 And I'd like to take this moment to introduce to you our speaker for today who will be speaking about the current state of professionalization of midwifery in Europe. Yuri Vermeulen is the head of midwifery at Erasmus Brussels University of Applied Science and Arts in Belgium. He's a researcher at VUB in Brussels, Belgium. He's also an executive board member of the European Midwives Association and the Belgian Midwives Association. So midwifery education and professionalization of the profession are his main areas of interest. And welcome. So good to see you, Yuri. And I'd just like to go ahead and make you present and you can present away. Okay. Thank you. Thank you, Suzanne. Thank you, Linda. Thank you for facilitating my session. Good morning. Good afternoon. Good evening. I am very glad that you all are here. And first of all, I would like to give you my best wishes for this international day of the midwife. And I hope you will enjoy this collaborative learning today here at VIDM. So enjoy your day. I also would like to acknowledge my co-researchers which are Anzloyben, Valerie Fleming, Rona O'Connell, Patricia Gillen and Ramon Esquivet. So today I would like to talk to you and to share my ideas about the professionalization of midwifery, especially focused on Europe. First of all, it is very important to know that midwifery is regulated in Europe by the European directive. The European directive is a kind of legislation for the whole of Europe, which determines the minimum training requirements for midwives, the minimum educational program for midwives and the professional activities of a midwife for the whole of Europe. That's one fact. The second fact is that we had in Europe the declaration of Bologna. It's already about 20 years ago. The Bologna declaration was a kind of a legislation reforming higher education into the level of bachelor education, master education or PhD education. I will come back to that later on. And a third fact is that midwifery is trying to professionalize over the last decades. So the aim of our study was to explore the state of professionalization of midwifery all over Europe. And we would like to focus on the education of midwives, research and practice of midwives in Europe. To structure our study, we used a very old criteria for a profession, the criteria of Greenwood. I will not go into much detail, but Greenwood said that you have a high level of professionalization when a profession has an own body of knowledge if they are recognized. Their authority is recognized by its clientele if they have a code of ethics and if they have a professional organization. We did two studies. First of all, we invited delegates from Europe, delegates who are delegates from a country in the European Midwives Association to complete a questionnaire. And in a second phase, we did an analysis of six countries. I will move to both phases. In the first phase, we had responses from the whole of Europe. We invited 30 European countries. So European countries, that means not only countries from the European Union, but also countries like European EU, applicant countries. So we had responses from 29 countries covering Iceland, Scandinavia, the Baltics, Romania, Bulgaria, until Turkey. So we really had a whole of Europe, which was excellent. So we asked what is the state of professionalization of midwifery in your country? And if we are going to the findings from this phase, then I think that we can conclude that midwifery education and midwifery practice evolved a lot over the last 20 years. Nearly all midwifery educations in Europe went to a bachelor or a master level. But on the other hand, we need also to acknowledge that a lot of midwives struggle in practice. And I mean by struggling in practice, in a lot of countries midwifers are working in an obstetric led system of care where her autonomy of independence is limited. Another striking result, yeah, we know it, but okay, now we have concluded it. We know that maternity care is not an exclusive domain for midwifers only, but you also have doctors, obstetricians, nurses, other health professionals, which makes it difficult for midwifers to fight, struggle for their autonomy. And it also means that midwifers not always have the responsibility for regulating their own profession. And we are midwifers. We are there to do our midwifery work. We are there to be midwife. That's all correct. But we can see that in a lot of countries, the involvement of midwifers, involvement of midwifers in health policy is quite limited. And that's a thing, an issue we should work on, I guess, in future. But I will come to that later. So the organization of health care in a country is determining midwifery work. If you have a country where maternity care is obstetric led, or a country where it is more midwifery led, it has a huge impact on practice. The involvement of the other health professionals. So we saw on a global European level that there are some matters of concern anyhow. The study of the phase one, we published this study in the European Journal of Midwifery. You can find the study easily via the website of the European Journal of Midwifery. I would also like to take the opportunity to highlight the fact that the European Journal of Midwifery is a free open access website where you can consult all full text articles for free. So in the next phase we did some descriptive case studies from six countries to focus on the professionalization in some countries. We selected