 I would like to go ahead and welcome session A, the World Health Organization Guidance on Maternal and Newborn Health during the coronavirus pandemic. This session is going to be presented by Mrs. Elizabeth Eero, the Chief Nurse of the World Health Organization, and Fran McConville, the lead midwife of the World Health Organization. I would like to go ahead and welcome Elizabeth. Elizabeth has a very extensive biography in maternal care. Before joining the World Health Organization, she had more than 30 years of experience in public health in the Cook Islands and regionally. She was Secretary of Health for the Cook Islands. She implemented health reforms to strengthen the country's health systems, and this involved developing many roadmaps and strategic plans for that. She also served as the country's Chief Nursing Officer and Acting Director of Hospital Health Services. For the first 25 years of her career, she was a staff nurse, midwife, and charge midwives at hospitals in the Cook Islands and New Zealand. It truly gives me great pleasure to welcome Mrs. Elizabeth Eero to the conversation, and I'm just going to give you over a microphone. Jane, thank you very much. I think I just want to say the World Health Organization is definitely very honored to be joining the Virtual International Day of the Midwife and to share a recorded message from the Director-General of the World Health Organization, Dr. Tedros Gebreasis, on this very special occasion. So we'll start off with a message from the DG. Thank you. Thank you, Jane, for sharing that and for that video recording with everyone. As I said earlier, it's a real honor for WHO to be participating in this event. And I wanted to say a few more words, and to start off, I wanted to pay respect and tribute to the midwives who have died in the line of duty during this COVID-19 pandemic, and I extend my condolences to their families in France. May the 5th is a special time for midwives, and this year even more so because it's happening in this international year of the midst of the midwife. And during the worst global pandemic we have ever experienced, it is special because it is about you, midwives. Midwives, alongside your nursing colleagues, are responding to the COVID-19 outbreak, placing yourselves at personal risk of contracting the disease, working longer hours at risk of physiological distress, fatigue, burnout, stigma, and physical, in some instances, psychological violence. And additionally, we're finding midwives are being placed away from expected mothers and newborns in some countries. You are being referred to as the heroes of our time. You continue to bring humanity through ensuring the continuity of respectful care, the companion at the birth, the skin-to-skin contact, and the respite and support that you so ably provide. I know that as you have accompanied women throughout history, you will continue to be by their sides throughout this pandemic and beyond. The midwifery profession demands exceptional knowledge, skills, patience, and compassion. I congratulate those students who have chosen this profession as their career choice. I know that because of your courage and conviction, you continue to care for women and their babies, even when you are working in the toughest of environments and conditions, applying principles of infection prevention and control measures to ensure safety for both mother and baby. Your actions are courageous and selfless, and I thank you. The midwifery profession also demands up-to-date data and evidence. And I thank our midwifery researchers and educators for the work they do to inform and advance the practice and the profession. I want to take this time also to congratulate Caroline Homer, who has recently been appointed as the chair of the WHO Strategic and Technical Advisory Group of experts for maternal newborn child and adolescent health and nutrition. May the fifth is your day, the International Day of the Midwife. Celebrate, knowing that WHO is not only profoundly grateful to you all for the care you provide, the sacrifices that you make, and the extraordinary impact that you have on the lives of women, newborns, and their families everywhere, but that we are committed alongside our partners to continuing to support the strengthening of midwifery globally. Thank you, midwives, celebrate your day, take care, and stay safe. It gives me now great pleasure and honor to introduce Fran McConville, the midwifery technical lead in the World Health Organization at Headquarters in Geneva to continue the WHO presentation along the guidance on maternal newborn health during the COVID-19 pandemic. Thank you, Fran. Hello, everybody. And thanks, Elizabeth, for setting the scene there. And a huge thanks to Jane and her team for setting this up and asking WHO to speak. And also happy International Day of the Midwife for me. It's fantastic actually being here in the UK and starting a little bit earlier. I love it. And I hope you all well. I think it's fantastic. So many people have been able to join and I hope you keep well in these difficult times. So we all know about COVID-19 and I just thought it would be helpful to put out a summary of some of the information that