Episode 189 - Midwives Save Lives
Mel:
[0:00] Welcome to the Great Birth Rebellion podcast. I'm your host Dr Melanie Jackson. I'm a clinical and research midwife with my PhD and each episode I cast a critical eye over current maternity care practice by grappling with research and historical knowledge to help you get the best out of your pregnancy, birth and postpartum journey. Welcome everybody to today's episode of the Great Birth Rebellion podcast. I'm your host, Dr. Melanie Jackson, and today we're talking to Kate Stringer from the International Confederation of Midwives. She's the midwife advisor there, and I'm going to introduce you to the ICM, introduce you to Kate. We're going to talk all about what midwives do, our scope of practice, the research behind midwives, why we need them, and the ICM campaign about one million more midwives. Welcome to the podcast, Kate.
Kate:
[0:56] Thank you. Thank you for having us on. We are super excited to be on your podcast and get to reach our message out to loads of midwives and women and families out there.
Mel:
[1:08] Oh, yeah. When you guys contacted me and said, hey, we want to, the International Confederation of Midwives wants to come on to the Great Birth Rebellion podcast, I could not jump on the opportunity fast enough. So I appreciate that you guys sort of saw this as an opportunity. I think it's a partnership made in heaven. Hello, Rebels. If you'll just give me 40 seconds of your time, I would like to personally thank the sponsor of this podcast because that means that you get to listen for free. Poppy Child from Pop That Mama is a doula and hypnobirth practitioner, and she's a sponsor for today's podcast. Poppy has an online course, hypnobirthing course. It's called The Birth Box, and it's already helped thousands of women five-star reviews across the board. And you know me, I am very picky about what I will endorse, but I get behind the work that Poppy is doing. In the birth box. It's practical strategies to help you get ready for labor and birth, but also the challenges of parenting. And with my code, if you type Melanie in at the cart, you'll get 25% off. So if you're preparing for birth, go check it out. You will be so glad you did. The link is in the show notes. Type Melanie at the cart and get 25% off. Thank you Poppy for sponsoring this
Mel:
[2:28] podcast so that everybody else gets to listen completely free. Let's get started on today's episode.
Mel:
[2:36] So Kate, do you want to just give us a quick introduction as to who you are and what your role is at the International Confederation of Midwives?
Kate:
[2:42] So my name is Kate, I'm a midwife advisor at the International Confederation of Midwives and there is a few of us here and we work in a team along with a whole other group of people who help support the International Confederation of Midwives. I've been a midwife for nearly 20 years, worked in clinical practice, policy, education. I'm from the UK, but I've worked in other countries across the world sort of developing midwifery. And what we do is we work to develop and elevate the profession of midwifery across the world. And we kind of do that through lots of different ways, setting global standards. So we have the global standards for midwifery education, the global standards for midwifery regulation, which can be used by countries to help develop midwifery or benchmark their own services in their country.
Kate:
[3:37] We also do loads of advocacy with different organizations. So, you know, we work with people like the World Health Organization, UNFPA, donors to really help them understand what midwives are, what they can do and why the world needs more midwives. We also develop the ICM Essential Competencies for Midwife Free Practice. So this is kind of the scope of practice of midwives that we hope and want all midwives to have all over the world. And that is to really strengthen the care that women and newborns and families can have. And what countries or institutions or governments can and should be doing is kind of looking at those essential competencies and thinking, you know, do midwives in our country offer them? How can we make sure that midwives are able to do all of those things? Because when they do, they make a huge difference to the safety and quality of care for women.
