limited evidence on which the policies were based. Although research questions remain, I don’t think more research is the prime need now. An outside observer can see the majority of women giving birth in ever larger obstetric units with rocketing levels of intervention and a few midwifery units and private midwifery companies for the minority of women who manage to find out that they have a choice. I know you midwives are run off your feet, but it looks like you have a choice between letting it all happen and becoming the RCOG / RCN Faculty of Obstetric Nursing or taking some action. 
 
Alison Macfarlane 
 
From: MacVane Phipps Fiona [mailto:[log in to unmask]<mailto:[log in to unmask]>] 
Sent: 30 October 2018 12:56 
To: Macfarlane, Alison; A forum for discussion on midwifery and reproductive health research. 
Subject: Re: MIDWIFERY-RESEARCH Digest - 26 Oct 2018 to 28 Oct 2018 (#2018-190) 
 
Alison 
Thank you for this. I didn't see your graphs. were they circulated on this list?  I find your suggestion very chilling yet very credible, particularly if this government plan, as widely rumoured, to throw open NHS contracts to any US trade deal. I can't think of anything worse than the UK maternity service being influenced/comtrolled by US care providers (read 'Insurance conglomerates'). I find it very hard to understand why the large body of evidence supporting midwifery care and the midwifery model of birth has failed to alter this trend. I'm happy to be involved in any discussion about research that could be done to investigate. 
Best wishes, 
Fiona 
 
 
________________________________ 
From: Macfarlane, Alison <[log in to unmask]<mailto:[log in to unmask]><mailto:[log in to unmask]>> 
Sent: 30 October 2018 12:29:53 
To: A forum for discussion on midwifery and reproductive health research.; MacVane Phipps Fiona 
Subject: RE: MIDWIFERY-RESEARCH Digest - 26 Oct 2018 to 28 Oct 2018 (#2018-190) 
 
Dear all, 
 
I hope you don't mind me commenting on this from a statistical perspective. The graphs I circulated show that in England childbirth is changing but in a non-evidence-based direction that I think most people on this list think is wrong. 
 
How long before some hard-nosed finance person notices that fewer than half of births in England are spontaneous and proposes that a 'solution' to the shortage of midwives would be replacing a substantial number of midwifery posts with obstetric nursing assistants to help the obstetricians conduct an ever growing proportion of births? This reached 39 per cent in 2007-18. 
 
Good luck and I hope you do better than King Canute. 
 
Alison Macfarlane 
 
-----Original Message----- 
From: A forum for discussion on midwifery and reproductive health research. 
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------------------------------ 
 
Date:    Wed, 7 Nov 2018 18:06:18 +0000 
From:    Mandy Forrester <[log in to unmask]<mailto:[log in to unmask]>> 
Subject: Re: MIDWIFERY-RESEARCH Digest - 26 Oct 2018 to 28 Oct 2018 (#2018-190) 
 
Dear Sheena and Colleagues, 
 
The RCM will be publishing new Midwifery Care in Labour guidance on 19th November. 
 
The guidance has been developed by Helen Spiby and her team at Nottingham University. 
 
Systematic reviews are registered on PROSPERO. 
 
Kind regards, 
 
Mandy 
 
Mandy Forrester 
Head of Quality and Standards 
Visiting Fellow Bournemouth University 
The Royal College of Midwives 
15 Mansfield Street 
London W1G 9NH 
 
Tele:  0300 303 0444 
Mob: 07824901466 
Direct line: 0207 312 3535 
Fax:   020 7312 3536 
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[MSW Week 2018 Email Signature] 
 
 
 
From: A forum for discussion on midwifery and reproductive health research. [mailto:[log in to unmask]] On Behalf Of SHEENA BYROM 
Sent: 07 November 2018 07:01 
To: [log in to unmask]<mailto:[log in to unmask]> 
Subject: Re: MIDWIFERY-RESEARCH Digest - 26 Oct 2018 to 28 Oct 2018 (#2018-190) 
 
Hello Gillian, 
 
I absolutely agree with you. And in a time when we are ‘not allowed’ to use the term ‘normal birth’ - a call to action similar to Unicef and BFI would seem sensible. I have debated this before with Francesca Entwistle. 
 
