 And now the moment I know you have all been waiting for is we get to hear from our speakers and we'll be talking about midwives in focus exploring professional identity, strong midwifery leadership and representations of midwifery around the world. So I'd just like to take a moment to introduce our speakers today. So one of our speakers is Dr. Sally Pizarro, who is a registered midwife, an adjunct associate professor at the University of Notre Dame in Australia, an assistant professor at Coventry University, a fellow of the Royal College of Midwives and an editorial board member of the United Nations Space Midwifery and the International Journal of Child Birth. She's also a panelist on the Nasting and Midwifery Council's fitness to practice investigating committee, a senior fellow of the Higher Education Academy, an invited member of the United Nations Danlos Society International Consortium, midwifery champion for the Nasting Now Challenge and the lead midwife for HEDSTtogether.com. Now Sally has clinical midwifery experience working in the UK, Gambia and Ethiopia. Reflecting on her own experiences, Dr. Pizarro ensures that her work now in research and academia remains challenge led. Now in 2021, Dr. Pizarro won a midwives award from the Eloth Midwifery Trust and a partnership working award from the Royal College of Midwives. In 2019, Dr. Pizarro was honored with a fast prize award from the Royal Society of Medicine in leading and inspiring excellence in maternity care. Dr. Pizarro was also fast runner up for the British Journal of Midwifery's midwife of the year 2019. The overriding vision for Dr. Pizarro's ongoing work is to secure psychological, safe professional journey and excellence in healthcare. So Dr. Sally is one of our esteemed speakers today and she worked on this assignment with one of her other colleagues, Dr. Pandora Hartman, who serves as the Chief Nasting and Midwifery Officer at JHPGO. She has gained 25 years of nurse midwifery experience working in the USA, Caribbean, Southeast Asia, the Middle East and Africa in varying capacities assisting women and families on four continents. She has worked closely with ministries of health and midwifery organizations to provide strategic direction, clinical and programmatic assistance for the design and implementation of global, regional and country level midwifery, maternal and sexual reproductive health programs. When in the US, Dr. Pandora also serves as supplemental midwifery staff, bringing a global perspective to her clinical care of ethnically and socially diverse clients in metropolitan areas. So it is my joy and honor to hand this over to Dr. Sally to just share with us from our wealth of experience around midwifery being in focus. So Dr. Sally, go right ahead, take it over. Thank you very much Susan and thank you to everybody at the Virtual Interstate National Day of the Midwives Conference for the amazing way you've all pulled this together and the technical staff have been highly supportive in enabling me to come here and everyone else. The organization's been fantastic and at the moment I'm actually on vacation. So I have internet as you can see and I have a camera. These are not my curtains. And I don't have my typical glasses on because the only glasses I have with me are my sunglasses. So apologies for that, but I'm excited today to be with you. I see some people in the in the in the room where which I recognize friends, colleagues, et cetera from all over the world. So welcome and thank you so much for joining me today. I'm going to take you through this this presentation which was prepared in partnership with Pandora Hartman who's unable to be here at the moment. Take you through some of the things we've been doing some of the things we've recognized some of the things we want to do and want to achieve going forward. We're also going to share be able to share some voices from around the world with midwifery voices and hopefully at the end of the session I'll be inviting you to share your voices into the midwives in focus work so that we can hear from yourselves as well. In terms of ways forward and things we can do to achieve what we're wanting to do. But this really is a program of work that's been going on for some time that we're excited to share with you today. So, first of all, you know, I'm just going to share with you some images we've got there from Quebec, Quebec, Sudan, Afghanistan. Showing the ways midwives have been working through the pandemic and before that in terms of doing the amazing work they do. I'm really needing to put that in focus and this whole session is going to be about how we put that important work they do in focus. You know, we know what what midwives can do we know what they can achieve. So, so why aren't they kind of really where they need to be right now in terms of that recognition. So this is another image from Kenya there. There's two days left to enter the midwives in focus photo contest. Share your photos and celebrating midwives and then life saving, life promoting work by April 1. Now, this was the first lots of midwives in focus work that was done by Jupygo and in partnership with other partners that you can see there highlighted on the screen. And this was really some of the work that Pandora did before we came together to join forces as a stakeholder group working towards what we're moving to now. So this is almost like midwives in focus part two where in 2021 they were putting midwives in the spotlight with international photo contest, etc. And now we're looking to really pull that work forward and bring it on so that we can actually make some tangible changes from that work. So in terms of midwives in focus what do we mean by that we want midwives to be in leadership positions we want them to demonstrate leadership but what does that really mean that's what we started thinking about. If you wanted to be a leader how do you go about it how do you lead projects how do you know you're a leader how do you know that leadership you're showing is strong. We want midwives to be involved with decision making at every level you know how how are they involved in decision making are they in the right places they need to be when decisions are being made. Because they're able to bring