 So, I would like to introduce to you Sheila Bynum, who is a practicing midwife of 40 years, having worked in the National Health Service for most of that time. Sheena was one of the UK's first consultant midwives, and as head of midwifery, successfully helped to lead the development of three birth centers in East Lancashire. As well as being an international speaker, Sheena provides consultancy services to both NHS trusts and to organizations globally, helping them to support normal physiologic childbirth. With her midwife daughter, Anna, is the proud owner of the Practicing Midwife Journal and an exciting online learning program, all from Eternity.com. Sheila's Midwifery memoirs, Catching Babies, is a Sunday Times bestseller and her seminal book The Roar Behind the Silence, Why Kindness, Compassion and Respect, Matter and Midwifery Care, jointly edited with Sue Down, is being used as a resource to improve maternity care throughout the world. Sheena and Sue have recently edited their second book, Squaring the Circle, researching normal childbirth in a technological world in 2019. Sheila was awarded an OBE in 2011 for services to midwifery and was made an honorary fellow of the Royal College of Midwives in 2015. In 2016 and 18, she received honorary doctorates from Bournemouth University and the University of Central Lancashire, and in 2017, she was made a visiting fellow at Bournemouth University. Her personal and midwifery related website is sheenabyrum.com. Sheena is committed to the humanization of childbirth, to maximizing normal physiologic birth processes, and for all women to experience a positive birth. The global onslaught of medical technology as a means to improve safety continues to influence childbearing. This physiology and autonomy and her work to reverse this trend is ongoing. So I'm going to turn it over to Sheena, here we go, here we go, here we go, here we go. Did we lose you, Sheena? We're not hearing anything. Sheena, can you hear us? Okay, we can't hear you at all, Sheena. So I need you to hit the little blue telephone again and redo your audio. Yes, I think I'm sort of... Ah, there you go. Okay. Hello everyone, I'm so sorry about that. I just had some feedback on my speakers, on my earpieces, so I had to take them off. So sorry about that. But thank you very much for that wonderful introduction, Catherine, and it's just brilliant to be here. I can't believe the time in my kitchen in Lancashire in England, and I'm surrounded by all my midwifery sisters and student midwives. So it's just great to be here. So yeah, sorry for the slow start. So I'd like to thank you all for joining, and I'd like to thank all the mothers and fathers who appear in my slides. And I'd also like to dedicate this, my talk, to all midwives and student midwives around the world. And a special mention to Professor Leslie Page, as a lot of Leslie's work has influenced mine and especially my presentation this evening. So just one moment and I'm just going to move that across. So the reason why there's a world on my front slide is because actually the humanisation of birth is of global importance. And actually what Leslie Page says that it's as critical as climate change, and yet it's given less attention. So now more than ever it's important, especially with this pandemic and the situation within the world, we really have to focus on what really matters during the childbirth journey. So welcome to everyone, for all of you in every country of the world, wherever you're coming from, you're really welcome to listen to my talk this evening. And I'm so excited that you're here to join me. And if you've stayed up late like I have, then I'm delighted that you've done so. So let's celebrate together. So with us all, I think even during a pandemic like this, even during really difficult, distressing times, we have to remember that we matter, mothers and babies matter, families matter. And just, you know, we have to try and celebrate and remember the absolute joy in our roles as midwives. And picking up on the ICM's slogan for this year and their focus is on making sure that we do celebrate, that we demonstrate, so speak out when things aren't right, that we mobilise ourselves and our colleagues and that we unite with others to make sure that the mothers and babies are kept safe, as well as us too. I just want to remind you of the evidence base behind midwifery and behind midwives. So coming from a base of the mother and baby and her family as a basis, there's an enormous amount of evidence. And I know that you probably all know this, but for student midwives in the room and anybody else, I'm just going to give you a little reminder just before we move on to the global situation at the moment. So we have the midwifery series and telling us that midwifery is a vital solution. So this for me was probably the most important thing that has happened in my career in terms of evidence base and in terms of letting the world know just exactly what midwifery can do. And then moving on to the scope of midwifery, seeing that actually we as midwives and when we're practicing midwifery can actually sort of help women in every situation. We're there through thick and thin in every possible scenario and that our medical colleagues are only needed for a small part of that. And that