 All these sessions are recorded and we'll put them up on the website in due course. And so it gives me great pleasure to welcome Dr. Sally Pearman to this final session of the day. Sally is the relatively newly appointed Chief Executive of the International Confederation of Youth Wives. She has held a number of positions over the past 30 years in New Zealand as Midwife Educator and Regulator and a host of other experiences as well, which we have summarised on the website. But I don't want to waste time saying all of that, so I would like to introduce, I would like to offer Sally the mic and off you go, thank you very much Dr. Sally Pearman. Thank you Linda. Cure everybody, it's wonderful to be here, to have this opportunity to close the conference. I can't believe really what an amazing opportunity this is for Midwives all around the world to be in an education session together at the same time and I just think the work that the team have done in putting this together and have been doing for years is really fantastic. So congratulations and thank you for inviting me to take part in it. I want to say too that we're nearly in the Netherlands anyway, it's 11 o'clock at night and so International Day of the Midwife is almost over for us. But we've been in the office today and it's been incredible really because it's been full of messages and videos and contacts from Midwives all around the world constantly all day sending photos and telling us what they've been doing and sending messages to each other and I think it's really quite exciting and amazing and I can see that Suicce is online and I wanted to just acknowledge her as our communications manager because she's done a phenomenal job getting ready for IDM and also today almost couldn't quite manage all of the Twitter that was running so hot so well done to Suicce but well done to everybody and I think what it is is a sign of how much Midwives really enjoy being Midwives and having this opportunity just to share the joy and the fun of it with each other even if only for a day but it's been fantastic so well done everybody and it's great now to be able to close the session. I want to talk a little bit about, oh hang on I have to remember how to change the slides, yeah there we go. I want to talk about who we are and I mean it seems like a bit of a silly question but I think really the answer is not that simple. We have an international definition that's been set by Midwives globally through the International Confederation of Midwives. We all work with women and of course with women is what Midwife means at least in Anglo-Saxon meaning and we all share an amazing opportunity, we have that joy, we all share that joy of being with women in that amazing wonderful transformative life event that is birth. We are in that privileged position of being with women as they become mothers, being with men as they become fathers, we are with families, new families, families getting bigger, we hold new life in our hands and that we share as Midwives that's what brings us together but our lives as Midwives, as practicing Midwives is very different and depending where we live we'll have a big impact on how we practice and how what it's like for us as a Midwife. There are huge variations across the world as I know you know, you know variations in regulation and education and titles and how Midwives are recruited, how women even access education to even become a Midwife, deployment of Midwives, how our services are supported or not within our health systems and you know all of these have a really big impact on the way that Midwives practice. There's been a couple of reports and you can see the photos of the covers here, the SOMI reports that I'm sure you're aware of, State of the World Midwifery reports that the 2014 report identified that Midwives you know who are educated, it basically shows all of the differences and variations in many countries around the world but what it concluded is that Midwives who are educated and regulated to international standards can provide 87% of the essential care that's needed for women in their newborns and that if governments invested in Midwifery education and supported Midwives to deliver community-based primary maternity services, there could be a 16-fold return on that investment in terms of the lives that those Midwives could save, the unnecessary interventions that they could reduce. And we also know that Midwives have different experiences and this report, the Midwives voices, Midwives realities that came out last year that captured feedback from two and a half thousand Midwives around the world and it shows that while we know and we know this that Midwives are deeply committed to caring for mothers and their babies and their families, but most often they are constrained by external factors. And some of the themes that were identified in this report show that Midwives experience lack of respect at work and in their communities, sometimes they are not safe at work, physically not safe, sexually harassed at work, that when they are needing to live in provided accommodation often it's totally inadequate, they are not well paid, they don't get pensions necessarily and many Midwives, all Midwives have difficulty juggling and I'm sure we all understand this, the competing roles of being a paid employee, managing the home and being a mother. There is also a lack of understanding by others about what Midwifery is. People just don't understand what Midwives do and what Midwifery actually means. There is an increasing medicalisation that's happening for all of us in our environment and a devaluing of the Midwifery profession, inadequate Midwifery education and inadequate or non-existent regulation. And that's everywhere, it's not