a wealth of experience a wealth of diversity of knowledge into those decisions. So they really need to be there right at the start and at the heart of where every decision making processes happening around the world in terms of health and health care. We want midwives to show critical thinking so not just go along with what's happening but think why am I doing this how am I doing it better. How could I be doing it better and what's my thinking process in terms of how I'm moving this work forward or what I'm doing making what I'm doing better. In that sense midwives have the power to have influence either through more role modeling or doing what they do already or showing others how they how they can do things better influencing at every level in terms of not just midwifery other areas of health care when we look at adolescent health and child health as well. And we have all the tools to do this you know there's nothing new that needs to be drawn out from from what we don't do or don't already know what's come out of the world midwifery report what's come out of midwifery voices midwifery realities. And today we've also got them what midwives want as well as what women want report coming out. We've got the reports we've got the voices there to say this is the direction of travel this is where we need to go. So what we were kind of looking at is why aren't we there why hasn't it happened and how can we get there. So moving towards that solutions focus narrative rather than thinking about all the problems we have getting to where we need to be and leading the way in that. And we felt it was really important. And we know there's core investments needed we need to follow the data that's been a big message and obviously you know everyone's in agreement with that I can't see anyone saying no that's not the right way forward. But how do we do it again so we need to do it in terms of health workforce planning, management and working environment. There are more midwives being invested in in terms of not just the numbers but when they're there how do we keep them how do we enrich them how do we nourish them so that they stay. And they're managed correctly the work work a load is managed correctly and also they're working environment is psychologically safe. It's physically safe it's a place where they can be and thrive and be who they need to be in order to address maternal neonatal mortality that we know they can do. We also need to invest in the high quality education and training. We know that the majority of well lots of people in the room were educators and we know we need to invest in that. And it's not just student midwives we invest in but education throughout the life course so training once you qualify and beyond you know midwives never stop learning. I never stop learning we never stop learning and growing as a profession. How do we share that knowledge how do we build on that knowledge and how do we enrich each other's practice through that high quality education and training, especially with in terms of research and putting evidence into practice and also evidence into our teaching thinking about how we can make teaching research inspired. And then in terms of service delivery how do we get those midwife led improvements making sure that all improvements are midwife led or at least midwife midwives being at the helm of that decision making process in collaboration with other colleagues. And then our own midwifery leadership and governance as well as regulation and how we how we take ourselves forward in terms of that. It is particularly difficult because in so many parts of the world, we're governed differently we're led differently and we have a different licences. So we really need to think in terms of the global perspective of how we invest those core investments into our into our profession. We know that there's a global shortage of midwives, and I particularly know from the UK it's not for want of people wanting to be midwives necessarily. It's people going into midwifery and then and then leaving the profession because it's not what they thought it was or what they thought they could achieve that they've been unable to achieve. Or the work environment is not being psychologically safe for them and they felt they have to leave for different reasons. But midwives are really essential and we know this and I know I'm talking to an audience that already know this, but we have to cover this as essential essential ground and midwives can deliver 90% of essential interventions as well. Really the hardest things there. Oh, someone just coming off mute. If you do have any questions, please do put them in the chat. I'll come back to them later. We have a section for questions at the end. So I will be looking at the chat. Don't worry. But if you if you keep on mute for now, that'd be awesome. Thank you. Okay, so when we talk about health workforce planning management and regulation and work environment Pandora and I really came together and thought about what does that mean. And this is a small list we've got got to go through but it's no way exhaustive and please do add to this in the chat if you feel you have other things to add but as I said it's data systems it's thinking about how do we bring together our knowledge. How do we bring together workforce in terms of thinking about how we work digitally. Regulatory systems, you know, vary around the world. We want to govern ourselves in terms of that. But when we're nurses or nurse midwives or you know a mixture of the two or one or the other. How do we work together to to think about how we sort of streamline that process. Obviously in terms of pay, we know that the midwifery work is underpaid undervalued around the world. And so how do we increase the value increase the status in our society you know throughout the world professions are offered you know status and statue and autonomy for what they do. And they're respected for being the the expert in that area you never have say to a hairdresser that they didn't know how to cut hair hairdressers are the experts in cutting care midwives are the experts in pregnancy and birth. So we really need to get that respected. How do we do that. I see Pandora has just joined the chat. Hello Pandora. Hello, can