Dear all thank you very much for all your inputs, I tried to say something. At the end of the presentation the problem was moved to ‘MLUs are too expensive we cannot have a team of 6-10 midwives for that number of births when there is a shortage of midwives in labour ward’ (useless to have said that the activities of a birth centre are not only intrapartum and that (unfortunately) many times midwives are moving between areas.
By the way maybe it was because there were enough argument to move the debate from the transfer issue ;)
When prejudice dominate there is always a problem for any solution :)
But at least I tried to make the point that the conversation will be L ways biased if we focus on professionials views instead on women’s health.
I enjoyed the opportunity at least to try to offer a different perspective and it was really impressive to me to see all your mails that made me once more again aware that each one of us wherever is and whatever the task has been asked is at some level giving voice to a community is not just speaking for her/himself

Thanks for all the support
I feel the chair of the session didn’t move from his position at all, but surely I did !
Laura

Inviato da iPhone

> Il giorno 14 nov 2018, alle ore 15:08, McCourt, Christine <[log in to unmask]> ha scritto:
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> Just to add a few points to the already excellent responses:
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> - in the Birthplace study, transfer rates were highest in alongside midwife units, where transfer time is very short and usually just a lift or corridor.
> - as Laura has said, when you look at the rates from Birthplace, they are different for multips and from different settings but also a large proportion are not emergency
> - we also had evidence in the Birthplace organisational case studies that a range of professional and organisational issues could be affecting transfer rates so attention is needed to skills, confidence (so training) but also integration and relationships within a service (so that transfers are based on good professional jdgement of clinical needs/women's wishes not on territorialism or professional conflicts or organisational imperatives such as crowding or lack of staffing)
> - the economic evaluation included the costs of transfers in a very comprehensive way
> - the analysis was designed to take into account all transfers when considering the clinical outcomes - this means that any such risks were included in the analysis - the findings represent the outcomes of the full continuum of care according to where women planned the setting, defined at the start of care in labour
> - the work done on experiences of transfers showed that from the women's viewpoint (and their birth partner's) it is how you manage the transfer that really matters: they could have a positive experience but it did need to be well managed and supported and with appropriately tailored good quality information. Professional conflict or poorly developed transfer arrangements will not support a positive experience. Women ideally want some continuity too, with the midwife able to transfer with them, and good care and attention on arrival, not judgement - of them or of the professional who provided their care to that point.
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> Other studies such as Overgaard's in Denmark and the Canadian studies and the Australian study have used similar methodology to ensure these kind of issues are taken into account.
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> It seems at times that people in quite senior roles feel entitled to speak on an issue without reading the research in detail, to check the methods and what is covered, so then draw misleading conclusions such as 'it is all very well to say it is cost effective but what about the cost of transfers' and convey them to others with an air of authority.
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> On 14/11/2018, 13:24, "A forum for discussion on midwifery and reproductive health research. on behalf of MacVane Phipps Fiona" <[log in to unmask] on behalf of [log in to unmask]> wrote:
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>    Keep up the good work, Laura! I agree with previous comments but where is the 40% transfer rate coming from? I think it is important to also talk about education, education for midwives, for women and for doctors about physiological birth. A lecture from a vet always goes down well. Imagine you are breeding horses, what conditions would a veterinarian say would be optimal for a safe birth? Vets usually say, a known, warm, safe, quiet, dark environment. No intrusions, let the mother do it herself (no tugging, pulling etc.) but know how to help if and when it becomes necessary, . The physiology of birth works for all mammals (and human babies don't have those long awkward legs with sharp elbows)! If physiology is respected and women and midwives both understand this and have developed a trusting relationship then transfers will go down.
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>    -----Original Message-----
>    From: A forum for discussion on midwifery and reproductiv

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