part as well, we're needed for too. So it's just really kind of thinking about all the things that we do for mothers and babies to help them through their journey of becoming parents and the vast sort of impact that we can have when we do our role to the best of our ability. So just just as a reminder, just for me, this framework of quality, maternal and newborn care is something that I kind of face all my work on because I feel that it's absolutely integral to all that we do. And again, the evidence is there to say that 80 percent of of maternal and newborn deaths can be prevented with quality midwifery care. And when we look at the key messages from the strengthening quality midwifery education document that sort of reiterates that and says tells us that with when we work to international standards and we have an education that's appropriate and that we're regulated and licensed and we work within professional teams, then we can avert 80 percent of maternal deaths or births and neonatal deaths. And on top of that, with quality midwifery care, it improves 50 other health related outcomes. And underneath that, you can see quite clearly that this document tells us from the evidence that actually it's very important that midwives immobilise during situations like humanitarian situations like our pandemic that we're in now. And actually, the countries with the most with the high maternal deaths face a significant shortage of midwives. So that in itself is telling us a very important message. And the evidence is clear as well that actually relations, relational care, relationships built with midwives and midwifery led relational care reduces interventions during the childbearing journey, unnecessary interventions and also women like it. So women like the experience of having that type of care. So what's happening in childbirth? So just moving away slightly just to kind of think about what's going on. Well, we have that we know very well that there's there's in some countries, there's too little support, too little intervention, too little resources, resources needed for mothers and babies. And then in others, there's too much. And if you haven't read this this paper, this document, this series, then please do because it's absolutely integral to make trying to improve maternity care for the whole world. So when we look at the kind of inside that those statistics, you can see clearly that this is just some countries but showing the huge variation within countries of this is just one marker, which is there in section. And why is it that there's such enormous variation when there shouldn't be? And not only are there variations in countries between countries, but there's some time there is variations in countries within countries and also there's variations within towns and cities. So we have to really understand that and keep looking and questioning why that is happening because it shouldn't be. Countries like America, for example, that have that high income country have a rising maternal death rate, which this is quite a shocking statistic that women in the U.S. are 50 percent more likely to die in childbirth than their own mothers, which is quite significant for me too because I've got family living in America and their caesarean section rates have skyrocketed by 500 percent in just one generation. So the Lancet series on and the Figo paper telling us how to stop caesarean sections epidemic is very clear and that we have to make sure that we think about the way that this will make sure that all the caesareans that are done are necessary and how we do that is very important. And I'll come on to that very shortly. But this this kind of like idea that and not like this this statement that actually caesarean section rates are more likely of sorry, of more than 10 to 15 percent aren't they're unlikely to improve maternal and perinatal outcomes. And that really is kind of, you know, if you think about that, that's showing that actually women that are having them are having a necessary if women are having them unnecessarily, then their their operation really isn't needed. And not only is it not needed, but it's potentially causing ill effects. Also women are telling us more and more women are telling us that they're unhappy with their childbirth experience and not just unhappy but traumatized. So women that are surviving, they're not just that they're not thriving. They're actually feeling distressed and unhappy and moving out of normal care, normal care that they can access to to really rejecting sometimes maternity services. And that's in every country around the world. This is happening. Disrespect and abuse is becoming more acknowledged. And this this goes right from the slapping of women through to organisational barriers to withholding treatment, withholding information, giving wrong information and also the use of clinical guidelines in appropriate ways. So it's a huge topic and one that we have to really focus on and think, how can we address this situation? What can we do about it? Because it's actually a global phenomena. So what about the pandemic? And with this, what does this bring? You know, what what how has this impacted on childbirth? We've heard from some speakers already, but we're kind of hearing about it in the news all the time and in