just in low income, middle income countries, it's everywhere. Excuse me, this is a slide from the diagram from the report, but it's talking about the barriers that Midwives face, but underpinning all of these of course is gender inequality and I heard a little bit from the previous speaker. This is a really significant issue for us as Midwives. Childbirth is women's work, it's seen as women's work and therefore Midwives have low social status because of doing that work. And as women ourselves, we also face then a double penalty in terms of the gender impact. Childbirth and Midwifery are human rights issues and in 2011 the ICM adopted a Bill of Rights for women and Midwives that called on governments globally to recognise and support accessible and effective Midwifery care as a basic human right for all women, babies and Midwives. Women have a right to have care from Midwives, Midwives have a right to have appropriate education, regulation and a practice environment in which they are respected and supported to practice autonomously and within the Midwifery scope of practice. This report tells the world what Midwives all know that these basic human rights are still being denied to women and to Midwives. And it's ironic because we know also that Midwives are the solution to so many of the world's problems. We've got these new sustainable development goals now, 17. We could say that Midwifery is only concerned with number three, that we achieve good health and well-being, but you can find Midwifery in all of them. Midwives are the solution and the World Health Organisation has identified that that Midwives are a crucial resource to achieving the United Nations sustainable development goals. There's lots of evidence out there now that care by Midwives is safe, that Midwife-led care produces better outcomes than care led by other health professionals, that Midwife-led care reduces unnecessary intervention, that women are more satisfied with care from Midwives, that Midwives influence the uptake of public health measures, that Midwife-led services reduce health service costs, and that Midwives save lives. So there's much to be gained for countries that establish Midwifery-led primary maternity services integrated within their wider health system. There's much to be gained by developing a Midwifery workforce, making sure that a country has got access to well-educated, qualified and regulated Midwives and that women can access those Midwifery services. So I want to turn now to talking a little bit about partnership. The theme of today, International Day of the Midwife, and I think again as Midwives we share this understanding about partnership because we do have this unique opportunity to work with women in a one-to-one and a very intimate relationship sometimes. But no matter what kind of environment we're working in, we are all with a woman, with women, during childbirth, during the childbirth continuum, and especially for those that can have that over time, but even for Midwives who are working in environments where they don't get to know the woman before they meet her perhaps in the maternity facility, we can still build a partnership relationship with each woman that we care for. And each of those relationships is going to be different because of the two partners, but there's going to be some common principles, equity, that we respect each other. We learn to trust each other, that the relationship is reciprocal, negotiation that we talk through together decides what to do. That women have informed choices, she knows what her options are, she understands them, and is able to give consent. That there is a shared responsibility and a mutual empowerment that comes from partnership relationships. Time, as I said before, is an important element, but every interaction with a woman can include elements of respect, information sharing, choice, power for her, etc. And these kinds of relationships are fulfilling for both parties, and they start to have a flow-on effect to the wider family, to the community. So when women have confidence and strength and feel really empowered through their experiences and relationship with their midwife, they start to stand up and to ask questions. And that starts to have an impact on their sisters and their mothers and their aunts and cousins and their friends. And it can actually start to flow out through the whole community. And midwives have partnerships in lots of ways. Of course the midwife-women partnership is central for those of us who are practicing with women. We also have partnerships with each other. Midwives working together to provide care in a partnership and a partnership. Midwives working with women who also have their midwife-free students working with them. And the midwife educators that they are working with because nobody, it's never just one person who educates a student midwife. It takes all of us. Midwives together performing the midwifery associations. And of course midwife associations in partnership with women's groups which can provide a very strong political voice. Through the ICM, there's a partnership of midwifery associations with the ICM. And the ICM also has partnerships with its global partners. WHO, UNFPA, JAPAGO, UNICEF, Safer Children, etc. And it's by working together in a partnership that we can advocate for change with our partners. We can support each other. We can network. We can share resources. We can build strengths. We can take the same message. We can advocate together to bring about changes. The ICM is essentially that's its job. And you can see here that the vision of the ICM is a world where every child-bearing woman has access to a midwife's care for herself and her newborn. We work with midwife associations to strengthen the