is coming out of WHO that would be especially helpful for midwives. And it is difficult as midwives and nurses sometimes to get hold of this information. I've covered quite a lot of ground here. So I'll keep moving through it but please do ask questions at the end and hope that we can answer most of them. Things are moving fast as you all know but we'll do our best. So first of all, I thought I'd just give the update on the evidence and what it's got to do with maternal and newborn health. I just wanted to talk about what that means for us as midwives during this pandemic and the continuity of essential services and then think a little bit about so what happens next beyond this pandemic and the impact that it's going to have and the needs of women, newborns and of midwives and then just run through a little bit about the thinking on future research and the documentation and policy dialogue that's already emerging. And then I've left a slide on some WHO resources. So first of all, we know this. I'm never going to stop saying it. We know that midwifery care could avert more than 80% of all maternal deaths, still births and neonatal deaths where midwives are educated to international standards and midwifery includes a provision of family planning. Now we know that came from Caroline Homer's article in paper two. As WHO, I've been absolutely delighted and stunned with the impact that quote has had on governments all around the world and how it's changed their approach to investing in midwifery because I think for many years they thought it's okay but they really couldn't put their finger on the evidence. So that will always remain until the next Lancet series a really critical quote. So the other thing that I was so impressed with that came out of the Lancet that's having a very big impact is for many people including where I work and where we all work and all the rest of it. They have this picture of the midwife with a mother giving birth and it's all fantastic and it's about childbirth. I think often they forget that midwifery education and care can improve over 50 other health related outcomes. Again from the Lancet series, Mary and I put this together for the framework for action on midwifery education launched almost a year ago at the World Health Assembly. So we know it reduces mortality, it reduces serious morbidity, it reduces preterm birth and low birth weight, it increases satisfaction with childbirth and mother-baby interaction, reduces anxiety and labor, depression, newborn crying. It reduces unnecessary interventions such as augmentation of labor, instrumental births, caesarean sections, episiotomies and unnecessary blood transfusions but increases spontaneous vaginal birth. And of course breastfeeding, the first and most important public health intervention which sets us up for life is increased through midwifery as well as birth spacing, improving and immunization hugely important and reduces smoking and late pregnancy. And then of course improved referrals for complications and less time actually spent on the labor ward. So a huge wide vision of midwifery that we can now really openly talk about and use in everything we say. And I wanted to say that before I move on to COVID because this is what matters in COVID that we continue to have this language, this evidence and this conversation throughout the COVID pandemic. Oopsie, sorry, I've gone too fast there. So when I think about what does this pandemic mean for midwifery? In essence, it really does not change quality midwifery care. And if we look at it, there is no current evidence that of course things change but at the moment that pregnant women who are infected with COVID-19 present with different signs and all symptoms or are at higher risk of severe illness. And that in itself is really important in the way that some facilities have reacted to pregnant women. So far and fingers crossed, there was no clear evidence of mother to child transmission. Now that means through amniotic fluid called blood, vaginal discharge, neonatal throat swabs or breast milk, very important. There is uncertain evidence of increased severe maternal or newborn outcomes because the evidence is really limited to infection in the third trimester because the evidence collected has really been so recent. So we're watching that one, but we know that at the moment there was really no certain evidence. We do however, as WHO recommends that pregnant women with symptoms should be prioritized for testing. So what we need to do is remember absolutely good quality midwifery, but we do need to adapt to maternal, to adapt our maternal newborn services. And I can't say this enough. We can do what we want as we normally do but we must strengthen infection prevention and control to prevent or limit the transmission in the facilities as well as in outreach and in community services. We must establish triage, early recognition and source control at entry into the hospital or the ward. Now that could be antenatal, during childbirth, postnatal care and adjust our personal protective equipment, our PPE and infection prevention and control strategies accordingly. Now that's a huge, huge task. We have to avoid moving and