journals and also on on social media. So these are some of the things that are being highlighted. Women's human rights are being raised to deny to the right to a birth companion and forced induction of labour, denied plans as area in section, sometimes enforces area in section, separation of mothers and babies and closure of midwifery led services. More things on top of that are being are being reported. And certainly the many organisations are looking into this and doing surveys, which is so important. So I know that if you if you know of any of these, please do comment in the comments box. Just tell me what's going on in your country, because it'd be really good to know. This is a report in a newspaper from Spain where a woman said that she had to give birth alone in the hospital in Madrid and she was separated from a partner. They didn't even test her husband. They wouldn't let him pass. She had a dreadful birth. Nobody accompanied her and she'd not been able to be with her baby. I mean, the whole the whole scenario here is absolutely tragic. So imagine the consequences for this woman and her baby and their family when this has happened. And this woman isn't alone. We're hearing more and more reports of this of this kind of scenario. So we shouldn't speak the human rights in childbirth movement, that the organization reporting on all these these situations that are happening or happening around the world. And you can read it. I think it's going to be published very soon, or it may indeed have been published already. But what they warn us is that we should be wary of any use of the pandemic to institutionalise harmful practices. And we can see, you know, even in my country, we've seen situations where services have been stopped really unnecessarily. And actually many of the many of the kind of interventions that have been put in place are breaching a woman's human rights, such as separation of a mother and baby and also separation of a mother from her her partner, her loved ones, when they want to support her during this crucial time. And you have to kind of think deeper as to why these these things are happening. Sometimes it's because of there may be an absolute shortage of staff. But in other occasions, it's because maybe maybe there's underlying reasons why this is happening. So what can we do about it, the most important part? What can we do? We really need to think of solutions to help us to overcome these barriers and these the consequence that's looking at reducing the consequences of some of the actions. First of all, let's think about what women want, what women tell us they want. And certainly this is this is from before the pandemic hit us. But I'm sure that these things won't have changed when women want to be safe. They want competent practitioners to look after them. But they all that means that they want to be clinically and physiologically and psychologically safe as well. So we keep these keep the focus of what women want right at the centre of everything that we do. The World Health Organization is very clear that all women have the right to a safe and positive childbirth experience, whether they've got COVID-19 infection or not. And that's upholding respect and dignity, compiling a choice, clear communication by maternity staff and pain relief strategies as the woman wants. And to be mobile during labour wherever she wants to be and in a birth position of her choice. These recommendations from the World Health Organization, together with others have been really helpful, especially being shared on social media, et cetera, because they can kind of try to reduce the fear that's been instilled within maternity workers, midwives and mothers and their families. So I think we've got to keep looking at the information that's coming out and sharing it as much as possible, really helpful in for graphics like that. Remembering and reading and really kind of focusing on the evidence of the short and long term implications of some of the actions that we're taking, not just during the pandemic, but even before, you know, the physiological and psychological health implications of the of the actions certainly were the over intervention of childbirth and where we're separating mothers from their families absolutely shouldn't be happening. The humanisation of childbirth really kind of brings this all together and helps us to imagine what it can be like right from the boardroom of government offices, right through to the smiling eyes behind a midwives mask. So I think wherever a woman gives birth in whatever circumstances that we can actually make a difference. The midwives who are caring for it and other maternity workers can be the ones that can transform a potentially negative experience into a positive ones just by simple things that we can do. But we have to act strategically as well, which I'll come on to in a short while. So using Leslie Page's she characterises the importance of the kind of the strategies for how to humanise childbirth. And she's actually published this again just very recently. And I think it's brilliant because you can see at a glance how we can move from one to the other. So we've got the medicalised, industrialised kind of depersonalised fragmented care. And we need to focus on respectful and relationship based