Soo Downe is working with the WHO on these matters, and may offer some insight. Soo and I are planning the development of something similar to the now abolished RCM's Ten Tops Tips (not using this phrase) for NB to support women and practitioners, but just in the early stages and any help welcomed. 
 
I would be more than happy to be part of a small team looking at developing standards etc - we have so much evidence and it would be good to pull it together. 
 
Something else, we are soon to launch a Normal Birth Repository of information - freely accessible to all - just making the final tweeks to the website, so this will be something else to contribute to a strategy… 
 
Thank you for raising this critical issue... 
 
 
 
With very best wishes, 
 
Sheena 
 
Website: sheenabyrom.com<https://eur02.safelinks.protection.outlook.com/?url=http%3A%2F%2Fsheenabyrom.com&amp;data=02%7C01%7C%7C6fba978558a04990166308d64554b1eb%7C84df9e7fe9f640afb435aaaaaaaaaaaa%7C1%7C0%7C636772627417267769&amp;sdata=Ta%2FR14PNCja5zy5%2Bq%2BlRvVfoc4YFr%2Fbi33Wts3Qx1Vk%3D&amp;reserved=0><https://eur02.safelinks.protection.outlook.com/?url=http%3A%2F%2Fwww.sheenabyrom.com&amp;data=02%7C01%7C%7C6fba978558a04990166308d64554b1eb%7C84df9e7fe9f640afb435aaaaaaaaaaaa%7C1%7C0%7C636772627417267769&amp;sdata=6GuFXwfEcrfyUUxPWf4cWXsedcMHkwX4leFeKdWL0XU%3D&amp;reserved=0> 
 
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On 1 Nov 2018, at 02:17, Gillian Meldrum <[log in to unmask]<mailto:[log in to unmask]><mailto:[log in to unmask]>> wrote: 
 
I think what is needed is an international & national normal birth strategy with a co-ordinating body. The UNICEF Baby Friendly Initiative, in partnership with WHO, is a good model to consider. 
They have made slow but steady progress over the last 27 years, with many challenges similar to normal birth. 
It has to start with an understanding of why normal birth matters - the increase in interventions is often lamented, but rarely do we see the negative impacts of this or it’s often weak rationales explicitly stated in the media or communicated to women. 
The importance of normal birth, and how to achieve it, may be taught to midwifery students, but not to doctors and most lay people are unaware. 
BFI at a local level means setting policies & guidelines for best evidence-based practice, training staff & auditing their skills, knowledge & understanding, and most importantly, auditing mothers’ experiences so that we hear their voices & find out if we are getting it right. 
Nationally, they co-ordinate a national network of infant feeding leads who link in to all maternity, neonatal, health visiting &  children’s centre staff in the country (except for some areas in England who are not signed up). They have established standards for universities training midwives & health visitors. 
Currently they are working on a medical student curriculum. 
They work together with other national bodies involved in 
https://eur02.safelinks.protection.outlook.com/?url=https%3A%2F%2Fukbreastfeeding.org%2F&amp;data=02%7C01%7C%7C6fba978558a04990166308d64554b1eb%7C84df9e7fe9f640afb435aaaaaaaaaaaa%7C1%7C0%7C636772627417267769&amp;sdata=5PQLCmNcwZ61bx6z0ZAUAQAlUKLF5PJjCK29j7Imb6Y%3D&amp;reserved=0 
They are a tiny unit, but have clear aims and focus - we have never had any organisation promoting normal birth in such a structured way. 
Who of you has contacts with WHO? We need an Innocenti Declaration for normal birth and a an equivalent of the 10 steps framework to protect it. Then a UK organisation which exists for the purpose of implementing those standards. 
 
On a slightly different note, I think the improvements in induction rates in the 1990s can be partly attributed to the contribution of NCT & AIMS which encouraged women to expect more oppprtunities for informed choice & resulted in more women asking for less intervention, together with the publication in 1989 of Chalmers et al Effective Care in Pregnancy & Childbirth - this gave massive support to clinicians. 
 