transporting patients. Now this is for women who are COVID positive as well so they're sick, out of their remote area unless medically necessary. And if transport is required, use pre-determined routes and have the patient wear a medical mask. And of course this is important for companion at birth. It's important to have that companion at birth but to limit the number of health workers, family members and visitors who are in contact with suspected or confirmed COVID-19 pregnant and childbearing women. And when I think of some of the countries where WHO works and often you'll have very large numbers of family coming in to the hospital and that's really got to be taken care of very seriously to make sure that the woman and the companion are there but not the rest of it. So moving on, it's very important that these services are sustained. And so we've got to sustain the routine services and care and the management complications but we must not ignore women's choices. Their rights to sexual and reproductive healthcare and these must be respected regardless. So for example, access to contraception and safe abortion to the full extent of the law really must continue. There's no reason why that should stop. We have to establish that triage and source control again of COVID infected women and adjust our PPE. And we must ensure an appropriate physical environment with adequate water, sanitation, energy, medicine, supplies and equipment. Now that's easy to say in many countries but as you know about 40% of health facilities globally are without water or sanitation. So it's really tough in those environments to keep this adequate appropriate environment clean and safe for the midwife as well as for others. So I think we really have to think about how we support midwives in those environments where it's really, really difficult. So health facilities really must prioritise infection prevention and control strategies. So special considerations where a woman is infected and it depends on the severity of the disease but there's very few reasons why she wouldn't have a companion of choice if she doesn't have the appropriate infection prevention measures and if that companion is educated about it, told what it means and has everything that they need. They must continue to have pain relief. They should be able to move around and be upright and in places where there are functioning midwifery programmes, midwife-led, so that continuity of care should continue. There's no need for this to be taken over by an obstetric only team or by a medical team. And of course, if a woman has to go for a caesarean section and she's COVID positive, you stay with her and you come back with her afterwards so that continuity of care is there and you stay with her while she's sick. So please do share and use those infographics that are there on the right. For special considerations when a woman is COVID-19 and she has complications, WHO still recommends that medical interventions including caesarean, induction of labour and apesiotomy are only carried out when medically justified and we've all heard that actually this is not happening everywhere and that in some places it's been a sudden spike in caesarean section, inductions and apesiotomy. So we really have to watch that one. WHO also recommends that anti-natal corticosteroid therapy for women at risk of pretemper from 24 to 34 weeks where there is no clinical evidence of maternal infection and adequate childbirth and newborn care is available. So we still recommend that. But where there is mild COVID-19, the balance of benefits and harms for the woman should be discussed with a specialist. The standard midwifery referral for a woman who's really not well. Now this slide, it seems almost crazy that we have to put it up. But we do know at the beginning of this outbreak that there was quite a lot of advice out there saying, stop, stop, women shouldn't breastfeed, which is not correct. So WHO recommends that all women should be supported to breastfeed. As mentioned earlier on, there is no evidence of transmission through breast milk. So babies and mums should stay together. There should be skin-to-skin contact, kangaroo mother care where needed, and rooming in day and night. Again, with those infection prevention and control measures. And for mothers who can't breastfeed during the first hour of birth, possibly because they're very sick from COVID, they should still be supported to breastfeed as soon as they are able. And whatever their status, mothers should continue to have that wonderful breastfeeding counseling, basic psychosocial support, and practical feeding support. And this should be provided by trained healthcare professionals, community-based professionals, lay and peer breastfeeding counselors. And on the right, you'll see there should be no promotion of breast milk substitutes, feeding bottles and teas, pacifies all dummies in any part of facilities, providing maternity and newborn services, or by any other staff. And this is so important at the moment. Now you can see I'm reading this stuff off. And what I had forgotten to say early on is these slides are forming what will soon be launched as a training app that will be launched