Mel:
[4:35] That's something I want to talk to you about, about what the difference midwives can make, because there's a stack of evidence about that. A question just came to mind, and this is a total curveball. that you weren't expecting but I'll ask it see let's see what happens my question was about the ICM's authority in the world of midwifery yeah do people governments other organizations take the work of ICM seriously and see it as an authoritative body or are you have you kind of self-appointed yourselves as the the bosses of midwifery a
Kate:
[5:10] Really really good question and I'm, We don't have jurisdiction over countries. You know, we are a non-governmental organization. And actually, now this bit we need to get in there before the other bit is that actually we represent midwifery associations all over the world. So we're a member organization. So what we do is support midwifery associations in their country to be the credible voice of midwives, elevate midwifery, work with the governments in that country. So essentially, we represent our members, which are midwifery associations. But within that, some countries don't have midwifery associations, or they're not well funded, or they're not well supported, or well respected. So ICM works with that association, kind of advocate for midwifery, and elevate their role so that they can be the voice of midwifery in their countries. So to go back to the question about ICM's status and body of knowledge, all of the ICM's global standards, the essential competencies for midwifery practice, our advocacy work is all grounded in evidence-based practice essentially. So we work with what does the evidence say, how can we develop that, what is the need globally.
Kate:
[6:32] Really, really excitingly, you know, the voice of ICM is a real credible voice. And actually, people do listen and come to the ICM for technical advice, policy advice, implementation advice, which is really, really exciting because we have that network all over the world with all of these midwifery associations. And we know that one size doesn't exactly fit all each country. You know, they have their own context and challenges. But what ICM has is a vision that all women and families all over the world, regardless of your economic status, where you live, your ethnic background, have the same quality of care and have the same outcomes. And we also have that vision for midwives. We want all midwives all over the world to have the same quantity education, have the same leadership and development opportunities and have the same joy and fulfillment in their role. And so that's kind of essentially what we're trying to do, yeah, is make sure that women and families have the same quality care and midwives also have the same types of experiences.
Mel:
[7:39] Because you guys have been around for 100 years or so. Is that this year, 100 years?
Kate:
[7:44] Over 100 years now, yeah. Yeah.
Mel:
[7:47] And the leadership of the ICM, I have to say, is exceptional. Yeah, I mean, I asked that question tongue in cheek. I agree. I think there's some upward trajectory for midwifery in recent years.
Mel:
[8:00] So, well, let's go through then. Let's start from the very, very beginning. What is a midwife? What is the ICM agreed definition of a midwife?
Kate:
[8:11] So, a midwife is a regulated and educated professional who is responsible and accountable and provides care to women and newborns across their reproductive lives. So midwives can and should be providing care, you know, pre-pregnancy, during pregnancy, family planning, abortion care, birth, postnatal, and then caring for newborns, usually up until six weeks. But some countries have slightly different scopes of practice where they might care for newborn or small children for longer than that. So they need to have undergone an accredited educational program and be licensed and regulated in the country that they're working.
Mel:
[8:53] And so this, in terms of the scope of a midwife, where does the ICM sit on what midwives are capable of, because I feel like the midwifery profession is underutilized within the maternity care system. We're capable of so much, and we're just kind of not allowed to unleash all of our midwifery powers. But according to the ICM, how would you define our scope? What can we do?
Kate:
[9:20] Yeah, great question. And I totally agree with you. So that's where the ICM essential competencies comes into practice. You know, that is what we regard as the midwives scope of practice. So all of those pre-pregnancy, sexual reproductive health skills.
Kate:
[9:38] Antenatal care, interpartum care, postnatal care, midwives predominantly should be caring for healthy, well women and newborns, and they should be the autonomous account professional, but they need to work in systems where there are referral systems and other obstetricians, gynecologists and other professionals where women's needs are outside of their own scope and experience of practice. So the essential competencies guide what midwives can and should be doing and they are based on the evidence about what midwives can provide and what a difference that they make. But we know that not all countries are fully signed up to those essential competencies or that midwives that isn't included in in pre-service midwifery curriculum i saw a really uh cool thing on linkedin the other day and i can't actually credit the person because i can't remember their name at the time but she was doing this teaching session she said and she it for for student midwives And she asked them, can midwives provide adolescent sexual reproductive health? And the student said, well, I don't know. Do you mean in this country or where do you mean?
Kate:
[10:50] And then she said, can a medical doctor provide this particular medication? And everyone said, oh, yeah, of course. No one said which country is that medical doctor practicing it. And I thought that is such a good example linking into what you said before about, you know, we have our own unique body of evidence. We have a clearly defined role of midwives and yet we are underpowered because that role is not really clearly understood and they're slightly different scopes of practice and slightly different expectations of what a midwife can do all over the world and that's kind of limiting the impact of midwifery and fragmenting what what people understand a midwife can be and and the impact that they can have so I thought that was a really good example and actually that's what the ICM is working towards so that all midwives can do the same in all countries. And when that happens, we know that there'll be a significant improvement in maternal and newborn health.