Gillian Meldrum 
 
On Wed, 31 Oct 2018 at 10:43, Macfarlane, Alison <[log in to unmask]<mailto:[log in to unmask]><mailto:[log in to unmask]>> wrote: 
We have a lot more research evidence since the early 1990s when the policies first changed and more recent robust research which has confirmed and extended the earlier more limited evidence on which the policies were based. Although research questions remain, I don’t think more research is the prime need now. An outside observer can see the majority of women giving birth in ever larger obstetric units with rocketing levels of intervention and a few midwifery units and private midwifery companies for the minority of women who manage to find out that they have a choice. I know you midwives are run off your feet, but it looks like you have a choice between letting it all happen and becoming the RCOG / RCN Faculty of Obstetric Nursing or taking some action. 
 
Alison Macfarlane 
 
From: MacVane Phipps Fiona [mailto:[log in to unmask]<mailto:[log in to unmask]>] 
Sent: 30 October 2018 12:56 
To: Macfarlane, Alison; A forum for discussion on midwifery and reproductive health research. 
Subject: Re: MIDWIFERY-RESEARCH Digest - 26 Oct 2018 to 28 Oct 2018 (#2018-190) 
 
Alison 
Thank you for this. I didn't see your graphs. were they circulated on this list?  I find your suggestion very chilling yet very credible, particularly if this government plan, as widely rumoured, to throw open NHS contracts to any US trade deal. I can't think of anything worse than the UK maternity service being influenced/comtrolled by US care providers (read 'Insurance conglomerates'). I find it very hard to understand why the large body of evidence supporting midwifery care and the midwifery model of birth has failed to alter this trend. I'm happy to be involved in any discussion about research that could be done to investigate. 
Best wishes, 
Fiona 
 
 
________________________________ 
From: Macfarlane, Alison <[log in to unmask]<mailto:[log in to unmask]><mailto:[log in to unmask]>> 
Sent: 30 October 2018 12:29:53 
To: A forum for discussion on midwifery and reproductive health research.; MacVane Phipps Fiona 
Subject: RE: MIDWIFERY-RESEARCH Digest - 26 Oct 2018 to 28 Oct 2018 (#2018-190) 
 
Dear all, 
 
I hope you don't mind me commenting on this from a statistical perspective. The graphs I circulated show that in England childbirth is changing but in a non-evidence-based direction that I think most people on this list think is wrong. 
 
How long before some hard-nosed finance person notices that fewer than half of births in England are spontaneous and proposes that a 'solution' to the shortage of midwives would be replacing a substantial number of midwifery posts with obstetric nursing assistants to help the obstetricians conduct an ever growing proportion of births? This reached 39 per cent in 2007-18. 
 
Good luck and I hope you do better than King Canute. 
 
Alison Macfarlane 
 
-----Original Message----- 
From: A forum for discussion on midwifery and reproductive health research. 
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------------------------------ 
 
Date:    Wed, 7 Nov 2018 18:25:00 +0000 
From:    "McCourt, Christine" <[log in to unmask]<mailto:[log in to unmask]>> 
Subject: Re: MIDWIFERY-RESEARCH Digest - 26 Oct 2018 to 28 Oct 2018 (#2018-190) 
 
Or mother-baby friendly as is also good for babies 
 
Christine McCourt 
Professor of Maternal Health & Centre Lead 
Centre for Maternal & Child Health Research 
School of Health Sciences<https://eur02.safelinks.protection.outlook.com/?url=http%3A%2F%2Fwww.city.ac.uk%2Fhealth&amp;data=02%7C01%7C%7C6fba978558a04990166308d64554b1eb%7C84df9e7fe9f640afb435aaaaaaaaaaaa%7C1%7C0%7C636772627417267769&amp;sdata=HR34o%2BVCtN%2FfvOZ6svU39N7wIdFYZmtzo1D1qn3Emu8%3D&amp;reserved=0> 
City, University of London 
1 Myddelton Street 
London EC1R 1UW 
 