globally for anyone caring for mothers, babies and their families globally. So what I'm saying, it will come out as a slide set, but also as a training app to be shared and used wisely. So just in terms of breastfeeding, it's very important again to protect the mothers. So a bit more emphasis now on washing hands before and after breastfeeding, practicing good respiratory hygiene, which does mean wearing a medical mask when possible, coughing or sneezing into the bent elbow or tissue, and bent elbow for women who don't have a box of tissues to hand, as many, many do not, and disposing of those tissues immediately. And routine cleaning and disinfecting services that have been touched. So a little bit more attention to all of that during breastfeeding these days. So those are the slides that have come out of the app, which we hope will be released any moment. And I just wanted to take you into a slightly different discussion now, which is really about what impact is COVID having on maternal newborn child and adolescent health, including sexual reproductive health. And I think, I hope you'll find this interesting because we're just trying to find out what is the long-term impact of reductions in services and lack of access of where we are. And as you know, we have made the most tremendous gains in reducing maternal mortality and newborn mortality over the last two to three decades. And there is such a risk now that we will lose those gains because of this pandemic. And there is much on our shoulders as midwives to make sure that that doesn't happen. So if we start with the top row, which is about family planning, and I might try and use this pencil here and see if I can make it happen. If we look at this, if this lockdown continues for three months, up to two million additional women may be unable to access and use modern contraceptives. Now, if that goes on for six months, it would be seven million unintended pregnancies. That is absolutely huge. Now, that is a timeframe estimate of six months of lockdown. It's based on Ebola outbreak disruptions applied to estimates of current, current modern contraceptive users in 114 low and middle income countries. And you can see it comes from Abermeer Health, John Hopkins, and Victoria University in Australia, and UNFPA. So it's just fabulous to see people starting to pull this data together, but it's really quite worrying. Now, if you move to maternal and newborn health and you look at excess maternal under five mortality from weak systems and lower utilization of 72 essential reproductive maternal newborn and child health services in two scenarios with two types of disruption scenarios, this is what you get. Reductions in coverage of around 15% for six months would result in an additional 253,500 additional child deaths and 12,190 additional maternal deaths. And then if this goes on with reductions in coverage in around 45% for six months, we're looking at 1.157 additional child deaths and 57, sorry, 56,000 additional maternal deaths. And that is absolutely terrifying. So we're going to continue to work on this data, but I just wanted to highlight to you, what is at risk here if we cannot continue to give good quality midwifery care to all women and newborns everywhere throughout this pandemic. So that's why the director general who you just heard in that video, and by the way, he loves midwives. He thinks you're absolutely brilliant. He knows that. He did a special call to attention to essential health services. And he raised the issue that there's rapidly increasing demand on health facilities and health workers for COVID care, threatening some health systems, so over stretch that they would be unable to operate effectively. And previous outbreaks, styles, MERS, Ebola and others have demonstrated that when health systems are overwhelmed, death due to vaccine preventable and treatable conditions increased dramatically. And I don't know about many of you, but I remember being in Bangladesh in the early 80s when one of the biggest causes of death for mothers and babies was tetanus. And the idea of going back to a time where women didn't have their routine tetanus vaccinations, before pregnancy would be absolutely awful, we've forgotten what it looks like, we've forgotten how to treat it, we've forgotten what happens to babies. And so we've got to keep those vaccinations continuing as well as all the other childhood vaccines. So essential health services really must continue. Babies are still being born, vaccines must be delivered, and people still need life saving treatment for many issues. And what I didn't show you is the similar data on vaccine preventable diseases, malaria, HIV. We're going to lose a lot of gains made if we can't continue these essential health services that midwives are so essential to. So this is just to show you that there is this document on operational guidance for maintaining essential health services during the outbreak, again, to prioritize essential, and that includes pregnancy, childbirth, and the post-natal period, and we must never forget that. We have to optimize our service delivery, settings and platforms. So we have to look at targeted outrage, use of