you hear me. I can hear you loud and clear. Thank you for joining us. Oh, apologies. Technology, it still fails. That is a challenge of being a global midwife. No guarantees. That's fine. We're just on slide 20, which I'm just covering some of the thinking around what health workforce planning management and regulation and in work environment. So I've covered some of the things that have been quite obvious to most of the people in the room because you know this isn't rocket science but I'm just taking them through those things and so I believe you're on the next slide so you can take us through some of that. I've missed saying anything in the earlier slides. Please do fill it fill in the gaps for us Pandora. Absolutely. Okay, so we've talked about opportunities for progression as well. So if you're in a work environment as a midwife and there's nowhere for you to go or there's nowhere for you to thrive and you're a high high high quality high performing midwife yet you can't progress. You're going to look for other ways to progress or other routes you can go other places you can thrive. And we want those people to thrive in the midwifery profession. So how do we create those opportunities for progression for those amazing midwives to do what they do at a higher level and be rewarded for the amazing work they do. And part of that involves civility in the workplace you know respect in the workplace there's a huge problem with bullying in midwifery we know that interprofessional problems lack of respect like undervaluing of midwives again. But if we can get that civility in the workplace then we get that psychological safety in the workplace that we need in order for midwives to thrive. And those opportunities for progression come because people feel valued they go where they're celebrated and we celebrate those who do make a difference and shine in particular ways. And in that again is gender equality which I know myself and Pandora feel highly strongly about that the majority of the world's midwives are female yet they are underpaid and undervalued in terms of their equity. In comparison with male health workers for example. So these are the things we really have to nail down and really have to think about in terms of how we are putting midwives in focus and how we are moving the board in terms of solutions focused stuff instead of looking at the problems. So Pandora I'll let you take this one. Absolutely. And this is a document that we hope many of you are familiar with. And if you're not today is the day to learn many things and perhaps get familiar with it. When we look at the framework for action for strengthening quality midwifery education. I think when we looked globally at this we could see that there were gaps everywhere and I think the gaps are common. No matter what we are working in. But when we look at what we need is just as much of the strengthening of the action from country to country so that when we look at a professionalized workforce when we look at what being a midwife is what are the commonalities even as we look at research and what EBP is and how we're bringing all of the pieces together for the education of midwives as fundamental and functional. You can see there's a lot to this and I'm going to pick out that meaning maintaining clinical competencies particularly in the educational space the awareness of how do we focus on this as a challenge because this can be a political challenge right it can be a financial challenge for many of the universities and higher educational institutes out there aren't necessarily supportive of faculty continuing to maintain that clinical competence even while they are the midwifery educators of the current and the future. What do we need to get to that point. Next slide please. Well this is another one midwife improvements to service delivery midwifery led models of care what does that mean and as many of you may know this is something that's under discussion because even just that simple word we know that that had different meanings for people. What did it mean to be in a midwifery led model of care. Well we know now that we are looking at the continuity of care from an individual midwife or a small group of known midwives as leading to outcomes. What are the contributions to public health reproductive health looking at the issues Sally mentioned bullying earlier of what it means to be in that multi disciplinary team. What is the value that is placed upon the midwife as a part of the team far beyond just the scope of labor and delivery. Next slide. And or you can advance your own slides now see the little arrows there we go. I made you presenter. Thank you. So whenever you're ready just advance and when Sally takes over again will make her the presenter and she can advance. Oh yes lots of fun and Sally and I have plans to go backwards and forwards on this and I. When we look at leadership and governance again global issues what are the senior midwife positions what are the mentorship coaching really wanting to bring midwives in focus we're hearing lots about this particular word mentorship but what does it mean for the midwife specifically who is a leader herself how does she still continue to even be mentored. So as we were talking about this we're being doing a lot of talk about what that continuity looks like. At every level of your particular career path the role modeling how do we even pull this into places who have never seen some aspects of what midwifery all of the aspects of midwifery care look like. How are we pulling in true midwifery leadership to not just do what's safe but to do what's also advocacy and what's also enterprising to lead us to higher levels of leadership and governance. Well we know why is the midwife not even seen in these spaces. Really great article professional identity self development the impact of the media right really great article in terms of she it was called she really just seems to sort of shine. This was an article that looked at the midwife. Her impact upon that entire family what it meant to be a midwife. But in her soul we often think about midwifery as the heart and the hands. But the recognizing as well that it's not the same because sometimes in Western cultures in particular people