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As others, happy to contribute in whatever way I can Best Wishes Jenny Dr Jenny Hall, Fellow RCM, Senior Fellow HEA Senior Lecturer, PGCert Education practice Centre for Excellence in learning, Bournemouth University, Executive Business Centre, ________________________________ From: A forum for discussion on midwifery and reproductive health research. <[log in to unmask]> on behalf of ntembo gunda <[log in to unmask]> Sent: 08 November 2018 15:27 To: [log in to unmask] Subject: Re: MIDWIFERY-RESEARCH Digest - 26 Oct 2018 to 28 Oct 2018 (#2018-190) I am a midwife from Tanzania in East Africa. I am one of the advocates of normal birth. I will be very much interested being part of this global agenda. Stella M. Mpanda, Childbirth Survival International (CSI), Tanzania On Wednesday, November 7, 2018, 10:01:05 AM GMT+3, SHEENA BYROM <[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://emea01.safelinks.protection.outlook.com/?url=http%3A%2F%2Fwww.sheenabyrom.com&data=02%7C01%7C%7Cf7132cf8d7674e7fae8d08d6458eb5ea%7Cede29655d09742e4bbb5f38d427fbfb8%7C0%7C0%7C636772876567050565&sdata=iZB3opFG4YngdGREPS8DieTJ7UIlBiNkhzNwPpbrz8o%3D&reserved=0> Twitter: @SagefemmeSB<https://emea01.safelinks.protection.outlook.com/?url=https%3A%2F%2Ftwitter.com%2FSagefemmeSB&data=02%7C01%7C%7Cf7132cf8d7674e7fae8d08d6458eb5ea%7Cede29655d09742e4bbb5f38d427fbfb8%7C0%7C0%7C636772876567060574&sdata=unl%2FuBanXyylqOHyWOaBrLLawOKHSHmyH%2FdxhfcU5ZU%3D&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://ukbreastfeeding.org/<https://emea01.safelinks.protection.outlook.com/?url=https%3A%2F%2Fukbreastfeeding.org%2F&data=02%7C01%7C%7Cf7132cf8d7674e7fae8d08d6458eb5ea%7Cede29655d09742e4bbb5f38d427fbfb8%7C0%7C0%7C636772876567060574&sdata=%2BA9nKwpfzQQhNStjivHD6F3gYkUyo1IC9UOk1Q7DVF0%3D&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]<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. 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