telephones, tele-consultation, many things that I know that you'll be doing and talking about over the next few hours. We've got to look at effective patient flow, screening, isolation, keeping it moving, rapidly redistribute health workforce capacity by reassignment and task sharing, but not taking midwives away from caring during midwifery work and putting them somewhere else and leaving women and babies without midwifery care. That's really important. But keeping the trust of the population as we move forward by keeping this infection prevention control going. I won't go through all of this, but just to say that mental health and psychosocial care for midwives, increasingly important as this pandemic progresses. And if we look at the SARS epidemic in 2003, there's a 30% increase in suicide of people around 65, around 50% of recovered patients remain anxious and 29% of health group workers experience probable emotional distress. That's a lot given that over half of health workers are women, most of them nurses and midwives. And a lot of the consequences of quarantine-associated social and physical distancing measures are themselves the key risk factor for mental health. Substance abuse, gambling, cyber bullying, feeling a burden, bereavement, loss and relationship breakdown, all things that affect midwives and we've really got to continue to support midwives and women, babies and their families, right the way through this epidemic. So, you know, we have, I know we've always done that, but we've really got to focus on that as well now. So I won't spend too long on this. I just wanted to just remind everybody that once the baby's born and we go back and care for a woman with that wonderful moment of postnatal care and the family is there, we have to, as midwives, just be aware also that these children are not the face of this pandemic, of course, that's the elderly, but they do risk being among its biggest victims, falling into poverty, exacerbating the learning crisis school threats to child survival and health and risk to safety. So as midwives, I think we have a very special place with the continuity of child-centered services as referral, being aware of protections that might be needed for vulnerable children, providing that early practical support in a postnatal period and ensuring child services wherever we can get started again as the lockdown measures unwind. And then a little bit on elderly, now I won't go into this too much, but you know, we all know many, many babies will go home with their mums and dads in the postnatal period and they'll be with their grandparents in the house. And so I think again as midwives, in the care that we give in the community, just to remember that those grandparents need support as well and to keep on top of that while we're giving our postnatal care and hand over to other health workers. So I know there's many of you here from the research community, absolutely amazing research community of midwives. And I just thought I would highlight these few points as to where we are now in WHO on research priorities around the COVID pandemic. So of course the natural history of the virus is transmission and diagnosis. We're still finding out more. We're trying to find out much more about the origin of the virus. There are a lot of epidemiological studies going on. We need to understand better clinical characterization and management, including in pregnant women and children. We're not really sure what's going on in children. We've got to get better infection prevention and control. We talk a lot about PPE and water and sanitation. It's not easy. How do we best protect our healthcare workers? A lot of research and development going on for candidates therapeutics. You'll hear all that in the news as much as I will. A lot of the news is coming from WHO. Research and development, oh sorry, that's for, oh sorry, for candidate vaccines. And very excitingly coming out of our department now is the Maternal and Newborn Child Health Department is collaborative global research network on maternal newborn child and adolescent health under development. And I'm really enjoying this because I think if ever there was a time we all had to work together, now is it? And we can see researchers coming together as they never have been recognising that we must work together to end this pandemic through research. So just a very brief summary. These are the current situation and key insights. We know there are direct and indirect effects, lives, livelihoods, ways of life. We really do need to work, including for midwifery national strategies, international cooperation. I know when with the massive refugee movement in Europe over the last few years it's been international cooperation across Europe that has kept women being cared for as they move across Europe. We do need to transition now to a steady state of low level or no transmission and midwives are going to have to keep moving on that and adjusting, but we must accelerate research innovation and knowledge sharing amongst midwives so that we're at the front foot of this and we're not constantly trying to catch up with what's going on with others. So for midwives as well as everyone else, it's about