have come to midwifery from a place of idealism because this is what they wanted to do. From but also recognizing that there's a fair portion of the world where midwifery may not be a choice because of different models of education system where sometimes the youngsters are funneled into midwifery practice. They may not have wanted to become a midwife in the first place or just a hierarchy. So why is she not seen as a leader maybe it's because that identity piece is missing and we haven't done an excellent job of pulling us together. Let's talk about the media. Let's talk about things even okay I'll pick on the US base here about Halloween time right when you see all the images of the naughty nurse or you know the naughty nurse midwife and all of these sorts of things negative imagery that can come. What's the impact upon us as a profession. When we can think of the code epidemic. There was a lot of a hero wisdom out there and I often say a hero a not much sandwich. You know so what did that mean for our internal identity when we are seen as self sacrificing saviors. So these were all the things that we know and we have found to be impacting why they don't see us as leaders why they don't see us as coming to the table. When we've got these images that are less than flattering in many cases or just serve self serve and that impacting the leadership and governance issues as well in terms of if you're an angel well why do angels need to get paid. Questions of why she's not seen as a leader so we decided to look a little deeper. Licensure or regulation who am I there are some of you who are watching today who are nurse midwives some of you who are direct entry midwives. Some of you are many sorts of midwives so it's interesting conversations I think working across. Continents and across cultures because often we are hearing about this issue of conflation particularly with the covid epidemic now right. Is it a nurse is it a midwife who is I and so even Sally and I as partners in this whole schematic together had to have some deep conversations and I'm like Sally. It's midwifery that's in my son she's like no you're a nurse midwife no Sally that was a licensure issue. What does the licensure what does the regulation say for many nurse midwives practicing in America. You have to do become a nurse midwife because that's what the law says but there's often the confusion with who your professional identity is in the larger spaces. So in collaborating and across continents we realize that even an identity. Well we got to be take some of these things out who is it just a licensure issue. How does one describe themselves when we look at some of the Caribbean countries as well the findings that because of colonial structures without being a nurse first. You may have some challenges in terms of the public service and your remuneration and things which we know are very important to maintaining yourself. So therefore it costs us to really begin to want to dig deeper into identity the soul of a midwife with our particular philosophy as midwives versus. Am I called a nurse midwife just because legal financial structural systems say that's who I need to be fascinating questions aren't they. And I think it showed us as well as a team that we need to talk more as midwives from different places and cultures as well about the why. Sally I believe this is your slide when we looked a little bit more at professional identity and the principles around what that meant looking at yourself your soul versus your identity. Yeah, so we looked at professional identity and thinking about how that how that has come to pass and we've looked in terms of occupational psychology as a background for example as why professional identity is important. Why do you need to feel a part of being of a profession who you are when you go to work every day. Do you have the identity of I belong to this group of people or I am this I'm a midwife but what does that mean and then is that projected in society. Do people know what midwives do do do they really know or have they seen it on television as Pandora said or have they they they had an encounter once with a midwife. But midwife don't just catch babies and this is a you know my rhetoric all the time we don't just catch babies. We're not just clinicians you can be a midwife educator a midwife researcher all these different things coming around. But these core principles really came out of those discussions and thinking about how do we identify this and really nail what we're talking about here. So you've got who you are as a person your professional responsibility and what you do at work who you are in your personal life. How does your personal affect your professional do you have do you have value in what you do are you proud of what you do. Are your neighbors proud of what you do are they clapping and cheering the problem can be sometimes as Pandora touched upon we can be put upon this pedestal. Of course once we put on that pedestal we have a long way to fall and that is another problem as well if anything goes wrong. So we really have to think about how do we then think about our quality in practice. Are we allowed to make mistakes without rock or shake our identity even further or are we fallible human beings and we're human like everybody else. We do have to have that kind of trust and confidentiality and and people putting their trust in us I mean they come to us in them in their most kind of important crucial powerful times in their life. They do have to come to us with that trust but if we don't have that professional identity that's respected or valued. How does that impact on families and how does that impact on us when we need to be proud about what we do every day when we when we do what we do. We also need to collaborate with others so I find great strength as a midwife in collaborating with not just other midwives but nurse midwives nurses. Historians occupational health psychologists other psychologists rheumatologists and in all of the work I do. I find great strength in that but I also feel highly valued in that because I am then the only person at the table sometimes with this midwifery knowledge that nobody else has and that's special. That is so special because you're