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INTERNATIONAL CONFEDERATION OF MIDWIVES 24th TRIENNIAL CONGRESS, OSLO 26-31 MAY 1996 Two thousand five hundred delegates from 89 countries gathered in the Oslo Spektrum for this conference entitled The art and science of midwifery gives birth to a better future. The venue had hosted the Eurovision Song Contest the previous week and those festi,rities and song were not forgotten as the flag parade of member nations and speeches preceded the entertainment in the opening ceremony. The conference anthem was sung by the Nordic Midwives choir: 70 midwives, dressed in colourful national costume, from Norway, Denmark, Finland, Iceland and Sweden. Yggdrasil, the Tree of Life in Norwegian folklore, is a symbol of hope and fruitful, everlasting experience, and formed part of the conference logo. It is also a symbol of knowledge. Ash wood, which is considered to be related to this tree, was used to create Pinard's stethoscopes for each of the delegates - a lovely gift. 'In search of the tree of life' was a musical tableau commissioned for the ICM conference. Sissel Kyrkjebo, a well known Norwegian singer who recently gave birth at home with the assistance of a midwife, sang the main part and we were entranced. In her opening address the President, Sonja Sjoli, explained that the theme reflected the important and unique role of midwives in improving care to women, children and families around the world. Art and knowledge are often portrayed as opposing forces. Art is associated with intuition, sensitivity and subjectivity, while knowledge is associated with reason, rationality and objectivity. Both of them are developed by practice, by a creative attention in relation to the world in which we live. To see midwifery as an art implies respect for the logic of nature, while at the same time knowing and noticing when it is necessary to intervene and use 'appropriate'.' technology, this is what it means to use the wise judgement of the midwife. The health and welfare of women is crucial to the generations of the future. Women undertake a vital function, of bearing and raising our children. But there has been too litlle attention directed to assuring that this takes place in safety. Pregnancy and birth are', natural processes, but we all know that Midn'ifery(1996) 12, 151-152 © 1996 Pearson Professional/td
they are by no means risk free. Women and children suffer and die, because they do not have access to the basic minimum of health services, which are their right. On a global basis over 500 000 women die each year as a direct result of pregnancy related complications. At least another 20 million experience serious and long-lasting morbidities and disabilities. Each year, over 4 million newborn babies die and millions more are harmed because of poor care during pregnancy and birth. Over 99% of these women and children live in developing countries, where 88% of all births take place. Most of these women do not have a trained birth attendant. It is not for lack of knowledge that the majority of women in the world still face the prospects of death or disabilities as a consequence of childbearing. This burden, of death or lasting injury, is borne by women and children to a large part because we, who are the holders of knowledge, the bearers of political authority and architects of health and social programmes, have failed to exercise our full creative capacity to commit energies and resources to health and the development needs of women. It is not possible to summarise the very full five-day programme in a review such as this so the keynote addresses and some of the themes which appeared to emerge through the sessions and workshops are highlighted. Molly Babu from India spoke to the topic Cultural diversities in childbirth and midwifery. She underlined the fact that health care has its own culture and customs. We need to incorporate the culture of clients with that of the health care system. Some of the barriers to cultural sensitivity in health care are firstly ethnocentrism - when an individual's beliefs and values are regarded as the best or only acceptable system of knowing and behaving, and secondly, prejudice - where there is a strong (negative or positive) opinion about some topic of a group of people. Rather than try and address individual differences she reminded us that there are some basic similarities and these revolve around basic human needs. The central message from Ulla Waldenstrom's (Australia) paper was to improve women's active participation in the decision making for their care. This related to use of newer techniques for example ultrasound, and for appropriate support and medication in labour. The dominance of the medical/illness model has resulted in insufficient attention being paid to the experiences and wishes of women in relation to their care in pregnancy and childbirth. The Norwegian Minister of Health, Gudmund Hernes, addressed the topic Health, politics and the effect on maternal
