ICM Asia Pacific Regional Conference Revitalising midwifery: refocus, redefine, rebirth: Sylvia...

After months of hard work by the midwives of the Hong Kong Midwives Association, and the ICM regional representatives--all in their free time--the 7th International Confederation of Midwives Asia Pacific Regional Conference was successfully held at the Sheraton Hotel on 27-28 November 2003 in

Hong Kong. There were over 260 participants from the Asia Pacific Region at the Conference and about 40-50 in each of the workshops. The Conference provided a forum to examine innovative and contemporary midwifery developments through keynote speeches, symposia, workshops and poster presentations, involving world-renowned scholars, local and international clinical practitioners and researchers.

Opening ceremony

Classical Chinese music set the scene for a welcome to delegates who came from Australia, India, Indonesia, Japan, New Zealand, the Philippines, Singapore, mainland China, Taiwan and Hong Kong. Speeches of welcome were delivered by Ms Sylvia Fung, President of the Hong Kong Midwives Association; Ms Caroline Weaver, President of ICM; and Ms Sandy Grey, Regional Representative of ICM.

The Honorable Ms Rita Fan, GBS, Justice of Peace, the Chairlady of the Legislative Council of Hong Kong, showing her unfailing support to midwives and the welfare of women, kindly officiated at the Opening Ceremony despite her tight time schedule in government affairs. She made many encouraging remarks.

Keynote addresses

Three internationally renowned midwife leaders enlightened us with their inspiring keynote speeches.

Joyce Thompson, Director of the Board of Management of ICM, expressed her opinion that it was very timely for us to 'rethink, redefine and rebirth' midwifery. In her speech, 'Midwifery: the challenges of being a profession', she highlighted the dependence of professional midwifery upon ethics, competencies, regulation and education. Those essential elements, as emphasised by ICM, would be a framework for exploring and understanding how professional midwifery could make a positive difference in the lives and health of women and childbearing families.

Professor Sally Pairman, Head of Midwifery at the Otago Polytechnic, Dunedin, New Zealand, focused on 'Building competency through education'. Scenario-based teaching, with clients' involvement, is used to integrate theory and practice. Clinical experience is mainly provided through continuity-of-care models. Students will be placed one-to-one with experienced midwives to develop competence and confidence as beginner midwives. A framework has been developed for the assessment of safety to practise through partnership between educators and midwife mentors.

Professor Maralyn Foureur, Clinical Professor of Midwifery and Women's Health, Victoria University, New Zealand, gave a presentation on 'Continuity, of midwifery care: a means to an end, not an end in itself'. She pointed out that changing to a continuous model of care would not he the complete answer to meeting women's needs and improving maternity care outcomes, unless midwifery education and practice could evolve to provide midwives with the necessary skills required to work within this model.

Leading change in midwifery

This plenary session began with Dr M Barnes (Australia), who demonstrated how to prepare women for the mothering role by two different but complementary approaches: the model of Health Literacy on information giving, and the Baby Friendly Hospital Initiative in improving breastfeeding education.

Ms F Kung (Hong Kong) concluded that early assessment and intervention, if necessary, during the postnatal period helped to reduce women's emotional problems following the birth and hence to lower rates of postnatal depression in Hong Kong Chinese women.

Ms NC Ng (Hong Kong) found that women in established labour, whose husband did not accompany them during the birth, chose to have older, female companions of the same race. All these labouring women experienced a significant reduction in anxiety level, and 80% of them perceived less pain in labour.

Ms Y Asaka (Japan) showed that rooming-in and bed-sharing were adopted significantly more frequently and much earlier by women receiving care from independent midwives, compared to care from those midwives employed in hospitals in Japan.

Ms MH Chiu (Taiwan) confirmed that more spontaneous vaginal births were achieved under the care of midwives than doctors in Taiwan. Women perceived that independent midwives offered more humanistic and family-centred care and achieved empowerment for labouring women.

Building competence through education

Ms F Hau (Hong Kong), beginning this session, showed that both students and panel examiners considered Objective Structured Clinical Examination (OSCE) a valid and reliable means of measuring clinical competence in Certification Examination. There was statistical positive correlation between the students' results in OSCE and written examination.

Ms Barrowclough (England) showed that students had developed competence through problem-based learning strategy in the areas of communication skills, working as a member of a team and independent, lifelong learning.

Ms CC Smart (England) showed that a portfolio of clinical evidence could help students demonstrate their midwifery competencies, expected professional behaviours, and also critical awareness of care, evidence-based practice and reflective practice.