midwife's association so that we can advance the profession globally and promote autonomous midwives as the most appropriate caregivers for child-bearing women. Head birth normal and enhance the reproductive health of women and the health babies and their families. The ICM is a non-government organization accredited with the World Health Organization. It has 131 member associations over 113 countries across the four regions of the world and represents over 400,000 midwives. So it can be a powerful voice for midwives globally. I think that the ICM has got a really important role in holding the space for midwives. And really continuing to emphasize and make it really clear that there is only midwives practice midwifery. We have a definition, as I said earlier, about who a midwife is and those midwives practice midwifery. Nobody else practices midwifery. There's no such thing as another health professional having midwifery skills. They have their own skills. They might work in maternal and child health and many do, of course. But we all share some underpinning knowledge, but only midwives practice midwifery. The ICM is the global voice for midwives. It's up to us to always talk about midwifery, to always raise attention around what midwives can do and work to support midwives wherever they are. We know that they do have access to education and regulation and practice environments that enable them to practice the way that they are educated to do. We work with midwives associations, our members in the regions, really working closely with them, trying to strengthen them so that they can take that role and do that advocacy and hold that space for midwives in their own areas. The ICM, through its council and its governance structure, sets global midwifery standards that midwives around the world have supported. Those standards for education, regulation, and the essential competencies then become a global benchmark, which is really important for contexts where we're trying to establish midwifery education, for example, to have a set standard that can be measured against is really important. The ICM develops and provides resources to strengthen midwifery and midwife association. It contributes to midwifery knowledge and professionalism. It also delivers projects with funding from many donors and there are a number of different projects that are happening around the world that the ICM is involved in with partners. The ICM provides technical advice and support at a global level and, as I said, works with global partners, governments, UN agencies, etc. Tries to influence as much as we can the global strategies and policies that impact women and babies and maternal and child healthcare and midwifery and advocates for midwives and midwifery. Some of the I've just put a couple of pictures here of some of the advocacy strategies that are happening at the moment that are important and relevant to midwife and some messages around partnership. We all know that the best partnership for a pregnant woman is with a qualified midwife and that if we have high quality midwifery care for women and newborns then we save lives, we contribute to healthy families and more productive communities. I've already talked about the fact that midwives contribute to achieving the sustainable development goals and we know that midwives are key health influences because we trust it, because we're with women, because we're part of a community. We're much, much more than a pair of hands during childbirth. So midwives, mothers and families, raise your voices to advocate for midwifery and maternity services. Our collective political power can generate change. The services must meet the needs of women and midwives around the world and that's the message that we have from this international day and midwife. We are partners for life. Collectively we have power and we need to use it together. So here we are, midwives, changing the world one day one family at a time and we know that that's true. That's really all I wanted to say to you to close the day. I want to remind you of course of the next big event in our calendar the Congress which is coming up incredibly quickly only a month away now and I'm really hoping that many of you are going to make it to Toronto. We're expecting over 3,000 midwives which is going to be fantastic. But just a little reminder in case you're still thinking about it. And that's it from me. I'm really happy to take any questions or any discussion. So can I ask if anyone has any questions? I have one actually. Sally if you don't mind me start the ball rolling. You mentioned that midwives should not be considered pairs of hands and this nicely links with the question I was devising anyway. We've had a couple of presentations today from midwives working in countries where they are only used as pair of hands where the medics consider them to only be capable of doing basic chores and not to have any autonomous ability to make decisions about the progress of the care of a woman. Do you see the ICM being able to do anything to help these midwives where they're struggling to maintain normality or return to normality and physiological growth? I think you know, under the ICM of that so what can we do? We can join together form an association if there isn't one in those countries. But if we've got a midwives association then we should be members of it. And then what the ICM can do, at least from the head supporters perspective, is try to help to support those medical free associations to actually build their capability and capacity to be able to advocate for midwives in their countries and to start to work out how are we going to address this? How do we take the messages to the decision makers around our health system that this