Bulgaria, Ireland, Germany, Norway, Luxembourg and Spain due to the variation in education, autonomy, practice and research. I would like to emphasize that I will, so we have got the information from those countries from key figures in maternity care from those countries, but I would like to emphasize that I don't make any judgment about a country or about their maternity care. It's not up to me, it's only, I only would like to highlight the differences in the different countries and it's not about right, it's not about wrong, it's sometimes about limitations that midwives have to work in accordance to the European directive. Like if we have a look to the midwifery education, you can see that in some countries midwifery education is on a bachelor level, in some countries it is on a master level, but we also have a country where today midwifery education is still on a diploma level, a diploma level, I mean by that it is like a kind of a secondary education level, it is, it is not a bachelor level and we can also see like, like in Germany, Germany only recently made the move to a bachelor midwifery education. So we can see a lot of variety in those education. You can also see that in some countries midwifery education is direct entry and in some countries it is directly after, it is after a nursing education. If you have a look at research or PhD in midwifery, in some countries it is obvious midwifers they can do research, midwifers they can go for the PhD, but still in some countries midwifers cannot do research, it is not a knowledge, it is strange if midwifers are doing research, she's not a doctor, why is she doing research? It's strange in some countries and in some countries it is difficult, even impossible to get a PhD as a midwife. If we will have a look at community sanctions or if the authority of a midwife recognized by its clientele, by the women, then you can see that in some countries midwifers are responsible, they can work independently, they are the specialists in the low risk pregnancy childbirth, but as I said in some countries midwives work in the hospital under the supervision of an obstetrician in a midwifery let, excuse me, in an obstetrician let care. Also it is a case that in some countries the manager of the maternity care is not a midwife but is either a doctor or a nurse. Let's move into the autonomy, autonomy in this study we understood autonomy as yeah independence, we are working separate from nurses autonomy in some countries and that's already determined in some countries midwifers are not at all the first point of care for women in some countries it is just the doctor and that is often when we are in an obstetrician let system. Also as I said before autonomy in a hospital setting is really limited in lot of countries if you think that autonomy is very important for you as a midwife then often it is better to go to work like in as an independent midwife or in a birth center all that kind of things because we saw in Europe a huge difference between autonomy in independent care and autonomy in the nurses in in in in the hospitals so it's really a huge difference. We also see in some countries that there is an increase in specialist roles for some midwifers like in some countries you have a specialist roles for lactation midwives bereavement midwives all that kind of midwives and if we will have a look at the community sanctions then first of all it is important to acknowledge that all midwifery all countries in Europe they have a midwifery association sometimes they have a midwifery association which is independent sometimes they have a midwifery association together with nurses in one country there is also an association all together with doctors but all countries have a midwifery association so that is fine but in some countries you have several midwifery associations and you could you could say oh that's fine the more the better but this is a personal thought I don't agree with that because but this is a personal thought I think that if you have several midwifery associations in one in one country then you will have different voices you will not have one strong powerful midwifery voice from that country and I think that that can be misused by policy makers because if I am a policy maker and I have to think and discuss about maternity health care of the future and I am going to talk with the midwifery association in my country the independent midwives the hospital midwives the midwifery educators the Catholic midwives the French speaking midwives the Dutch speaking midwives then as a policy maker I will get a lot of information I will get a lot of contradictory information and as a politician I will take what I want to take I will take whatever I like I will not be as a politician confronted with one midwifery voice so I think that is something to think about that is something to reflect but this is only a personal thought the issue is we have midwifery associations okay that's great but the issue is do we have influence on politics on legislation and you can see like my my my my colleagues from Bulgaria Luxembourg Spain they said to me no no we have no influence as an association at all um yeah that can have different causes but very often it is politicians they are not interested in us they don't listen to us we are with not enough midwifers they will listen to the doctors and go so on go so on yeah so the fact is that not in all countries midwifery uh midwives have influence um I think