care. So rather than separating mother and baby, that keeping them together, seeing them as one and when we mistrust normal physiology and focus focus on pathology and risk, then we things can really easily move from from good to bad. And we can see that, you know, every day we see the consequences of that. So let's focus on physiology of birth with using trusted. And to trust that process and also focus on solutogenesis and promoting well-being, moving from a cultural belief in safety and technology and medical intervention as the answer to evidence based appropriate care intervention when indicated. And thinking about the environment to use, you know, with kind of focusing on when you're looking at reducing risk through the environment, but looking at the environment to cultivate that support and that nurture because it actually influences birth. So these this is really kind of like looking how we can how we can improve what we're doing rather than focusing on technology, but keeping the women at the centre of the care of the care that she receives and eradicating or limiting mistrust of midwifery and scaling up midwifery. So really easy to kind of see how we can do that. And Liz Newnham, she actually did her whole PhD on this topic and has published a fabulous book, which is accessible. And you can it's really worth a read. I learned so much from reading Liz's book and her work. And Liz has also published in the Practising Midwife Journal. And she's published a series, some of which is used collaborators, including Leslie, and she's written this wonderful series of eight papers, which we're hoping to publish in an ebook very shortly. So well worth a read if you can. And actually, the professional advisory group, the the Professors of Midwifery in the United Kingdom, did a rapid review very recently for the Royal College of Midwives, helping them to kind of give direction as to where maternity services should be going during this pandemic. And if you read some of these pointers from this rapid review, you'll see very clearly to glance that it mirrors what humanisation of childbirth is all about. So here they give evidence based recommendations as to what we should be doing during the pandemic. And they just really replicate the human humanisation agenda. The ICM are clear as well, giving us this direction that in countries where health systems can support homebirth, healthy women experiencing a normal pregnancy and with support from qualified midwives with appropriate emergency equipment, birthing may be safe at home. And I know this is part of the kind of, you know, let's focus on physiology, keep birth as safe as possible with the right right appropriate transfer when it's needed. But just focusing on what women really want and what they need at the right time. So how can we do it? First of all, let's step back and think about the importance of understanding the hormonal interaction of a woman's body when she's in labour. It's interesting before labour, actually, during labour and afterwards. And it's interesting, because wherever I go around the world and I talk to midwives and student midwives and obstetricians and I ask them about the cocktail of hormones and how it how it impacts on on every aspect of a woman's childbearing journey. Sometimes individuals tell me that they're either forgotten or they weren't quite clear about it. So whether you really understand it or not, it's really worth revisiting. And Dr. Sarah Buckley has got a fabulous website where you can access lots of resources free of charge and they're good for everyone to kind of revisit. I've been kind of looking around the world at examples of good practice and picking up on what was happening in Indonesia. You can see how these this midwife is really helping a woman to connect with her with her body, with her mind and and and utilising the space that she's got to kind of keep her free and mobile during labour. Really good examples of women using that knowledge of physiology of childbirth. Relational care. This is an example from maternity service in the United Kingdom, where the focus is on building relationships, whether it's through continuity of care models or whether the midwife has just met that midwife, that woman for the first time, but building that relationship, that trust, that love, that kindness and that respect between each other. And this is an example from Norway where this respectful maternity care where this midwife is really listening to what the woman wanted. The woman didn't want to go into a hospital. She wanted to stay at home. So, you know, absolutely respecting that that choice. And opposite to kind of the the media images that very often come forth and we see all the time in the in the in journals, in sort of newspapers, etc. And on TV, where you get images like this that are disrespectful, where a midwife sat between a woman's legs and her legs are openly thought of me. Why are we using images like this to portray roles of midwives? This was about midwives in the Sunday times, just last week in England. So, you know, we have to try to influence the media, try to move away from from disrespect, disrespectful kind of visions of what midwives do and how women should give birth because that really matters. Moving into the the love and the care and the