health and his paper is reproduced in full on p109 of this issue. At the end of his presentation he was given a Pinard's stethoscope by the President with the injunction Listen to the midwives. His reply was 'I will listen to the women and children!' Dorothy Namate (Malawi) spoke to the title Meeting women's reproductive health needs through research and education. She asked the provocative question 'Why do so few midwives do so little research, and those that do fail to get their findings implemented?' This is a key question as she stated that nine out of ten maternal deaths are preventable, and the focus of research should be on the reasons why these have not been eradicated. She challenged the ICM to ensure that research findings have influence on the community it affects. In terms of education, she addressed the issue of whether or not there should be separation or integration of nursing and midwifery preparation. Wisely she reminded the gathering that each country had to make that decision within the social, economic and political contexts in which they find themselves. What is important is that midwives be actively involved in these decisions. Kate Jackson (UK) outlined some of the process which resulted in the Changing Childbirth project. She hastened to add that this should not be viewed as a blueprint, but that some key lessons could be learned and certain issues explored where other health systems were undergoing review. Ultimately the women entering the service should have choice of the professional who provides care, place of birth and information, continuity and control. The issue is not about providing a service, but providing the right service in the right situation. Gro Harlem Brundtland (Prime Minister of Norway) practised as a physician for 10 years prior to entering politics 20 years ago, and commands authority when she speaks. She stated that the role of the midwife had not received the world recognition that it deserves. Part of the reason that childbearing is a threat is because there is a lack of emphasis on primary health care, while some poorer countries continue to spend vast amounts on military budgets and gratuitous spending. More specifically she addressed the situation of women and the national and international initiatives which need to be implemented. She indicated that there had been many good resolutions made by the United Nations in the past couple of years through the conferences at Cairo and Beijing. At these meetings delegates had resolved to increase the money available to address health, education and poverty (1996 is the year of eliminating poverty!) and to address women's needs and to promote equafity. These resolutions are all laudable, but the Prime Minister said that
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'Now is time to deliver!' We hope that she will continue to pressurise her colleagues in international leadership to implement their well-sounding words!
Posters There were four afternoon sessions offering a total of 159 posters covering aspects relating to education, research, cultural practices, physiological and psychological aspects, reproduction and baby health. Presenters were requested to attend their posters in order to encourage discussion - a good idea. However, each poster session was in competition with about six other oral sessions. Until people appreciate that this is a credible way of presenting, and presenters pay due regard to the quality of their posters, this session of congress activities will continue to be the Cinderella session.
Congress newspaper Congress News was a new development in the history of the ICM congress. This daily four-page paper was available to delegates as they arrived each morning. Not only did it give highlights for the day, it reported
some of the sessions from the previous day, brief comments from delegates relating to aspects of the congress and the apres congress programme. There were also some excellent sketches, drawn by Karin Segolson, of participants. This was a worthy and appreciated effort.
Themes which emerged during the congress • Knowledge gives power. • Midwives need to be politically astute and to engage the politicians in their own agendas to ensure changes in the health services which will be to the benefit of all women. However, midwives involved in this type of action will need to ensure that they have a mandate from women to speak on their behalf, otherwise they will be as guilty as other health professionals of being arrogant. • The need for research-based practice. We need to be able to defend our practice, based on credible research. To this end there needs to be greater capacity-building amongst midwives. • Safe Motherhood. This continues to be a
key area for action. Shocking statistics for maternal mortality in some countries were presented, and death owing to childbirth and pregnancy related causes remains a human tragedy. The closing session marked the handing over of positions to the new office bearers. Margaret Peters and Joyce Thompson continue as Director and Deputy Director respectively of the Board of Management of ICM. Sonja Sjoli handed over her chain of office as Alice Sanz de la Gente of the Philippines was inaugurated as President of ICM. She then took the opportunity to tempt us with visions of Manila for the 1999 congress, 22-26 May. If there had been a travel agent on site ... ! In bidding us farewell the Nordic Midwives choir sang the conference anthem, and then everyone's favourite, the Tree of Life. It was quite a sight to see this huge venue with people seated as high as the rafters, arms linked and singing and swaying to the music. What a lovely way to end the conference. Sheila CIows