that could be because uh yeah because there is no formal place for a midwifery officer uh in government or in advisory committees if I may say something this needs to change um if I ask my colleagues from the different countries what changed in your country over the last 10 years then you can see it legislation regulation legislation education recognition education legislation legislation education financial situation that's also about legislation education I think we should focus on this one the con this countries they made huge changes over the last years and the trigger for the change was always if I may say it legislation regulation education I think that we should keep in mind if you want to make changes those are the triggers which can help us if we asked our colleagues about what is difficult or how do you see uh the future or what are challenges for the futures then we see again it's about low directive education strategy which is also kind of legislation education competences are underused I think we know a lot of we know about that in a lot of countries profession education perception strategy so it is all about again education legislation and regulation I think on the other hand I I wanted to make a side note because I am talking about education legislation regulation regulation yeah okay that's good but that's also a personal thought I think you should you should need to keep in mind that it is difficult to make changes to your profession or to your professionalization if you are not supported by the public I mean and I don't know and we can have a discussion later on I think that in a lot of countries midwifery associations are not linking very good or very structured with women's groups and I think that's an important one because we really need to know what do women want and so that we are partners together because if I am to if I am talking to politicians about midwifery is so important and we need more autonomy and we because we are so important okay I totally agree that we are so important but the politician in the next half hour he will hear the doctors talking how important they are they are important he will hear about the nurses he will hear about the dentists the pharmacists and every professional group who respects itself they say I am important what I am doing is in is an important job yeah and so for midwifery I totally agree we should evolve to more midwifery let's care but we need to do it hand in hand with the women with the public um if we can have some overview about the conclusions of the two phases of our study then I think we can say that the move to higher education is an important trigger for the professionalization of midwifery so I think that if midwifery education is still on a secondary level uh that is quite concerning uh but okay it is what it is uh but I think that's an important evolution that we have the education at least on a bachelor level you can discuss about it so but I think that's a move we need to go anyhow uh if we are looking to the European Directive and the Bologna Declaration so that's that's a move we need to go uh in Europe for the moment it's only like one country who is struggling with that move and it is not because of the midwives again it's about politics um we can see an increase in midwifery research we can see more and more midwives with a phd we have uh in some countries uh midwifery professors uh and like in my country uh we at this moment it's a quite new recent move but we have to my knowledge like only three professors in midwifery at the moment which is a good evolution so it's going slowly but it's it's going it's it's an evolution you know you can feel I am uh I am positive uh um if you have a look at the changes in midwifery practices we we had some people from countries who were very positive they said yes okay we have specialist roles we can work uh like we are not working only in labor rooms but we can only also work like infertility clinic in the gene ecology in the neonatal work but on the other hand I have to say to you that we see also also some negative responses from people from midwives who say um no there was no evolution uh even my scope of practice is limited and there is no and no there is more and more medicalization uh of birth and we all know if you have an increase in the medicalization then you will have a decrease in the professionalization of the midwifery you will have a decrease in the autonomy of the midwives so that is a very uh difficult balance we should think about uh because we see indeed if you are looking like to the euro peristat figures we can see an increase in medicalization so the bolonia declaration the european directive was very important in the professionalization for midwifery and I really mean mean it uh the european directive is a legislation and the legislation is talking about the seven privileged professions privileged professions are professions who are privileged because they have an own chapter in the european directive because they are so important for the public health I think we need to keep that european directive uh yeah we we need to keep the european directive and we as midwives we need to kept in the european directive because I say to you and I am very clear about it uh if the uh midwife would not be a separated chapter in this directive then I am sure that midwifery in some countries and I will not name the countries will disappear in some years so the european directive is a very important