Tel: 0207 040 5863 
Mob: 0791 235 1476 
Twitter: @ProfMcCourt 
 
[ps://blogs.city.ac.uk/mchresearch/files/2015/06/cute-newborn-babycute-newborn-babies-21k444f-624x390.j]<https://eur02.safelinks.protection.outlook.com/?url=https%3A%2F%2Fblogs.city.ac.uk%2Fmchresearch%2F&amp;data=02%7C01%7C%7C6fba978558a04990166308d64554b1eb%7C84df9e7fe9f640afb435aaaaaaaaaaaa%7C1%7C0%7C636772627417267769&amp;sdata=oj%2FVGRgUMgyEETJZuwEB1%2BDi%2BxPriXd88F4tzCnwi%2Fc%3D&amp;reserved=0> 
 
Centre for Maternal and Child Health Research | City ... 
The Centre for Maternal and Child Health Research carries out high quality research that aims to improve the health and care of women, children, families and communities. 
Read more...<https://eur02.safelinks.protection.outlook.com/?url=https%3A%2F%2Fblogs.city.ac.uk%2Fmchresearch%2F&amp;data=02%7C01%7C%7C6fba978558a04990166308d64554b1eb%7C84df9e7fe9f640afb435aaaaaaaaaaaa%7C1%7C0%7C636772627417267769&amp;sdata=oj%2FVGRgUMgyEETJZuwEB1%2BDi%2BxPriXd88F4tzCnwi%2Fc%3D&amp;reserved=0> 
 
 
 
Want to further your clinical and academic career? To find out more about City, University of London’s MSc Advanced Practice Midwifery programme please click here<https://eur02.safelinks.protection.outlook.com/?url=http%3A%2F%2Fwww.city.ac.uk%2Fcourses%2Fpostgraduate%2Fadvanced-practice-in-health-and-social-care-midwifery%23course-detail%3D0&amp;data=02%7C01%7C%7C6fba978558a04990166308d64554b1eb%7C84df9e7fe9f640afb435aaaaaaaaaaaa%7C1%7C0%7C636772627417267769&amp;sdata=8iyqcIdC1JGvHHNe4vG7ywUMgb3u7iTiKvxCvyx%2FJFk%3D&amp;reserved=0>. 
 
 
 
 
[cid:[log in to unmask]] 
 
 
 
 
From: "[log in to unmask]<mailto:[log in to unmask]>" <[log in to unmask]<mailto:[log in to unmask]>> on behalf of Hilde Agema <[log in to unmask]<mailto:[log in to unmask]>> 
Reply-To: "[log in to unmask]<mailto:[log in to unmask]>" <[log in to unmask]<mailto:[log in to unmask]>>, Hilde Agema <[log in to unmask]<mailto:[log in to unmask]>> 
Date: Wednesday, 7 November 2018 at 09:33 
To: "[log in to unmask]<mailto:[log in to unmask]>" <[log in to unmask]<mailto:[log in to unmask]>> 
Subject: Re: MIDWIFERY-RESEARCH Digest - 26 Oct 2018 to 28 Oct 2018 (#2018-190) 
 
Hi all! 
 
This sounds like a good idea.  One could call it the “MotherFriendlyInitiative” (promoting normal/vaginal birth) where the “BabyFriendlyInitiative” promotes breastfeeding. 
 
Have a good day. 
 
Hilde Agema 
 
From: A forum for discussion on midwifery and reproductive health research. [mailto:[log in to unmask]] On Behalf Of Scamell, Mandie 
Sent: Wednesday, November 7, 2018 10:48 AM 
To: [log in to unmask]<mailto:[log in to unmask]> 
Subject: Re: MIDWIFERY-RESEARCH Digest - 26 Oct 2018 to 28 Oct 2018 (#2018-190) 
 
This is a really exciting opportunity. Every cloud and all that. I would be happy to be involved if I can help at all. 
 
BW 
 
Mandie 
Sent from my iPhone 
 
On 7 Nov 2018, at 07:01, SHEENA BYROM <[log in to unmask]<mailto:[log in to unmask]><mailto:[log in to unmask]>> wrote: 
Hello Gillian, 
 
I absolutely agree with you. And in a time when we are ‘not allowed’ to use the term ‘normal birth’ - a call to action similar to Unicef and BFI would seem sensible. I have debated this before with Francesca Entwistle. 
 