Appreciating transcultural midwifery practices

Ms HW Cheung (Hong Kong) demonstrated that the experience of pregnancy was much more stressful and risky among new immigrant and transit residents from mainland China. Most felt they were stereotyped; had poor support systems; suffered difficulties in their marital relationship; thought the language barrier an obstacle; and lacked knowledge in pregnancy, local health and cultural practice..

Ms WL Cheung (Hong Kong) demonstrated that employment, family support, support from health care staff, Chinese cultural practices and public attitude were important factors influencing participants' commitment and confidence in initiation and continuation of breastfeeding in Hong Kong Chinese women.

Assistant Professor SC Kuo (Taiwan) identified seven themes in her phenomenological study examining the breast-feeding experience of families in Taiwan: early decision by the family; commitment; belief that breastfeeding was unique; learning the individuality of the infant; the need for adjustment; management of sibling reaction; the change in family interaction and relationship.

Advancing clinical midwifery practices

Dr M Barnes (Australia) has examined spontaneous births with squatting, kneeling, lateral, semi-recumbent, lithotomy, standing and sitting positions. Results showed that the need for suturing was associated with first vaginal birth, regional anaesthesia, deflexed head and larger babies. The semi-recumbent position was also associated with a need for suturing but the adoption of other positions appear to have lessened this need.

Ms I Ho (Hong Kong) showed that parents learned the baby bathing procedure vividly and also could address their common concerns of baby care through the use of a baby care teaching video. Busy mothers could learn the skill at their own pace or reinforce previously learned skills.

Ms W Cheung (Hong Kong) found a significant correlation between both feelings of control and expected ability to cope with pain when there was involvement in clinical decision making, in the Chinese primigravida. Maternal age was also associated with the level of feelings of control during labour.

Ms E Mau (Hong Kong) revealed that midwives in Hong Kong possessed a positive attitude toward their role as bereavement counsellor. However, they reported difficulties during the initial engagement stage as well as dealing with clients' feelings.

Ms J Ng (Hong Kong) found that during the 2003 outbreak of severe acute respiratory syndrome (SARS), 95.3% of pregnant women in Hong Kong were satisfied with the hospital's precautionary, measures. However, 82.2% reported negative socioeconomic impact whilst 87.8% experienced moderate to high level of anxiety. There was a significant relationship between these two factors. Midwives should facilitate and support the women's psychological adjustment during such a crisis.

Professor JA Noronha (India) found that, among primiparous women, more subjects in the experimental group who had teaching conducted to strengthen self-care ability during the first five postnatal days had less pain and obtained relief from pain earlier. The control group had one episiotomy wound gapping.

Workshops

There were pre-conference (25-26 November 2003) and post-conference (1-2 December 2003) workshops designed to consolidate midwifery knowledge.

The one-and-a half day pre-conference workshop led by Dr Joyce Thompson was focused on 'Clinical precepting: how to be a preceptor in clinical practice, and competencies of a clinical preceptor'; and 'Ethics in midwifery'.

Another half-day pre-conference workshop on 'Prevention of postpartum haemorrhage' was run by Ms Ann Hyre and Dr Joyce Thompson. This was a session supplementing the launching of the joint statement of ICM and FIGO on the 'Management of the third stage of labour to prevent postpartum haemorrhage'. Ten free places were allocated to midwives from developing countries to promote safe motherhood.

The topics of the post-conference workshop conducted by Dr Maralyn Foureur were 'Model of care for midwifery: competencies required to implement/practice the model of care for frontline midwives' and 'Model of care for midwifery--competencies required to implement/practice the model for care for managers and senior midwives'.

Other conference events

The post-conference dinner was held at a restaurant located in one of the exotic spots of Hong Kong. Overseas and local delegates enjoyed the Beijing cuisine and the world-renowned harbour view of Hong Kong at night. All participants took advantage of the occasion to network on cultural and professional issues.

A hospital visit was also arranged for 18 overseas delegates. They visited a private hospital, Matilda & Memorial Hospital and a public hospital, Pamela Youde Nethersole Eastern Hospital. Throughout the visit, participants shared their views on clinical practices in their own countries.

Acknowledgements

We are much indebted to the invaluable guidance from ICM HQ, especially Caroline Weaver, Joyce Thompson and our 2 Asia Pacific Regional Representatives, Sandy Grey and Junko Kondo. Without their support and input, our conference would not have been as smooth, successful and glamorous.

We cordially thank all the participants for their active and warm sharing of their experiences. We have definitely reinforced our collegial friendship as well as international neighbourhood.