Mel:
[11:54] I'm imagining a time where we could have like international registrations. You know, I'm going to be in my country, but then to just go to another country and be a midwife there and do the same job for women as we could.
Kate:
[12:07] Amazing. We're doing a lot of, that is exactly what the ICANN wants to do a lot of work on, because then that really helps this workforce gap, which is, you know, we're going to talk about the campaign later, but, you know, the world needs a million more midwives. And if midwives can easily move between different settings and countries then that makes a real difference for the workforce gap and you know that there's examples around the world where it's easier for a midwife to leave you know leave one country and go all the way across the other world than it maybe is for her to leave that country and go to a go to another neighboring country in their region and and that's ridiculous you know we we need midwives to be able to move around um their regions and be able to provide midwifery care where there's real lack of midwives and you know i'm in usa is a really good example of that where you know they have very complex registration you know different states require different things and there's huge midwifery deserts there and but midwives can't go and work there because they've got slightly different you know processes around how they qualify and real real workforce issues in africa really similar challenges there where sometimes it's easier for midwives to perhaps emigrate to Europe, Australia.
Kate:
[13:23] These other countries, and maybe go to another country in their region and provide midwifery care. And that's because the pre-service education programs are so different and the requires of midwives. So something that the ICM is doing in the next few months is publishing a global sample curriculum along with UNFPA.
Kate:
[13:42] Which kind of includes all of the elements based on the ICM essential competencies for countries and institutions to hopefully start to adopt, which will really standardise what hopefully midwives can do all over the world.
Mel:
[13:55] What does the research say about the power of midwifery care? You know, we're talking about, oh, we need midwives, we need midwives, how amazing we are. But what is the evidence for that?
Kate:
[14:07] Okay, so, I mean, there's lots of really good quality evidence about the impact that midwives had. There was a really important study in 2021 by NOVA published in The Lancet, which says that by scaling up midwifery, midwives who are working in a neighborhood environment, they're educated to ICM's global standards, you could have a reduction in 67% of maternal deaths. If there was universal coverage of midwifery, 64% of newborn deaths and 65% of stillbirths if midwives were able to cover the needs all over the world. So we know that midwives can provide about 90% of sexual reproductive health care. Again, that was in the Lancet paper. But we only make up about 10% of the workforce all over the world that are working with women and families during their reproductive or pregnancy journeys.
Kate:
[15:06] And so by scaling up that number, we could have a dramatic impact on maternal mortality and neonatal mortality. But not only that, you know, there's many studies that support the midwife's role in improving outcomes for women in terms of psychologically safe births, reducing trauma. The Cochrane Review by Jane Sandall shows that where women receive continuity of midwife care, there's a significant reduction in cesarean birth, instrumental birth, and an improvement in the experience that those women might have. So midwives are ideally suited to be providing rights-based, equitable care all over the world. And if we scale that up, we're going to have a dramatic reduction in maternal and neonatal mortality.
Mel:
[15:54] So essentially, midwives can save lives. There's evidence that by utilizing midwives as primary care providers for women in their reproductive years, that we can tangibly reduce maternal and neonatal death rates. You guys would see, you know, I'm in Australia. It's a very safe place to give birth. We have incredible statistics.
Mel:
[16:22] But you guys see and represent the whole world. What are the problems that you see for women across the world that sort of is the, I don't know, have you got like a focal triage point where you're like, whoa, we, this like, it needs to be a priority right here. What are the problems that you guys see that you really want to focus on?
Kate:
[16:49] The problems in maternity all over the world are kind of complex and multifactorial, but actually... There is lots of similarities between the global north and the global south. You know, what we know is that in many settings, there's too much intervention, you know, that isn't grounded in evidence. It might not be what women and families necessarily want at a population based level. And that happens in low and middle income countries all over the world.