is a complete and absolute waste of resource. That we're not using the skills and education of a health professional that's there that we have and we're using other health professionals like concentrations inappropriately actually by the sound of it. I know these are not easy to change because this is the way that many, many maternity services have developed across the world and midwives are not at the forefront, they're not able to practice autonomously as they should be. And that's our struggle. That's what we have to keep working with. I've got to say that I still think, and we from New Zealand we know this to be true, that if we midwives associations can partner up with women in their communities, build relationships with women's groups and build relationships with women and make a collective voice. Take that collective voice to challenge what's actually happening. If women start to say this is not okay, this is not the kind of maternity service that I want, midwives are saying this is not okay, you know, that's how we can get the message heard. But it's not easy, I don't deny it and it's certainly not a quick change. That's what we want to do is to make that change. I totally agree with you there. And interestingly enough as I asked that question Bucky also asked us a related question, how can the ITM help midwives in developing countries, especially in Nigeria to have a voice? Midwives in developing countries, especially in Nigeria to have a voice, yes. It's the same answer. You have a free association in Nigeria. Join it if you're not already. Work in terms of the association, how can you as an association get a voice? What is it that you need to do? How do you develop your capacity and capability? How can we help you in the ICM? Is there another association nearby? Are there others within the ICM that can provide support within your region to help you build capacity, to help you build confidence? And really it is about taking that step. And it's also about working with women and bringing women along with you to get that voice heard. Sally Joy Kemp from the UK RCM has also continued that vein really. What do you think is the role of National Midwifery Associations in better resource countries in supporting global midwifery? Thanks Joy. I think there are several things. One of them I guess is to keep being a member of the ICM because that's incredibly important. It's really important to the ICM in terms of what it can do that it has got a lot of midwife members. And that's how we can actually be resourced enough to do anything effectively. And I think that the better resource countries have got a lot to offer. They can contribute resources. They can offer support. I mean there's been twinning programs in the past. There's still in quite a number of places there are midwife associations in well resource countries working with midwife associations in less resource countries and actually helping them to build their capacity. And the ICM can facilitate that and help that to happen. But I think also in well resource countries you often have access to forums that other places don't have access to. And so it's up to us in the well resource parts of the world to also continue to take the message. Even if we're in a country where midwifery is autonomous, where midwives are respected and so on we have to continually raise it up and talk about the fact that this is not the case everywhere. That women around the world have a right to care for a midwife. And that it's just plain ridiculous of governments not to recognise the untapped resource that they have. So we can all talk and we can all raise our voices in support of countries where there are a lot more issues than effects on their own. Cynthia has made a comment that she thinks one way midwives can develop a voice is to do more research and publication. Well I think that's true. I mean I think we've seen in the last few years a huge increase in midwifery research. And I think it's fantastic that we're starting to actually get evidence about what midwives can do and how midwifery care can make a difference. And I think it's definitely one way. It's absolutely essential. It's totally important. The thing that depresses me though is how easily dismissed often midwifery research is. So even when we have brilliant evidence from incredibly well done research we often face a situation where those who don't actually want to pair the method or don't want to take on board findings are able to dismiss it and quite often and very distressingly around in many contexts the media buy into this in quite a big way. So I think it's yes research is important and yes publishing is important but we also have to fight the gender battle year again to even get the findings out publicly sometime. And your colleague from the ICM is pointing out that there's a Congress app so that you can keep up to date with ICM Congress News. That's very good. I seem to remember there was one in Prague. I think I'm sure I downloaded that one. Someone has also made the comment that we should be starting with the students. Yes of course we should be. Well we should be starting with everybody but it's very, very important in our midwifery education programs. Teaching students the values and you know the important philosophical views in midwifery. I mean our students need to understand what it is to be a midwife. They need to understand the importance of working in partnership with women. They need to understand the gender issues that they face. We need to be talking to them about that. I think it's really important that our education programs as much as they can find ways for our students to have continuity experiences where they get to actually see what happens to a woman and her family