Soo Downe is working with the WHO on these matters, and may offer some insight. Soo and I are planning the development of something similar to the now abolished RCM's Ten Tops Tips (not using this phrase) for NB to support women and practitioners, but just in the early stages and any help welcomed. 
 
I would be more than happy to be part of a small team looking at developing standards etc - we have so much evidence and it would be good to pull it together. 
 
Something else, we are soon to launch a Normal Birth Repository of information - freely accessible to all - just making the final tweeks to the website, so this will be something else to contribute to a strategy… 
 
Thank you for raising this critical issue... 
 
 
 
With very best wishes, 
 
Sheena 
 
Website: sheenabyrom.com<https://eur02.safelinks.protection.outlook.com/?url=http%3A%2F%2Fsheenabyrom.com&amp;data=02%7C01%7C%7C6fba978558a04990166308d64554b1eb%7C84df9e7fe9f640afb435aaaaaaaaaaaa%7C1%7C0%7C636772627417267769&amp;sdata=Ta%2FR14PNCja5zy5%2Bq%2BlRvVfoc4YFr%2Fbi33Wts3Qx1Vk%3D&amp;reserved=0><https://eur02.safelinks.protection.outlook.com/?url=http%3A%2F%2Fwww.sheenabyrom.com&amp;data=02%7C01%7C%7C6fba978558a04990166308d64554b1eb%7C84df9e7fe9f640afb435aaaaaaaaaaaa%7C1%7C0%7C636772627417267769&amp;sdata=6GuFXwfEcrfyUUxPWf4cWXsedcMHkwX4leFeKdWL0XU%3D&amp;reserved=0> 
 
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On 1 Nov 2018, at 02:17, Gillian Meldrum <[log in to unmask]<mailto:[log in to unmask]><mailto:[log in to unmask]>> wrote: 
 
I think what is needed is an international & national normal birth strategy with a co-ordinating body. The UNICEF Baby Friendly Initiative, in partnership with WHO, is a good model to consider. 
They have made slow but steady progress over the last 27 years, with many challenges similar to normal birth. 
It has to start with an understanding of why normal birth matters - the increase in interventions is often lamented, but rarely do we see the negative impacts of this or it’s often weak rationales explicitly stated in the media or communicated to women. 
The importance of normal birth, and how to achieve it, may be taught to midwifery students, but not to doctors and most lay people are unaware. 
BFI at a local level means setting policies & guidelines for best evidence-based practice, training staff & auditing their skills, knowledge & understanding, and most importantly, auditing mothers’ experiences so that we hear their voices & find out if we are getting it right. 
Nationally, they co-ordinate a national network of infant feeding leads who link in to all maternity, neonatal, health visiting &  children’s centre staff in the country (except for some areas in England who are not signed up). They have established standards for universities training midwives & health visitors. 
Currently they are working on a medical student curriculum. 
They work together with other national bodies involved in 
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They are a tiny unit, but have clear aims and focus - we have never had any organisation promoting normal birth in such a structured way. 
Who of you has contacts with WHO? We need an Innocenti Declaration for normal birth and a an equivalent of the 10 steps framework to protect it. Then a UK organisation which exists for the purpose of implementing those standards. 
 
On a slightly different note, I think the improvements in induction rates in the 1990s can be partly attributed to the contribution of NCT & AIMS which encouraged women to expect more oppprtunities for informed choice & resulted in more women asking for less intervention, together with the publication in 1989 of Chalmers et al Effective Care in Pregnancy & Childbirth - this gave massive support to clinicians. 
 
Gillian Meldrum 
 
On Wed, 31 Oct 2018 at 10:43, Macfarlane, Alison <[log in to unmask]<mailto:[log in to unmask]><mailto:[log in to unmask]>> wrote: 
We have a lot more research evidence since the early 1990s when the policies first changed and more recent robust research which has confirmed and extended the earlier more limited evidence on which the policies were based. Although research questions remain, I don’t think more research is the prime need now. An outside observer can see the majority of women giving birth in ever larger obstetric units with rocketing levels of intervention and a few midwifery units and private midwifery companies for the minority of women who manage to find out that they have a choice. I know you midwives are run off your feet, but it looks like you have a choice between letting it all happen and becoming the RCOG / RCN Faculty of Obstetric Nursing or taking some action. 
 