you're the one profession or professional person in a group of or a collaboration of multidisciplinary teams who has that and that's you know your professional identity is part of that. What you know that special knowledge that we have and we share and we give and so they were the principles we were looking at in terms of professional identity. And also one last thing that's just been an identity are evaluation of the challenges that come with identity. The challenges of our identity being so subsumed as a midwife where you live, eat, breathe, think midwifery all the time and the cost of that professional and one self identity when you look at principles one and three being completely all midwifery all the time when we look at the issues of the burnout and we look at the issues of resilience building and when we look at ladies are codependency issues. Yes, there are there, you know that can get can contribute to that feeling guilty feeling bad when things don't go as one would have wanted or our ideal for the woman. So looking really a little bit more deeply to pull some of these issues to light as well. Absolutely bring that out while still giving good care. Yeah, because we can we can it can be like you know you cut through me and all you'll see is midwife there's nothing else. But we are we are whole people and we are kind of thinking about how the personal effects the professional and vice versa in our lives. And that pedestal you know we put ourselves up there as well as the public putting us up there we put ourselves up there. We can't be you know we can't make mistakes we can't be fallible etc. That's a long way to fall. So we need to be you know human about that and kind to ourselves and each other. But in thinking about the professional identity more widely and more solutions focused as I said before we last month published it well March published in the Lancet on midwifery which was exciting because the Lancet you know there's hardly anything published about midwifery other than the midwifery Lancet series and other bits and bobs this was important to get across. And because it was thinking about you know why aren't we valued who do we do we have any role models you know that we have Florence Nightingale for the nurses. And it's just been you know the year in the nurse and the midwife on the bicentenary of Florence Nightingale. But but that's but where's our midwifery hero where is that kind of kind of knowledge and understanding about our own history and how it can shape our future. And so as Pandora was saying before about you know the the the naughty nurse in the media etc. We have like Sarah Gamp and and those historical figures that that kind of an agnodic who who kind of put midwives in a kind of mythical sense of history but not a real sense. You know lived history lived experience of what we've been through where we've come from and where we're going. And that was very well received and I think it's important to think about where we shape our work going forward where we think about next directions in terms of how we come together and shape our professional identity. Well we've perhaps gone wrong in the past or not have the voice to be able to shape our identity in the future. So so I have a read of this paper because it kind of shapes together the the idea of why we need a professional identity and how we might get there in one shape or another. So Pandora did you want to do the self development part or am I carrying on teamwork when we tag team together with how do we continue to improve ourselves. Well these I think are the obvious ones that have been talked about the degrees is what we did. The leadership is what we did before but now focusing a little bit more on some of the softer skills as we focus on emotional intelligence. Who are we what are our learning and community dynamics. We do know that with so many midwives having pulled out into facility based births and facility based birthing models that some of what were once our early historical learnings in terms of the community have been lost through time. What do we look at as data. How will we understanding data as we look at the emergence of digital technology which is not going away. How do we use that for both our benefit as midwives. We know that if these are not fields that we're getting into that we're going to left behind because they're developing the big data platforms without us because we as midwives tend to be a little bit afraid of the numbers or we're not dealing with it. The and the interoperability of systems. What does that mean. What does it mean to say patient wearables versus EMR versus this. So when we look at keeping us in focus we know that these are the self development areas without a deeper understanding that we can never have a total holistic viewpoint of what a midwife is the midwife of our future. Building confidence so that we can be there speaking to some of these areas as well that we may not have thought of. As natural midwife. We've touched on this already looking at this. I'm just going to pull one really fun one in for you nurse midwives for change. That's a massive product that under my work spaces in Jepayga we've been working we've done a whole campaign over the past year that was focused completely on shifting that image and completely on bringing us as midwives. We've put into the focus and using actually other kinds of influencers that are out there with hey your Instagram influencers and your Facebook followers and your tweets tweets excuse me and all the rest of it to really help to shift that perception. And we're seeing a massive impact as now the governments as well are noticing and saying you know what we want to know about this midwifery more. How can we help to finance. Pushing midwifery to the new frontiers so this led us to where we are today with the midwives and focus challenge. And this being our motto I know time is getting short so we're going to move a little quickly and you see here our steering committee. That would and are the thinkers behind why midwives and focus came to be we know that through the nursing now challenge nurses have their day and we came together and said midwives this is going to be our day for the future. So you see here the faces and the