over time. To write through pregnancy, the labour, the birth, the postnatal period. Because that is a unique experience that can change how you feel about what it is that you do. I totally agree. I just think education is so important. We have to equip our students with the skills, the knowledge, the ability to be midwives and help them get the confidence that they can practice. And I think we also have to help prepare them for the reality of the world they're going to step into. They will see it as students of course. But starting to actually do work with the students around how are you going to respond in a situation where you're treated badly by another medical practitioner or in a situation where something goes wrong. How will you challenge? How can you challenge what you see around you in a way that's not confronting but able to actually have an impact. Which is depressing to say that we should also prepare them for the reality because what we really want them to understand and feel is the joy of being a midwife. It's a hard world out there for many many midwives and we should be preparing them but at the same time we should be giving them confidence that they're joining an incredibly wonderful profession. So yeah, totally agree with you. You can't go past education. It's so important. I was just about to ask you, I know if you wish to actually speak the question but I see you put it in the chat box. So one of our participants's questions is how does the ITM support midwifery research? Well the ITM has a standing committee, a research standing committee as it also has for education and regulation. And the research standing committee is active, gets involved with research projects that's been involved with the Lancet series for example, the research there. Sometimes members of the standing committee are representing the ICM in various forums where they are bringing their understanding of research, their knowledge of research. For example I know there's going to be a meeting concurrent with the Congress around helping plan a research agenda for midwifery globally. So the ICM is really trying to support whatever is going on in terms of the search and through its standing committee mainly. It also, the standing committee is also undertaking some small pieces of research. Of course the ICM doesn't have, you know, we don't have a lot of money or anything to run big research projects that we always participate and have participated in them. We participated in the Sony report development, we participated in the midwifery voices, midwifery realities and so on. And that's a role that we can play to enhance research. And of course through the Congress. I mean the Congress is all about sharing knowledge, developing knowledge, supporting midwifery research. We've got four days of fantastic presentations coming up in a month and brought together by the ICM and again regionally. So it happens every three years at the Congress but every other year there's a regional conference of the ICM which is doing the same thing to a smaller extent. So it's all important and it's all about supporting research. You probably shouldn't be surprised by my next question and that is will any of the sessions at the ICM Congress be being streamed so that those who are not at the Congress can follow some of it? I believe that they will be Linda. I think the plenaries definitely are but I don't think that the concurrence can be. No that's a little bit more different. I look forward to that because many of us can't get to the Congress for one reason or another. I thought I wouldn't say that. Susanna it's too expensive unless someone's paying for you. It would be useful to get the information out to the rest of the world so streaming it would be a great way of doing this. We look forward to that. There's more that the ICM can start to do in that direction in the future I hope. There's always that kind of pay off thing isn't there? If you stream it or lots of it people might not come to the Congress and you need people to come to the Congress for their money in order to put on a Congress and stream it. There's a pay off there isn't there? There is but there's so much more that happens at a Congress anyway isn't there which we know those of us that have had the privilege of going. To be in an environment for four days or a week with 3,000 plus midwives, or 4,000 I think actually I might be even underestimating it. It's incredible because it's just such a unique opportunity to be with midwives from all around the world. The scientific program is really important and there's so much to learn and it's brilliant to see so many midwives actually standing up and presenting their work. It's fantastic. But then there's all the networking and the connections and the socialising and there's the talking midwifery that goes on that's kind of another whole experience that just adds to it. If we can take some of that out and stream it and share some of that through the app and through the ICM website and through our Twitter feed then that's what we're going to be doing and Sweche and others are going to be working very hard the whole time to actually take the message out and take it outside of the Congress so that midwives everywhere can actually access some of it. Yes but I do agree it's a wonderful experience especially seeing everybody in their national costumes etc. I've been to three I think of them, yes three and it's a wonderful thing but as someone has said here she can't afford it on her salary. Yes the BIDM is a great opportunity to have that virtual feeling. There was a comment made higher up which I think we should be kind of closing in a minute but someone made the comment that actually the world-resourced countries can learn from