Alison Macfarlane 
 
From: MacVane Phipps Fiona [mailto:[log in to unmask]<mailto:[log in to unmask]>] 
Sent: 30 October 2018 12:56 
To: Macfarlane, Alison; A forum for discussion on midwifery and reproductive health research. 
Subject: Re: MIDWIFERY-RESEARCH Digest - 26 Oct 2018 to 28 Oct 2018 (#2018-190) 
 
Alison 
Thank you for this. I didn't see your graphs. were they circulated on this list?  I find your suggestion very chilling yet very credible, particularly if this government plan, as widely rumoured, to throw open NHS contracts to any US trade deal. I can't think of anything worse than the UK maternity service being influenced/comtrolled by US care providers (read 'Insurance conglomerates'). I find it very hard to understand why the large body of evidence supporting midwifery care and the midwifery model of birth has failed to alter this trend. I'm happy to be involved in any discussion about research that could be done to investigate. 
Best wishes, 
Fiona 
 
 
________________________________ 
From: Macfarlane, Alison <[log in to unmask]<mailto:[log in to unmask]><mailto:[log in to unmask]>> 
Sent: 30 October 2018 12:29:53 
To: A forum for discussion on midwifery and reproductive health research.; MacVane Phipps Fiona 
Subject: RE: MIDWIFERY-RESEARCH Digest - 26 Oct 2018 to 28 Oct 2018 (#2018-190) 
 
Dear all, 
 
I hope you don't mind me commenting on this from a statistical perspective. The graphs I circulated show that in England childbirth is changing but in a non-evidence-based direction that I think most people on this list think is wrong. 
 
How long before some hard-nosed finance person notices that fewer than half of births in England are spontaneous and proposes that a 'solution' to the shortage of midwives would be replacing a substantial number of midwifery posts with obstetric nursing assistants to help the obstetricians conduct an ever growing proportion of births? This reached 39 per cent in 2007-18. 
 
Good luck and I hope you do better than King Canute. 
 
Alison Macfarlane 
 
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------------------------------ 
 
Date:    Wed, 7 Nov 2018 21:01:02 +0000 
From:    Gillian Meldrum <[log in to unmask]<mailto:[log in to unmask]>> 
Subject: Re: MIDWIFERY-RESEARCH Digest - 26 Oct 2018 to 28 Oct 2018 (#2018-190) 
 
Yes, humanisation of birth and human rights in childbirth/reproduction is 
what it is all based on - all normal birth issues really relate to human 
rights - to information, choice & autonomy, support, bodily integrity, 
health etc 
(WHO/UNICEF BFI is founded on UNCRC’s rights for children.) 
We need a partnership of policy makers, academics & clinicians. Who are the 
potential normal birth policy makers in the world? Are there any? 
 
Gillian 
 
On Wed, 7 Nov 2018 at 15:03, Page, Lesley < 
[log in to unmask]<mailto:[log in to unmask]>> wrote: 
 
Have just been in email communication with Liz. 
 
 
I wonder if the Humanization of birth would be a good framework to use? 
WHO might be interested? 
 
 
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 
 
 
 
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lesleypageCBE@humanisingbirth 
 
 
 
 
 
 
 
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------------------------------ 
 
Date:    Wed, 7 Nov 2018 21:13:34 +0000 
From:    Gillian Meldrum <[log in to unmask]<mailto:[log in to unmask]>> 
Subject: Re: MIDWIFERY-RESEARCH Digest - 26 Oct 2018 to 28 Oct 2018 (#2018-190) 
 
Good point about terms can under people’s skin ... 
But units which have not taken the trouble to audit themselves to find out 
from mothers what their experiences were may indeed be “baby unfriendly” 
and will never know. 
Which units can demonstrate, through regular feedback from women, that they 
are providing “xxx salutogenic/empowering care”? The only data we have is 
birth outcomes ... but nothing about the steps (as in 10 BFI steps) women 
experience which will lead to the final outcomes. 
 