one I also would like I also wanted to say to you and I've said it already that our professionalization is uh limited by the organization of health care and by the involvement of of other health care professionals in the maternity care as a conclusion I would like to say that as I emphasized that legislation regulation are very important tools for the professionalization of midwifery for the empowerment of the professionalization I think that you also keep need to keep in mind that it is very important to build on very good useful networks if you want to midwifery to professionalize you you should not focus only on midwifery but you need to look for partners in crime like other health professionals and like policy makers because we as midwives and that is that is a very important task for midwifery associations we need to be on the table where the policy making is discussed we need to be there we need to be invited or we need to to invite ourselves and the last thing I wanted to say that is we need a united midwifery community at least in your own country I see a lot of examples of countries where midwifery associations are opposing to each other where they are not unified and I think that it's very bad for midwifery because if you are not talking with one strong midwifery voice then your voice will not be heard that is my conclusion for today I wish you once again a very nice international day of the midwife and please take today and this vidm education take this as a moment to reflect on where we want to go in the future so thank you very much thank you thank you thank you so much Yuri for that very insightful and inspiring conversation thank you for walking us through the history of professionalization of midwifery in the in Europe and for your key focus areas where you've said that we have made progress in the last few years in terms of legislation regulation and education but we still need to do a lot more a lot more in terms of partnership a lot more in terms of policy making having a seat in policy making and I think one of the other things you really highlighted is public support where women's groups are key to actually letting the legislators themselves know exactly what kind of support women need and there's a lot of consensus in the in the chat so Rona says that the EU directive is very important for advising us sorry advancing midwifery and education is also key to effect change then Cleo says that fortunately we have autonomy in practicing as freelancers here in Greece. Haveri says midwifery to become political is such an important message one that I have been hearing from around the world and then Cleo also says thank you and H. Gomar Atiyahu you say you had a couple of things to say so they said it's a very inspiring presentation a call for unity and a need for more collaboration so I'll just let us take just one quick question Yuri and that came up earlier when you talked about autonomy there was a question of why are nurses involved in the the peanut of care should in that be the work of a midwife so that was a question that had come earlier as you were speaking about autonomy so perhaps you could respond to that and then we can close this very insightful session yeah so the question is about autonomy in anti-natal care or in postnatal care so you had your sliders in postnatal care ah yeah okay ah yeah okay I see it it's a question from Linda yeah Linda I totally agree I totally agree why are nurses involved in postnatal care should that not be a midwife yeah I think it should be a midwife and it is also stated in the european directive that midwifers should have access to postnatal care uh maybe for some people here around it's some it sounds stupid and strange it is normal that the midwife is involved in postnatal care yeah uh maybe you think that is normal and I thought also that is normal but when we asked in so uh when we asked the european countries then we saw that in some countries uh midwifers are not allowed to do to perform postnatal care it is nurses uh why is it like that I don't know why it is like that but it is like that uh very often it is from history it has always been like that it is the organization of the health care uh and it is like it is just like that uh like for instance I don't know if we have people from Slovenia want but for instance we know that in Slovenia uh midwifers have a lot of difficulties to work in the postnatal care it's uh because the uh yeah that that has something to do with the organization of health care we also have an another example like from uh Finland in Finland you see that anti natal care is performed by nurses and not by midwifers so that's also quite strange in our thinking it is not very compliant with the european directive but yeah it's the way it is and very often uh midwife associations from those countries they are struggling uh to change that they are always with a paper from the european directive it is mentioned in the directive that I am allowed to do postnatal care but once again it is about legislation political influence history it has always been like that yeah okay thank you so much Yuri and I I think it provides an opportunity if nothing else now that we have had people attend this session they can begin to think about how they can pull together and bring about the change that they want to see it will definitely take some time it'll definitely take some concerted collaboration as we had earlier from the chat but I think it can be done