shaping of our joint campaign to bring midwives and focus. Workstreams. Sally this is your work stream in particular that she loves. Yeah, so so yeah I'm the project lead for midwives and focus and really I wanted to have kind of this shaped by by people I was talking with along the way and we've done several webinars. Coming bringing people together and talking to people about how should these work streams look what should we do as part of this work. And work stream one quickly was just to bring people together cross cutting themes thinking about evidence based responses to the to the major problems that have been brought up by the reports we've seen. And then we were going to recruit midwives to get into leadership positions, let them advocate let them educate let them activate others so we could really sustain those posts and those influences wherever we could place midwives across the world really. And not just the post but looking at maintaining you as a workforce while you're in service not just educating the new generation, but this is my particular piece I'm sure as you can tell with the advocacy. Read training and sustaining our workforce and our lofty goals here to play some midwives in the prominent regions and other placements to be seconded to support our development further. So I won't read it out because it would take too long, but they're up on the screen at the moment. And we also recruited mariama this is a mariama cafe we asked you know the nursing now challenge said can we have a global solutions initiative. Come forward with your solutions to the problems you see in midwifery that are faced by midwifery now. And we had lots of entries and mariama was our winner so we were able to recruit her from different she worked in all different parts of the world. Recruit her to come on board and really shape the work going forward and we want to recruit more of you as we move forward as well. So what have we done so far like I said a series of global webinars consulting on what we should do engaged a consortium of global partners to think to kind of say how do we move this forward. Is this the right direction. We've solidified our task force the stakeholder group and we've now started early data collection which you will be a part of very shortly. Makes make a safe respectful and natural childbirth available to every woman. We've got some lovely pictures there. Those are from the Mamato center in Trinidad next beautiful. So in terms of the midwives perspective Pandora has sought these wonderful perspectives from midwives around the world. Thinking about including their voice in this. So strongly with really leadership full scope of autonomy. Advocates midwifery is a heart of the professional heart. And Pakistan amazing. Who you may remember as a former ICM board member when we ask them about their questions about their dreams for midwifery their identity. You're seeing as well as we're flashing these slides some of the women who have also been shaping and guiding the midwives and focus global solutions challenges. What were their thoughts as the leaders and shapers we just saw the ACM policy director and of course our young midwifery leaders from Namibia particular in this case. I'm looking at Esther here what were their dreams we asked what were your dreams what do you see as midwives and you can see their. Compilation of their recommendations of what we needed bridging the youth together bridging the elders how academics public policy protocol how can we learn from each other. And what's fascinating is as we bought these leaders together they you're seeing the responses from our global call for nurses. And nurse midwives it's the all over the world to pull together in our global. Solution our global focusing on what is our identity. So you'll see her qr code that you could scan with your phones even as we're sitting here right now today. And contribute your voice to what is the tale that will be told about who we are as a professional identity. We this is up until June 14 we've extended a wee bit because the response has been absolutely overwhelming. We've got over a thousand so far just being out about a month or so. And we want to hear from you. So as they say until the lion begins to roar the story right the stories will be told by the hunter. We will no longer be the midwives whose story is told by someone else. It is time for us to step up and to own our identity and to own our professional future now and into the beyond. Thank you very much Pandora thanks everybody that's the end of our presentation. I put the survey link in the chat so you can please fill out the survey and make sure your voice is heard as well in this work. I'm sorry our time has come to an end but thank you so much amazing. Dr Pandora Dr Sally thank you thank you thank you your work is amazing. And one of the things I love is that you not only told us the theory part you actually give us practical tips we can actually go out and apply immediately in terms of how do I develop myself how do I find my professional versus my personal identity. What does it actually mean and is there hope for the midwife to actually take a seat. And you've clearly shown us that there are those midwives who've gone before and they are taking those seats across the world. So thank you both so much for sharing with us. Just that amazing call to be strong midwives and only to be strong but to have an identity and also to be hard and be seen beyond the crazy ads that we get to see every so often. And Dr Pandora there's a question about the article you mentioned earlier. You said something about she just seems to shine what if you could please type in the chat the article titles. A few people had asked so that they are able to read it in their own time. Thank you all so much for joining us. I wish we had more time because this topic is exciting. I mean because you're telling us about ourselves and how we can improve ourselves. I definitely wish we had more time but we do not have more time we need to wrap up so that we can jump into the next session. Well we will send troops to the website so you can find us on our next interactive webinars so we can still hear from you. We look for the midwives and focus and we shall talk again.