the speed of how we act. It's about the scale at which we act as midwives and it's about equity. And I think that's where we are so important, making sure that no one is left behind and all women have access to this care and know that they can breastfeed, know that they can have a companion, know that they'll be cared for if they're sick and all the rest of it. So these are a few resources. This is the page from the department that I work on. There's a whole load of stuff on there about COVID maternal newborn health and the training app will be on there as many other places. So please do visit it. I wanted to let you know that we do have clinical guidelines on the management of COVID. Now, this is a lot about respiratory distress and how much oxygen women need. So perhaps not so relevant to all of us, but I just thought I'd let you know that as I'm sure many of you know, WHO guidelines are a very long process. Many of you are involved in them and thanks for that. At the moment, we just don't have that two to three years to get the research together and set up the steering groups and all the rest of it. So we're having to move very fast and issue interim guidelines. And we have a clinical network that's continuously sharing the data and field experiences and new topics for guidance that are identified or current guidance is updated. And it's very important that your comments that you make here and the questions that you're asking, if we don't have time, well, I can't answer them, which is very likely, that we collect those and I will send them back to the team and they will continue to develop guidance for the things that you're asking about. It's been really helpful for us to have those questions and it's happening every day and we really value them. So here's a page just with a lot of updated links and I'm sure that this will be available. So please do use them. They're coming out all the time. I know there's going to be a new breastfeeding one very soon. There's going to be a new guidance on essential health services. There's one coming out very soon on communities, how to ensure that communities continue to be involved. But this is where we are now. And I just thought you'd like to know that there is a global survey of health workers and I would just love it that all of you on this wonderful International Day of the Midwife send this round, share it and participate. It's WHO and the International Labour Organization together. We are really worried about what's going on with frontline health workers, midwives especially. And we want to know how you are, how safe you are, what level of protection you have at the workplace. And whatever we get back and it will prickle in and we'll keep watching, these results will inform what we do about targeting the most important risks for health and safety of you guys. And what preventive measures are needed. And it's going to contribute to raising awareness amongst responders about the risk for health and safety and their prevention. And it is already available in all these languages. So please do participate and share as widely as possible. Your voices are so important in this. I'm very concerned that we get lots of doctors and others but that we really don't have midwives. So to have midwives with a strong voice here would be so influential, would be fabulous. And then it's 200 years next week since the wonderful Florence Nightingale, who I think is incredible, was incredible. I'm a complete Florence fan. And I've been very concerned about the progress we made as some of you know, over the past 200 years in terms of the recognition and appreciation and pay for example, and the gender power dynamics around nurses, midwives 200 years after the profession was professionalized particularly in the UK. I know it had happened in other countries as well. And I just love this quote of hers, which is obviously about 170 years ago, which is, no man, not even a doctor ever gives any other definition of what a nurse should be than this, devoted and obedient. This would do just as well for a porter. It might even do for a horse. It would not do for a policeman. Now to those of you, some of you might want to think back to Victoria in UK, horses were the most important thing of everything, especially for the military. So we weren't quite up there. We weren't up there with the horses. But I'd be quite concerned, but I have to say in the last few weeks watching this COVID pandemic and listening to what Elizabeth just said now, all of a sudden this language is changing and we are being described as the heroes of our time and the most trusted of professionals. And I just think that's such a tribute to you as midwives and all of you working out there. It's quite clear that the profile that you're having, the vision you're having is probably unmatched into what France Nightingale did. I think it's quite fabulous. So we've got to keep that up and we've got to make sure it translates into investment and better pay and better working conditions and recognition and all sorts of other things. And now I'm just going to indulge because this is a poet, a spoken poet called Holly McNish and please visit her. She's quite fantastic. And