Kate:
[17:20] Sometimes there's a real disparity, you know, between even in individual countries or cities, you know, and in between hospitals, you know, cesarean birth rates can dramatically differ. We also know that in some parts of the globe, there's too little intervention. So we call it too much, too soon, too little, too late. That actually in these midwifery deserts, in fragile and conflict-affected settings, you know there may be no midwifery care no obstetric care no tertiary level hospitals so if women do need intervention help if there are concerns for themselves or their babies there isn't any available option so you know both sides of the spectrum and they often exist within the same country or or the same region we also know that there's loads of evidence that that women's needs are unmet. There's growing levels of dissatisfaction with pregnancy, anxiety, birth trauma. The numbers of women that are telling us that they're anxious, they're worried, or maybe they didn't feel that they had rights-based respecting care is growing. And actually, that's growing all over the world as well. So sometimes the solutions to these problems may differ depending on the country or the region, but actually the overarching themes remain fairly similar across the countries.
Mel:
[18:46] Well, the current dialogue around maternity care is this push towards respectful maternity care that is safe physically but acknowledges and prioritises the emotional, social, cultural, spiritual, psychological, mental safety of women as an equal priority to physical safety. And one of the big solutions to the problem of disrespectful maternity care, the research keeps coming up to show that women are asking for the care of midwives. And so while, and I think you're right, that the problems are universal. You know, even here we've got rural settings where we have to fly women out of their communities and bring them to tertiary centres just to get access to care. Whereas if you're in Sydney or a city, you could choose three different hospitals and have high-level tertiary care. You know, it's this weird juxtaposition even here and in the US, as you were talking about with maternity care deserts. But I think you're right in saying that a lot of the problems that we see, regardless of where women are, midwives seem to be the solution.
Kate:
[20:05] Particularly where they're working in midwifery models of care, where they're able to provide continuity of midwife care, either through individual practitioners or as small groups of midwives. And, you know, the evidence is really strong about that. And in, you know, the last year, there's been some really strong policy documents from the World Health Organization. You know, it feels like a really exciting time to be working in midriff because, you know, these big organizations, you know, the World Health Organization has done a global call for countries to transition to midriffing models of care
Kate:
[20:41] because the evidence is so overwhelming. And like you said, it's not just about physically safe outcomes, but that's really critically important. But women need psychologically safe outcomes where they feel supported, empowered. And when they do, that transition to parenthood can be really profound and make a huge difference on the woman in the family for the rest of her life.
Kate:
[21:04] The evidence that midwives can do that is great. But often when we're working in those midriffing models of care, where we can develop that relationship with women so that we get to know them, we understand what they need and want. And actually, you know, that can be implemented in lots of different ways, in lots of different settings. I think historically we often hear that that can only be done in this certain way. And yes, midwife continuity of care does need to be implemented in effective health systems, you know, with referral systems and support for midwives. But there's really good examples of that happening in humanitarian settings, in low-income countries and in high-income countries. So we just need to kind of bring all of that evidence together and think about how we can make it work for more women.
Mel:
[21:53] There's no doubt that midwives have the skill. It's within our scope. We can make a difference to women and solve some of the problems that we're seeing for women in their childbearing years.
Mel:
[22:05] My next question is about what problems does the ICM see in the maternity care system? Because particularly for midwives, and here's where, you know, here in Australia, we recently did a review of maternity services, and we discovered that midwives here, and this is not isolated to Australia, this is happening currently in the UK as well, is the current, you know, really big groundswell of issues there. Midwives are becoming increasingly dissatisfied with their work as midwives we've got a really short career now because we're burning out there's a lot high level of moral distress with the types of things that we're seeing and with the jobs we're expected to be doing because our role and scope as midwives is not really being fully respected or utilized and we don't want to be relegated to sort of an obstetric nursing role. We want to work to our full scope and do the amazing things we know we can do. The issue that I'm seeing currently in maternity care and people are feeding back to me all the time through messages is that we desperately want to be midwives. But the real issue is we're kind of working in unsustainable workplaces for our own mental health.