the poorly resourced countries in some ways for example breastfeeding which we're not very good at and they are very good at. I completely agree and in fact you know it was interesting we had a lovely conversation today at Morning Tea ourselves in the office and two of our colleagues were sharing who come from countries in Africa and sharing the fact that at a birth and when a mother has a baby there's incredible kind of continual support from her family and from the community and it's everybody's baby and everybody's involved and I was reflecting on that and thinking that in many parts of higher resourced countries we've kind of lost that. We're a little bit more isolated in our houses and we don't necessarily have extended families that are involved with us in that same way or involved with our children and I think that's a sad and I completely agree there's a lot to learn I mean absolutely there is. There's no way that you could say that the developed world or the high resourced world has got it right. Absolutely and Joyce made a final comment here. She's really excited as we have our twinning partners from Uganda, Nepal and Cambodia coming together with the RCM and Zoralto to discuss the long term impact of twinning and reciprocal learning. That's brilliant, fantastic it can be great to see. I wish I hadn't retired before twinning kind of really got cracking. I would have loved to have got involved in such things. Okay, oh yes she says please come to our symposium. I'll try. And Lola from the Wilds of Shetland I know has made the point that the loss of community of birth has caused so many problems. Yeah, because we've lost faith in ourselves haven't we? Yes, faith in our ability as midwives or as women to give birth and that impacts all of us. That's our role to try and build that confidence back up again to help women to trust themselves. Okay, if anybody else have any questions I'm just delaying things a little bit Sally I'm sorry I know it's really late where you are. Deb is preparing our final slideshow and it's slow so we're just waiting to see whether or not she's going to have it ready for us to say cheerio. Hi Lorraine. Linda. Hi I have a question actually who's coming here. So they're asking if the ICM conference in Toronto is going to be on live by internet. Is there any way that it's going to be live through internet? I asked that question just now actually but I'll let Sally reply again. It's my understanding that the plenary session will be live streamed. So not the whole congress unfortunately and there's so many sessions I think it would be pretty it'll be a pretty big tour order but maybe in the future somebody will fund us to do that it'll be brilliant but at the moment I think it'll be the plenaries in the each day, the daily plenary sessions which will be live streamed. And then as I said before there's a lot of work going on in terms of the social media activity to try to get out as much as possible with the experience and the experience of having little interviews with people, stories every day and getting that information out beyond Toronto, beyond the congress venue around the world to provide so that you can feel experience some of it in one way. Fabulous. Okay thank you very much indeed then Sally. That was about a very interesting presentation to finish off our conference. We don't think we're going to have our slideshow ready for tonight so we're going to put it on Facebook and Twitter once it's completed so we're not going to worry about that and we're not going to keep you up any longer. So thank you very very much for coming and honouring us with your presence today and maybe we'll see you again next year or maybe somebody else from the ICL will come next year. It would be wonderful. It wouldn't Dave and thank you London very much for your support and once again thank you to your whole team for doing it. Thanks. I think we've worked brilliantly and you know really really well done and thanks everybody for attending. It's great to see so many people here. Hello special hello to New Zealanders that I've spotted and thank you that's been a pleasure. Thank you very much. Okay so there we have come to the end of the IDM 17 but before we go finally I think we should have a few words of thanks. My colleagues and I have been working on this for seven months now and near enough we start in September with a due date of May which is not quite nine months but it's pretty well there. So I want to thank my fellow committee members for giving up evening weekends and sunny days. We've had a sunny week and I spent much of it at the computer and in Scotland sunny weeks are not very common and we meet virtually quite often at antisocial hours to organise this conference so my very warm thanks to everybody on the committee. I want to also say thank you to our facilitators for their support of our speakers. The facilitators do a one to one sterling job at helping those speakers get their IT sorted and to understand the whole process of an online conference and many of our speakers have presented this time for the first time in an online environment. I would also like to thank the speakers themselves for their presentations. We've had a wide range of subjects and we've had more than a dozen countries represented on the IDN17 and we would like to hear from many more countries next year. I'd like to thank our participants. Many of whom have attended a huge number of sessions and they waited patiently while we dealt with a small number of technical challenges and finally I want to thank our sponsors who are mentioned at the beginning and I've forgotten to go through the rest of the slides here so someone is doing that for me. I will just complete it all by turning off our recording.