compassion, you know, we've been doing sort of like a small campaign around the importance of smiling behind the mask. And it was interesting because a dental nurse approached us and said, absolutely, you know, this is what we've had to learn right from the very beginning. When we're when we're working with dentists, for example, in a dental surgery, the only thing that's shown is our eyes and we can we can reassure people with our eyes. And so if you look at the difference between someone smiling behind that mask and someone not, it can make a huge difference. That connection with a woman, eye to eye contact, that smile makes a huge difference. Within a split second, never underestimate that power. And actually what it shows the woman is that you're connecting with her heart. You're connecting with that love, that build up of compassion and trust and respect. So really just try to think about that smile. And actually what we somebody else coined the the hashtag smiles. So smiling with your eyes. And so we keep tweeting that and Instagramming it all the time when women when midwives send us photographs, excuse me. Excuse me, I've got a croak in my my throat. And so that's sort of at the micro level, at our level where we're connecting with women all the time and connecting with our colleagues. Just remembering that sort of support of each other as well as the women that you're caring for. So those smiling eyes are important for your colleagues as well. And you know what comes back to you, does your your soul good and it actually rewires your brain. So all those acts of kindness really matter too. And also, but, you know, kind of also at the same time as well as being that compassion, compassionate, courageous midwife at that level, it's remembering that we do have to speak up. The evidence is absolutely crucial, but it's not sufficient for change. It's only when we get that evidence and we actually communicate the evidence thoughtfully and as, you know, some of my colleagues who I work very closely with do that beautifully and really help us all to understand, but we have to persistently be activists so that we can bring about change. And this is Jean DeClerc slide from Sydney in 2016 from the normal birth conference. So use your voice midwives and student midwives and all childbirth activists who are listening. Don't think that your voice isn't important. All our voices are collectively. We can really make change and challenge change because women deserve women and babies, birthing people, families deserve our very best care and they deserve the very best opportunity and we deserve it, too, as midwives. Use social media to rally your support. Make sure that you keep engaged with if you can engage with individuals on social media, we can really lobby for change again together at the touch of a button. And I've seen how that how change can how kind of how sort of the momentum can be built through social media, using it very carefully, of course. So we have lots of lots of partners, lots of organisations that can help us with this, the World Health Organization, the United Nations, the the International Confederation of Midwives, Jepaygo, we've got we've got birth rights. I know that's a UK based organisation, but anyone from around the world can actually contact them, make birth better. So many different organisations that we can access to help us to do this, the White Ribbon Alliance really, really keep engaging with them and keep using their their resources to bring about change because we need them. We all need each other. So let's remember that actually if we focus on safety and not on risk on relationship based care, not system based care, we can make maternity care safer for everyone, women, health professionals and organisations. And that's from Hannah Darlan, the wonderful Hannah Darlan. And keep thinking about human rights and the principle of human dignity depends, demands that every person is treated as an end in herself and not as a means to an end. It provides a basis for respect for maternity care that treats women as capable of making their own autonomous decisions about their birth. And Leslie's quote, remember that the birth of a baby is the birth of humanity. And also another of Leslie's messages is it's also the birth of a mother. And what we have at our fingertips, the very the very power to either make that the best experience and the best opportunity for that meeting of mother and baby to happen or we can turn it into a disaster. So with our colleagues and with each other, we really have to try so hard on remembering that while we are midwives, we are here to help all those families. They need us so much. So the greatest joy is to become a mother and the second is to become a midwife. So please do remember to celebrate this wonderful occasion on the fifth of May because we are we are we are part of this humanity. We are right right there at the beginning of life. And so keep being joyous about it because it's so important. And as Franca says, she urges us to stop being well behaved and to take on our duty to advocate for a woman's right to a good birth. Never has that been more important than now. So just my last slide is that we are a feminist profession. And this is the the calling to arms. We need to harness the power and