she wrote this poem which always, always makes me feel great and makes me laugh and I find quite emotional as well, but it's an apology from her and an ode to midwives. And so this is my thank you to you, all of you through Holly McNish's poem. And she says, sometimes I lie and I say I'm a midwife, when strangers on trains ask what I do, I want them to think I am good. I want them to look at my hand and imagine those hands have held more than a pen. I want them to think I have run between bedsides, mermaid to ships, carrying sailors to safety on shores, delivering life or toast or condolences, comforting those in the midst of an earthquake, sewing stitches in skin like life-saving tapestries, sitting for seconds, catching breath between screens. So I just love that so thank you and it's my thank you to you all. And with that, I just want to put this up on the screen. This is from midwives in the Western Pacific, Papua New Guinea, Australia, New Zealand. And this is a huge tapestry that they wove at a WHO collaborating center in Australia over two years ago. And you can see whether we call it the egg, the placenta, whatever's in the middle and then the hands of midwives all the way around and then the rivers of love and joy and they've done all their fantastic drawings all over that. So because we're starting really in that region I just thought we'd make sure that they had a beautiful picture there and that was painted through this beautiful ethnic group of people. So thank you to midwives all around the world on this really special day of International Day of the Midwife in 2020 and where in earth would we be without you? You are more valued than you will ever understand. Thank you very much. Thank you Fran so much and welcome everyone again to our celebration and our presentations for International Day of the Midwife. I'd love to hear first, is there any questions in Spanish that we might hear for Fran? I have a question in Spanish that I would like to hear in the chat. I don't have any Spanish questions yet, Jane. Thank you. And is there any other questions for Fran or we just have so much gratitude to everyone from the World Health Organization? So fantastic presentation from the Director General, Dr. Tedros to Mrs. Elizabeth Aro and to yourself, Fran, we really, really appreciate you so much. Oh, and is it, Becky says, do you recommend washing with water and soap before skin to skin after birth? Yeah, hello, can you hear me? Sorry, I managed to disconnect myself. Yeah, you sound great Fran. Yes, yes. So for water is good, before skin to skin. Yeah, so it's just very, very... Oh, I'm, Becky, can you just clarify that? Certainly washing hands, but actually not the woman's body because that skin to skin is so important. What you don't want is to have, you know, COVID from your face or from sneezing on your hands when you're holding the baby. But what you do want the baby is to go straight skin to skin. Does that make sense? That makes perfect sense. And I really appreciated you clarifying. I know initially I live in the United States and we were told, oh, you must separate the newborn from the mother. And I found that very distressing. So I really appreciate that. We are going to share all the links that Fran kindly shared with us today. And please, when we will share the survey monkey widely, please complete the survey because we need your voices around the world. It's so very important to midwifery. And I'm not sure if there's any other questions in Spanish for us. I don't think so. That's fantastic. So I'll let the, oh, and Baker is asking, can the virus also be on the body? Do you mean the body of the baby or of us or as midwives? Can you clarify? Hi, maybe I'll just try and respond to that. You know, we know it's not passed through childbirth, you know, vaginal fluids, whatever. So if it's on the mother's body, it's because she sneezed on her hands or touched her face and then put her hands on her tummy, which is why the hand washing is so important. But, you know, there shouldn't be, it's just the respiratory thing. If the baby's coming straight onto the mother's skin and the mother hasn't sneezed on her tummy or wiped her hands after sneezing on her tummy, it should be fine. I see a question about the virus be transmitted in breast milk and at the moment, no, we have no evidence that it is transmitted in breast milk. I also see a comment about BAME women and we're just trying to find out about that. What's very interesting is, I've been asking in my department how we're collecting that data about BAME and midwives. And the interesting thing is very few countries are collecting that data. And where they are, it's not at scale. So we really don't know what's going on with ethnic minorities and midwives working with ethnic minorities, but at least the discussion has started. So I was very good to see it coming up in the question there. And in the interest of time, Janine, to answer your question, we do have Rebecca Decker is doing a session on evidence-based birth and COVID-19. And I do believe there's other speakers going to be addressing the emotional wellbeing on that. So I think that was so incredible Fran. I'm going to go ahead and...