Mel:
[23:26] Is the ICM, does that reflect what the ICM is seeing with midwifery at the moment or do you feel like, because I'm in a little box here, I probably get all of the really sad stories, but are you seeing a different trend to what I just described?
Kate:
[23:42] Midwifery is a challenging profession in many different settings across the world and a lot of what you've said there does resonate with midwives in many different settings. What we see is that i've talked about that sort of confusion between nurses and midwives so a lack of professional identity for midwives what is a midwife what can she do does the community and her colleagues understand that and and and within that sort of a lack of leadership and development opportunities you know are midwives supported in their professional development in some countries You know, you can only go on and do a master's or a PhD if you're a nurse or a medical person and a midwife that doesn't have those same opportunities. Are midwives sitting at the table where decisions are made so that they are able to influence those decisions and really explain what a midwife is and what she can do? And I think like you've touched on, you know, midwifery is an emotional role. It's really emotionally demanding.
Kate:
[24:48] Myself and others, you know, we will have experienced moral distress in our role through that real conflict of the care and provision that we want to provide versus what is feasible sometimes. So the ICM does see that. We're doing quite a lot of work with Figo at the moment around interprofessional collaboration, which feels really exciting as a clinician from my past. You know, I know as a midwife, we need to have really effective working relationships with our obstetric colleagues. That's what makes a difference. That's what women and families want, you know, that we're all working together to meet their needs in the way that they want. So we need to think, how can we make sure that we're working in really respectful working environments so that that translates to women and families? So, yes, you know, there are lots of challenges that are going on. And I think that's why we need to continue at ICM and with everyone else, you know, really continue to raise a profile of midwifery, help people understand what there is out there. But also there's loads to love about midwifery. You know, I absolutely love being a midwife. The true joy, I'm a self-confessed birth addict. So, you know, I love working with families at birth. It's super exciting. I never don't feel the privilege and honour to be with people at that really exciting, vulnerable, transformational time in their lives. So I would urge midwives out there listening to kind of hang on in there.
Kate:
[26:17] Together, we are much stronger. At ICM, we do a lot of work to kind of help. Work with the midwifery associations, develop networks. We have regional professional committees. We have regional meetings, regional workshops. The Congress is a huge opportunity to get everyone together and really kind of celebrate our profession. And there's so many different spaces in midwifery that we need midwives, you know, in policy and regulation and education, in advocacy that, you know, there's lots of different opportunities. And I feel like the world is waking up. At ICM, we're working a lot around midwifery leadership. So working on a leadership academy, working on connecting people together to kind of really help midwives be in those spaces where we can hopefully start to shift some of those working environments,
Kate:
[27:07] policy things and opportunities for midwives.
Mel:
[27:10] Yeah, I do think we're on the cusp of something. It feels like there's a buzz in the air and that things are aligning and soon midwifery is sort of going to launch itself in a big way through the world and we're all going to be confused about the time where remember when we were fighting just to work as autonomous clinicians do you remember that when oh my gosh everything was so heavily supervised by every other profession one day we'll be like no we just go about our jobs as if we're you know autonomous health professionals so then the ICM sees the solution to the the global world problems for women and midwives. The campaign that you guys are currently working towards is for 1 million more midwives. Before we start on that,
Mel:
[27:56] Is there any? So, okay, I spoke to a midwife two days ago on the podcast and she's like, and she was, I don't know about this one million more midwives, Mel. I reckon we should just utilize the workforce we already have and we just need to get the current midwives actual jobs that they want. This is something that comes up all the time is the students graduate and they think, oh, great, I want to go into MGP program. I want to do continuity of care midwifery. I want to join the local public home birth program, whatever. And there's just no jobs. There's no job opportunities. And they desperately want to be midwives. So, I mean, she was like, she was very uppity about it. And I thought, ooh, I said, actually, I'm talking to Kate from the ICM, um,
Mel:
[28:47] And I do agree we need more midwives. And I think over the world, units are short-staffed. They're doing long hours. And then midwives are struggling to find the place where they want to work. So the campaign is for one million more midwives. Yeah. So what's the plan?