momentum of women's movements. So bring women with us and with a united voice and demand political action. If the one million midwives represented by ICM, each partnered with one woman in advocacy, we could raise the voices of over two million women with the same message. So that's my intention tomorrow when I wake up on the International Day of the Midwife. So thank you so much for joining me. And I hope I hope my slow beginning didn't spoil it at all. Thank you. Well, I can see why so many students turned in to hear you. Sheena, you are very inspiring. Do we have questions in the chat box? Does anybody have a specific question for for Sheena? Heidi says, I transferred a woman for home birth and was not allowed to stay. Mom was suctioned with the doctor, never introducing herself or explaining what he was going to do. That's sad. It's so shocking. It's so shocking. And it's kind of, you know, what to do in those situations when you're when I know that it's happening sometimes with with doulas, for example, in the United Kingdom, they're they're they're being kept out, even if there's, you know, there's there's some vulnerability. And it's just how do we deal with that situation? It's very shocking. So I'm so sorry that that's happened. Has anybody got any questions for me? How do we deal with fear? OK, Caroline, thank you for asking that question. I actually I'm actually really interested in fear. And ever since I read Hannah Dolland's amazing work on how to reduce fear. So I suppose it's tackling, first of all, I would say that it's separating the fear that's real from the fear that's not real. So that's kind of, you know, looking at what the evidence is. And yet or what or what he or say is or what somebody's opinion is, but really taking on board what the evidence is. And that that goes for reports, media reports, as well as sort of clinical research evidence. But, you know, because sometimes what we do and this is human nature is we make things up. So we all have kind of our own risk risk agenda in terms of what what's acceptable to us and what isn't. And some of us are more afraid of things than others. But I know in Hannah's work, she talks about manufacturing fear. And sometimes we do that, we we kind of think all that might happen. So we'll do this, you know. And I've done it certainly since the pandemic started, since COVID, you know, came upon us because I was kind of thinking, oh, I mustn't do this and I mustn't do that when actually what that was inappropriate. So, you know, how we deal with fear is first of all, we find out what the evidence is. And then we have to really find out what it is that's frightening us and and tackling that. So so learning more about it, if it's a clinical situation or or addressing it in terms of getting help in that. So, yeah, I just think it's a personal thing and that there are there are definitely strategies. I also think self care, looking after yourself. And I know that can become a bit of a cliche, but certainly there's lots of ways that we can we can really help ourselves to to not get frantic with fear. So I certainly, since this has happened, I've been doing meditation. I've never done it before. I've been doing some yoga. I've just got an app on my phone. I've been doing it in a little room on my own. I've learned how to do it. So I just think that, yeah, we just have to address our own fear. So thank you. I hope that's OK. Any other questions? She'd love to know more about Ruth's question. So Ruth Dodds, what do you advise a student when they observe poor care and not know how to stand up and fight for a woman? OK, yeah, that's a good question, Ruth. Thank you for asking that. But I get asked that all the time, actually. That's that today. I did a session with some Rwandan student midwives via WhatsApp and they asked me the same question as well. And so I think every situation is individual. But I would say that you you it's, you know, it is hard, but you have to address it because actually, if you're advocating for a woman, if you don't address it, then you you're almost you're almost complicit with what's been happening. And but you have to choose your moment and you have to. Obviously, what the person is doing is dangerous, then you'd have to intervene. But but then choose your time to talk about it. Get support from someone else. Get support from someone you trust, someone you work closely with to to help you to address that situation, because it really you really can't let things happen that are inappropriate, especially if it's if it's poor care and the woman isn't receiving the right care. I always think about when I was sick in hospital and if somebody did something for me and they were giving me poor care and I saw that someone else was watching how I would feel about that. So keep that focus in your mind. Keep the woman and her baby or her family at the center of all your decisions. But do get help, Ruth, to do it. Do get support because sometimes it's hard to do it on your own. But it's worth it. It's worth it getting that help to make sure that you do address it. Excellent advice. And I know that is definitely a question and a conversation that is ongoing with practicing midwives and student midwives. But our time is just about up. So we do have to wrap up the conversation. I think.