report m
INTERNATIONAL CONFEDERATION OF MIDWIVES 24th TRIENNIAL CONGRESS, OSLO 26-31 MAY 1996 Two thousand five hundred delegates from 89 countries gathered in the Oslo Spektrum for this conference entitled The art and science of midwifery gives birth to a better future. The venue had hosted the Eurovision Song Contest the previous week and those festi,rities and song were not forgotten as the flag parade of member nations and speeches preceded the entertainment in the opening ceremony. The conference anthem was sung by the Nordic Midwives choir: 70 midwives, dressed in colourful national costume, from Norway, Denmark, Finland, Iceland and Sweden. Yggdrasil, the Tree of Life in Norwegian folklore, is a symbol of hope and fruitful, everlasting experience, and formed part of the conference logo. It is also a symbol of knowledge. Ash wood, which is considered to be related to this tree, was used to create Pinard's stethoscopes for each of the delegates - a lovely gift. 'In search of the tree of life' was a musical tableau commissioned for the ICM conference. Sissel Kyrkjebo, a well known Norwegian singer who recently gave birth at home with the assistance of a midwife, sang the main part and we were entranced. In her opening address the President, Sonja Sjoli, explained that the theme reflected the important and unique role of midwives in improving care to women, children and families around the world. Art and knowledge are often portrayed as opposing forces. Art is associated with intuition, sensitivity and subjectivity, while knowledge is associated with reason, rationality and objectivity. Both of them are developed by practice, by a creative attention in relation to the world in which we live. To see midwifery as an art implies respect for the logic of nature, while at the same time knowing and noticing when it is necessary to intervene and use 'appropriate'.' technology, this is what it means to use the wise judgement of the midwife. The health and welfare of women is crucial to the generations of the future. Women undertake a vital function, of bearing and raising our children. But there has been too litlle attention directed to assuring that this takes place in safety. Pregnancy and birth are', natural processes, but we all know that Midn'ifery(1996) 12, 151-152 © 1996 Pearson Professional/td
they are by no means risk free. Women and children suffer and die, because they do not have access to the basic minimum of health services, which are their right. On a global basis over 500 000 women die each year as a direct result of pregnancy related complications. At least another 20 million experience serious and long-lasting morbidities and disabilities. Each year, over 4 million newborn babies die and millions more are harmed because of poor care during pregnancy and birth. Over 99% of these women and children live in developing countries, where 88% of all births take place. Most of these women do not have a trained birth attendant. It is not for lack of knowledge that the majority of women in the world still face the prospects of death or disabilities as a consequence of childbearing. This burden, of death or lasting injury, is borne by women and children to a large part because we, who are the holders of knowledge, the bearers of political authority and architects of health and social programmes, have failed to exercise our full creative capacity to commit energies and resources to health and the development needs of women. It is not possible to summarise the very full five-day programme in a review such as this so the keynote addresses and some of the themes which appeared to emerge through the sessions and workshops are highlighted. Molly Babu from India spoke to the topic Cultural diversities in childbirth and midwifery. She underlined the fact that health care has its own culture and customs. We need to incorporate the culture of clients with that of the health care system. Some of the barriers to cultural sensitivity in health care are firstly ethnocentrism - when an individual's beliefs and values are regarded as the best or only acceptable system of knowing and behaving, and secondly, prejudice - where there is a strong (negative or positive) opinion about some topic of a group of people. Rather than try and address individual differences she reminded us that there are some basic similarities and these revolve around basic human needs. The central message from Ulla Waldenstrom's (Australia) paper was to improve women's active participation in the decision making for their care. This related to use of newer techniques for example ultrasound, and for appropriate support and medication in labour. The dominance of the medical/illness model has resulted in insufficient attention being paid to the experiences and wishes of women in relation to their care in pregnancy and childbirth. The Norwegian Minister of Health, Gudmund Hernes, addressed the topic Health, politics and the effect on maternal