Kate:
[29:07] Well, we know from the State of the World's midwifery report that we are nearly
Kate:
[29:13] one million short midwives all over the world. And as I said before, midwives can provide up to 90% of sexual reproductive health care, and yet we only make up about 10% of the workforce. Midwives are really economically sustainable. They're really good value for money in really underserved rural positions. Often midwives are the only people working in that community providing maternity care to families. And therefore, we really need more of them. Yes, you're right. You know, there's pockets of challenges around recruitment, retention. You know, we can't just increase the workforce without doing all that other word that I've talked about around having career opportunities for midwives and supporting them in practice and making sure that they're working in enabling environments. And certainly, if people have been educated in a pre-servant official program, they need to have a job to go to. That's madness. You know, if governments are allowing that to happen where, you know, they've spent all this money educating someone and they haven't got a role to go to. And that's where we need midwives at these really kind of policy and workforce positions. And, you know, the ICM would advocate that every country has a chief midwife. You know, her role is then really working with the government about what midwives can and should do and helping with that workforce strategy.
Kate:
[30:33] But why we need one million more midwives? The campaign is we are urging on the midwifery associations to work in their country, in their region to get more signatures on this petition.
Kate:
[30:48] And what we're going to do then is at the ICM Congress, present this petition to really high level government stakeholders and demonstrate, look, this is what we need and call on the governments to make a real commitment to make a difference. So every person that signs this position is saying, I know and I want and I need a midwife or I am a midwife and I need more people on that shift for me. And then what we're going to do with all of this evidence is really present it all over the world to as many different people as we can. And united, we will make a difference. You know, that's what the ICM is really about, kind of bringing people together. We need to stop all these fragmented and speak as one voice as midwives about what we need so that women and newborns get the same care all over the world. What we're going to do is then help the midwifery associations to kind of use this data in their own country to really advocate with providing tools and resources to them to make a difference.
Kate:
[31:48] People can find out loads more on the millionmore.org website, and that's where they can sign up. We need lots more people to do that. But if we get more midwives, we're more likely to keep hold of the midwives that are already working. Because the shift towards midwifery works, people understand what a midwife is and what she can do. And we're able to support each other with sustainable workloads. And actually, you know, there's that kind of workforce optimization.
Kate:
[32:22] You know, there's lots of things that other people working with families during pregnancy and birth do at the moment that midwives could do. And I think sometimes we're not able to do those things because there's not enough of us. So, you know, we are prioritized sometimes in some institutions, you know, to just be providing services. Interpartum or labour care. And that's because that is often the most complex and risky period of that pregnancy. But that doesn't mean that we can't provide all of this free pregnancy care, antenatal care, postnatal care. But if there's not enough midwives to do all of that care, then we're having to make, or institutions or governments are having to make really difficult decisions about where to prioritise midwives. But we can do a lot more. And we know that women and families really value having that kind of wraparound care where it's the care from a midwife that they know throughout that first pregnancy and maybe in future pregnancies that midwife is respected in her community and able to provide all of that sexual and reproductive health care but at the moment that doesn't happen because there's not enough of us to go around.
Mel:
[33:33] It's a lofty goal it's kind of sits as a beacon it's like here's what we're aiming for and then And it's up to individual countries and organisations to comb out and tease out the detail of all that from the bottom up. You know, it's one thing to pour students into the universities to learn about midwifery. And then the hospitals go, oh, we only have room for 10 students this year. We can't, you know, there's all these little roadblocks that we come up against that at each level, you know, if the universities or the governments go, great, we'll fund a hundred more midwifery places, no problem. And then the hospital's like, well, we're not going to take a hundred more students. And you're like, oh, there we go. Now we face the next problem.
Kate:
[34:16] Well, absolutely. It needs to be done in a safe, sustainable way. Increasing the midwifery workforce is not often a very quick fix. It needs to be done. You know, we are highly educated professionals and to be able to do the full range of the essential competency midwifery practice, that takes time to make sure that we're able to do it properly. But if we do do it properly, you will get those significant outcomes.
Kate:
[34:42] You know, we can't cut corners really in developing highly educated midwives.