Gillian 
 
On Wed, 7 Nov 2018 at 16:09, Sophie Alexander <[log in to unmask]<mailto:[log in to unmask]>> wrote: 
 
Yes, but "humanisation" is a bit like the "baby friendly" wording which 
looks as if all other units are "baby unfriendly" and here the opposite 
would be "unhuman birth"?...And all this gets under the skin of some 
people. 
 
I would vote for something which includes the "positive experience of WHO" 
and NO UNNECESSARY ACTION (if it's not broken why mend it?), and promotion 
of salutogenesis and empowerment... 
 
 
Sophie Alexander MD, PhD 
PERU (Perinatal Epidemiology and Reproductive health Unit) 
Ecole de Santé Publique 
Universite Libre de Bruxelles 
808 route de Lennik 
1070 Brussels 
Belgium 
Tel +32 2555 4063 
 
-----Message d'origine----- 
De : A forum for discussion on midwifery and reproductive health research. 
[mailto:[log in to unmask]] De la part de Page, Lesley 
Envoyé : mercredi 7 novembre 2018 16:04 
À : [log in to unmask]<mailto:[log in to unmask]> 
Objet : Re: MIDWIFERY-RESEARCH Digest - 26 Oct 2018 to 28 Oct 2018 
(#2018-190) 
 
Have just been in email communication with Liz. 
 
 
I wonder if the Humanization of birth would be a good framework to use? WHO 
might be interested? 
 
 
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 
 
 
 
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------------------------------ 
 
Date:    Wed, 7 Nov 2018 21:20:31 +0000 
From:    Soo Downe <[log in to unmask]<mailto:[log in to unmask]>> 
Subject: Re: MIDWIFERY-RESEARCH Digest - 26 Oct 2018 to 28 Oct 2018 (#2018-190) 
 
this measure might be useful?: 
 
 
https://eur02.safelinks.protection.outlook.com/?url=https%3A%2F%2Fwww.internationalchildbirth.com%2Fuploads%2F8%2F0%2F2%2F6%2F8026178%2Fici_full_bw.pdf&amp;data=02%7C01%7C%7C6fba978558a04990166308d64554b1eb%7C84df9e7fe9f640afb435aaaaaaaaaaaa%7C1%7C0%7C636772627417267769&amp;sdata=E1TZzAVJrkHzm%2BWjRM2kN17udxkd6rDj7%2BdtFRqK0Dc%3D&amp;reserved=0 
 
 
all the best 
 
 
soo 
 
 
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------------------------------ 
 
Date:    Wed, 7 Nov 2018 21:28:21 +0000 
From:    Sheila Brown <[log in to unmask]<mailto:[log in to unmask]>> 
Subject: Re: MIDWIFERY-RESEARCH Digest - 26 Oct 2018 to 28 Oct 2018 (#2018-190) 
 
Perfect 
 
On Wed, 7 Nov 2018 at 21:21, Soo Downe <[log in to unmask]<mailto:[log in to unmask]>> wrote: 
 
this measure might be useful?: 
 
 
 
https://eur02.safelinks.protection.outlook.com/?url=https%3A%2F%2Fwww.internationalchildbirth.com%2Fuploads%2F8%2F0%2F2%2F6%2F8026178%2Fici_full_bw.pdf&amp;data=02%7C01%7C%7C6fba978558a04990166308d64554b1eb%7C84df9e7fe9f640afb435aaaaaaaaaaaa%7C1%7C0%7C636772627417267769&amp;sdata=E1TZzAVJrkHzm%2BWjRM2kN17udxkd6rDj7%2BdtFRqK0Dc%3D&amp;reserved=0 
 
 
all the best 
 
 
soo 
 
 
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-- 
*Sheila JS Brown* 
*07840 296 731* 
 
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End of MIDWIFERY-RESEARCH Digest - 6 Nov 2018 to 7 Nov 2018 (#2018-197) 
*********************************************************************** 
 
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