health and his paper is reproduced in full on p109 of this issue. At the end of his presentation he was given a Pinard's stethoscope by the President with the injunction Listen to the midwives. His reply was 'I will listen to the women and children!' Dorothy Namate (Malawi) spoke to the title Meeting women's reproductive health needs through research and education. She asked the provocative question 'Why do so few midwives do so little research, and those that do fail to get their findings implemented?' This is a key question as she stated that nine out of ten maternal deaths are preventable, and the focus of research should be on the reasons why these have not been eradicated. She challenged the ICM to ensure that research findings have influence on the community it affects. In terms of education, she addressed the issue of whether or not there should be separation or integration of nursing and midwifery preparation. Wisely she reminded the gathering that each country had to make that decision within the social, economic and political contexts in which they find themselves. What is important is that midwives be actively involved in these decisions. Kate Jackson (UK) outlined some of the process which resulted in the Changing Childbirth project. She hastened to add that this should not be viewed as a blueprint, but that some key lessons could be learned and certain issues explored where other health systems were undergoing review. Ultimately the women entering the service should have choice of the professional who provides care, place of birth and information, continuity and control. The issue is not about providing a service, but providing the right service in the right situation. Gro Harlem Brundtland (Prime Minister of Norway) practised as a physician for 10 years prior to entering politics 20 years ago, and commands authority when she speaks. She stated that the role of the midwife had not received the world recognition that it deserves. Part of the reason that childbearing is a threat is because there is a lack of emphasis on primary health care, while some poorer countries continue to spend vast amounts on military budgets and gratuitous spending. More specifically she addressed the situation of women and the national and international initiatives which need to be implemented. She indicated that there had been many good resolutions made by the United Nations in the past couple of years through the conferences at Cairo and Beijing. At these meetings delegates had resolved to increase the money available to address health, education and poverty (1996 is the year of eliminating poverty!) and to address women's needs and to promote equafity. These resolutions are all laudable, but the Prime Minister said that
152
Conference report
'Now is time to deliver!' We hope that she will continue to pressurise her colleagues in international leadership to implement their well-sounding words!
Posters There were four afternoon sessions offering a total of 159 posters covering aspects relating to education, research, cultural practices, physiological and psychological aspects, reproduction and baby health. Presenters were requested to attend their posters in order to encourage discussion - a good idea. However, each poster session was in competition with about six other oral sessions. Until people appreciate that this is a credible way of presenting, and presenters pay due regard to the quality of their posters, this session of congress activities will continue to be the Cinderella session.
Congress newspaper Congress News was a new development in the history of the ICM congress. This daily four-page paper was available to delegates as they arrived each morning. Not only did it give highlights for the day, it reported
some of the sessions from the previous day, brief comments from delegates relating to aspects of the congress and the apres congress programme. There were also some excellent sketches, drawn by Karin Segolson, of participants. This was a worthy and appreciated effort.
Themes which emerged during the congress • Knowledge gives power. • Midwives need to be politically astute and to engage the politicians in their own agendas to ensure changes in the health services which will be to the benefit of all women. However, midwives involved in this type of action will need to ensure that they have a mandate from women to speak on their behalf, otherwise they will be as guilty as other health professionals of being arrogant. • The need for research-based practice. We need to be able to defend our practice, based on credible research. To this end there needs to be greater capacity-building amongst midwives. • Safe Motherhood. This continues to be a
key area for action. Shocking statistics for maternal mortality in some countries were presented, and death owing to childbirth and pregnancy related causes remains a human tragedy. The closing session marked the handing over of positions to the new office bearers. Margaret Peters and Joyce Thompson continue as Director and Deputy Director respectively of the Board of Management of ICM. Sonja Sjoli handed over her chain of office as Alice Sanz de la Gente of the Philippines was inaugurated as President of ICM. She then took the opportunity to tempt us with visions of Manila for the 1999 congress, 22-26 May. If there had been a travel agent on site ... ! In bidding us farewell the Nordic Midwives choir sang the conference anthem, and then everyone's favourite, the Tree of Life. It was quite a sight to see this huge venue with people seated as high as the rafters, arms linked and singing and swaying to the music. What a lovely way to end the conference. Sheila CIows