Mel:
[34:47] I'm curious to know how the 1 million midwife number, how did that get calculated? How do we know that that's the golden aim?
Kate:
[34:58] Good question. So it comes from the State of the World's midwifery report. And there's a lot of detail in there around how the numbers are made and there's lots of complex calculations. We had some meetings recently actually to try and, you know, dig into it a little bit more. Because that's one of the problems in our profession. And I've touched on it a little bit today already, you know, that... Not all countries have really good quality data. Definition of a midwife might vary in different countries. Sometimes midwives, they are listed as a midwife, but actually they're not deployed in midwifery. You know, maybe they're working on a medical ward somewhere. So it is quite difficult to capture the data, but they work all of that out in different countries. And then what they also work out is all of the different activities that our midwife could be doing based on the essential competencies versus all the different activities that other people are doing. And then to work out, you know, for a midwife in that country to be able to do all of those different activities, this is how many more people you would need. So lots of very, very clever data analyst type people work it out. But it's been tested and published, you know, in places like the Lancet. So, you know, lots of people have had a really good look at it and they're pretty confident that that is the number. And, you know, unfortunately, it's likely increasing that we need more.
Mel:
[36:26] Sure. Yes. I mean, as the population increases, they might be having more babies, all the things. And we'll make sure, you know, all these papers and links that Kate's been talking about, they'll be in the resource folder of the, if you're on the mailing list for the podcast, you will get access to the resource folder. So we'll make sure all these research papers are there. I'm sure there are listeners for the Great Birth Rebellion podcast who just love to comb through all of this data, which is why I'm asking, because people are going to be like, well, how did they get to 1 million? We want to know. So you can have a look at the resource folder about all the
Mel:
[37:00] evidence behind midwifery care and the efficacy behind that and the few papers that you mentioned. So 1 million more midwives, it's essentially all we need to do as members of the public and midwives is sign the petition.
Kate:
[37:15] Yeah, and it is like less than five. You just need to go onto the website, so millionmore.org. And then literally fill in your details and click. And then what you can do when you see there is to see how many people have already signed up. Once we get the data, we'll be breaking it down into the regions as well so that we can see how many people have signed up in more places. Please do sign up. It only takes a couple of seconds. But these things actually really help with advocacy, high level advocacy actions, you know, calling on government. For too long midwives and midwifery voice has been silenced and I think your podcast is perfect for that now yeah you know you can't be a rebellious group of staff and we need to stand up now and and be counted and women families who want a midwife or know what midwives can offer can make a real difference in helping call for more midwives you know not only in your own country but by adding your voice to the petition is making sure that there's more midwives all over the world because all women and families need a midwife.
Mel:
[38:22] Change happens in these teeny tiny little bite-sized increments and if there's already something happening in your country and then you add the ICM voice and then your association is strengthened and then, you know, here in Australia we're getting chief midwives in every state and slowly that's happening. You know, there's lots of tiny little increments that, you know, So we've had lots of inquiries, like governmental inquiries into maternity care and into the maternity service. And so then, again, there are people petitioning. And so then if they can go, oh, and by the way, we've got this huge petition from the ICM and, you know, 100,000 Australian women and midwives signed this petition. So that's what the governments are there for is to advocate for people, you know, to do what their population is asking of them. so you know wherever you are adding your voice only helps your country but the world So we'll put the link so you can sign that petition. If you just scroll under the podcast, wherever you're watching it, we'll put a link there. You can click directly from there and sign the petition. Kate, is there anything else you want to share before we wrap up?
Kate:
[39:32] Just thanks so much for having us on. The podcast is great and, you know, obviously influencing lots of people and it's great to listen to quite a few episodes in the run-up here, so that's been fun. And, you know, just keep on with the work. There's so much information on the ICM's website. So if people want to know more about the International Confederation of Midwives, have a look on the website. For midwives out there, there's loads and loads of resources. So, you know, if you, you know, all of the global standards are there. The essential competencies are there. Other policy documents about midwifery models of care, midwifery birthing centers are all there. So, you know, if you're facing challenges in your practice, in where that you work, you need extra evidence or resources to help you, then have a look on the ICM website. Like we touched on already, you know, fortunately, the ICM is a really powerful, incredible voice. And so we want more people to be able to kind of use what we've got in their role to really elevate and strengthen the midwifery profession. If you're women and families out there, you can do exactly the same. You know, have a look at what midwives can and should be doing. You know, are those the services that are being offered to you? Are those that you should be able to receive? And think about how you can use that to help put pressure on your services or institutions to be able to offer families what they deserve and need.
