In my career as a midwife, I have been to many midwifery conferences, but this year's BJM conference was the most valuable. It gathered together some of the best speakers in the midwifery profession and covered many aspects of optimising women's experiences during childbirth. The venue, Manchester Central, was comfortable and spacious, and we delegates had the advantage of sitting at tables rather than in rows of seats, to facilitate note-taking.
Frances Day-Stirk kicked off the conference with a comprehensive tour of the global perspective of normal birth, looking at the four main world areas: Africa, the Americas, Asia Pacific and Europe. She highlighted that each area has a different definition of ‘normality’ in childbirth and that, consequently, all areas present different challenges for midwives. Because midwives in the UK care for mothers from around the world, we should consider that our definition of ‘normal childbirth’ may not match theirs, and this has implications for how we deliver optimal care for them during their birthing experience.
Professor Soo Downe took us through some of the issues affecting normal birth today. Rates of spontaneous vaginal birth continue to fall across the industrial world (World Health Organization, 1996). Professor Downe highlighted the importance of the new National Maternity Review (2016) for changing this trend, and looked at emerging evidence to support normal birth. For example, there is evidence that during the birth process, the baby's gut is seeded with microbes that may help prevent infections in infancy, which makes normal birth an important process for the newborn. Professor Downe also pointed out that although midwives tend to encourage mobility in labour, there is no formal evidence to conclude that this actually helps the process along.
Dr Tracey Cooper highlighted that place of birth is important to women, and we need to get it right if we are going to achieve satisfaction for women in childbirth. Dr Jennifer Hollowell delivered a packed session on the influence of birth place, saying that women should be informed that giving birth is generally very safe for mothers and babies (National Institute for Health and Care Excellence, 2015). She went on to present the findings from the National Perinatal Epidemiology Unit's Birthplace national cohort study, which examined the birth outcomes for different localities: obstetric units, homebirth, free-standing midwifery units (FMUs) and alongside midwifery units. The statistics she presented suggested that FMUs may be considered the best place for women to achieve a normal birth free from intervention and with a lower risk of third- and fourth-degree tears.
Dr Mary Ross-Davie presented findings from the Keeping Childbirth Natural and Dynamic (KCND) study (NHS Health Scotland, 2010), which aimed to maximise opportunities for women to have a birth free from intervention. The researchers raised the profile of midwives as the first point of contact during their pregnancies and developed new pathways and guidelines for care of pregnant women. As a result, the proportion of women going directly to the midwife for pregnancy care grew; however, an unintended repercussion was that GPs were sometimes left unaware that a patient was pregnant, which led to prescribing problems and GPs feeling unhappy that they were excluded from care.
Successes of the KCND study included:
Consultant midwife Jo Wright of Heart of England NHS Foundation Trust spoke about optimising birth for women from minority ethnic groups. Births to women born outside the UK now represent 27% of all births. These demographics are important, as Black and Asian babies are at a 50% higher risk of stillbirth, and we need to have a service that meets the needs of the population. Statistics show that the total fertility rate for women from minority ethnic groups is higher than for White women. Jo highlighted that for optimal maternity care of minority ethnic women, we must:
Royal College of Midwives Director for England, Jacque Gerrard, emphasised the importance of good leadership for optimising women's experience of birth, also highlighting the importance of having enough midwives who practise evidence-based care. Kathryn Gutteridge also drew attention to the fact that, as midwives, we need strong clinical leadership to optimise the birthing experience for childbearing women. She said that too many midwives are working in fear, which results in clinical practice being affected, innovation being scarce, quality being sacrificed, and defensive models of care being used.
To avoid this, we must be brave, positive, honest and compassionate in our practice as midwives. Most of all, we have to set an example. In this effort, Debby Gould said:
‘We may fail—and we may fail more than once—but the real failure is when we stop trying.’
Professor Jacqueline Dunkley-Bent, the current interim Head of Maternity, Children and Young People for NHS England, talked about national policies that will enhance the delivery of professional midwifery care, particularly the NHS Five Year Forward View (NHS England, 2014), which proposes a care model for modern maternity services, and the National Maternity Review (2016), which discusses how best to sustain and develop maternity care services.
Professor Dunkley-Bent supports midwifery supervision and believes it should remain as part of the function of the profession. Carol Porteous also spoke in support of midwifery supervision; she actually held a vote in the conference asking delegates if they thought midwifery supervision should stay, following recent criticism. The vote suggested that most midwives at the conference were in favour of keeping midwifery supervision.
Dr Denis Walsh reminded us that the next generation of midwives must understand normal birth, and we must make sure that, by the end of their training, they are able to:
Dr Bryan Beattie dressed up as an Native American chief to illustrate that ‘professional tribalism’ has to stop and that all the professions involved in obstetric and midwifery care need to have good communication lines to deliver optimal care for childbearing women.
Nicolette Peel offered a moving account of the work the Mummy's Star charity, which helps mothers cope with a diagnosis of cancer during pregnancy and beyond. The organisation provides comprehensive, easy-to-understand information about cancer in pregnancy, aiming to save families time and stress.
Overall, the conference left us with the message that we can optimise normal birth for women if we work together, and Jacque Gerrard provided a ‘cake recipe’ for an optimal maternity service (Box 1).