Mel:
[41:01] Yeah, it's a great reminder, actually, because a lot of people feel powerless to, they think, oh my gosh, who would I even talk to? If I wanted a continuity of care program in my area, who would I even talk to? Well, the fact is in a lot of places, maternity care is publicly funded by taxpayers. And if you, for example, found something, I'll give you another practical example. A midwife contacted me and said, hey, with your water birth episode, I petitioned our hospital to start offering water births. And the obstetrician said, if you can provide me with some evidence that this is an appropriate and safe option, I will help petition this hospital for baths to go in there. She literally went into the podcast resource folder, printed off all the water birth resources and research papers, kind of created a little bit of a presentation and made an argument about why we should be offering it. And now they have water birth in their hospitals. So what Kate's saying is on the ICM website, there's all of these little resources. If you, for example, even as a woman, as a consumer, as a midwife, whoever you are, and you think I want to start a midwifery group practice program through our hospital,
Mel:
[42:18] There's resources that you can go, hey, the ICM advocates for this. Here's the research papers. I mean, go into the Great Birth Rebellion resource folder to print off as many papers as you possibly can, create a little bit of an argument about why we need to offer this and why it's going to improve safety for hospitals but also talk about the costs, the fact that it is cheaper for women to receive midwifery care with equivalent outcomes, sometimes even better. But there's all of these resources available and it's literally about finding a person to give these to and just start making some noise. So Kate's saying that all those resources are on the ICM website as well, which is really super helpful. I'm glad you mentioned that. Well, I think we've done it, Kate. So really, your job, everybody out there, I would say two jobs. Click on the link and sign the One Million More Midwives Petition. Nearly a more midwives. Please. Five months left. It closes around July, June, end of June.
Kate:
[43:22] Yes. We're hoping in the run-up to International Day of the Midwife on the 5th of May, we'll be able to really elevate this petition. And then at the Congress in June will be the closing date where we present it to the stakeholders that are at the Congress.
Mel:
[43:39] Great. So wherever you're listening, if it's prior to May 2026, sign the petition if it's after that we may have ended but there's still something you can do the other thing you can do is you can always be petitioning your local services for what you want it's not as hard as you think just start the ball rolling pick the low-hanging fruit that midwife picked water birth and she's like I want to get baths and she just spoke to the right people and boom there's baths in the birth unit so there are there's low-hanging fruit for everyone if you're a midwife or a consumer and the ICM is here to elevate all of that thank you so much Kate I will be at in Portugal great
Kate:
[44:19] I'm so looking forward to seeing you in person that'll be really fun I'm sure we'll be running around like crazy things but I hope to be able to see some things myself as well and and you know really looking forward to connecting with so many midwives you know people say that the congress is super super special
Kate:
[44:35] and to get us all together so I'm really looking forward to that.
Mel:
[44:38] Yeah it'll be the first time I've been able to go i'm bringing my whole family to portugal and uh and we've sponsored we've sponsored the program for i said great birth rebellion so hopefully we'll be all over everybody's you know fantastic thanks so much kate that's been this episode of the great birth rebellion podcast click the link sign the petition and pick the low-hanging fruit that you can do to help elevate midwifery and increase the safety for women all over the world in their childbearing years. I'm Melanie Jackson, and we'll see you in the next episode of the Great Birth Rebellion podcast. To get access to the resources for each podcast episode, join the mailing list at melanethemidwife.com. And to support the work of this podcast, wear The Rebellion in the form of clothing and other merch at thegreatbirthrebellion.com. Follow me, Mel, @MelanietheMidwife on socials and the show @TheGreatBirthRebellion. All the details are in the show notes.
This transcript was produced by ai technology and may contain errors.
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