midwives 46 relationship between eating culture with anemia among postpartum mother in majalengka,...

Eastern Mediterranean, Southeast Asia & Western Pacific Regions

International Confederation of Midwives

6—8 September 2018 / Dubai — UAE

Abstract Book

ICM 2018 MIDWIVESCombined Regional Conference

2abstract book 6—8 september 2018 / Dubai — UaE

ICM 2018 MIDWIVEs DUbaICombined Regional Conference

Eastern Mediterranean, southeast asia & Western Pacific Regions

International confederation of Midwives

Oral Presentations and Workshops

o 01 Cancer during pregnancy – role of the midwife and midwifery care 8

o 02 Midwifery Helpline 9

o 03 Creating awareness regarding ICM’s global standards for midwifery education and competencies among midwifery educator/stakeholders in Pakistan: An advocacy project 10

o 57 Impact of trained midwives in Somalia: Shifting from traditional birth attendant to skilled midwives 11

o 04 Introducing standardised methodology and reviewed curriculum in midwifery education: Experience of James P Grant School of Public Health, Brac University 12

o 05 Enhancing quality of care – the Midwifery Education Accreditation Programme 13

o 06 Strengthening midwifery education for the next generation of a new midwife in Indonesia: findings from a qualitative study 14

o 07 Impact of introducing PROMPT in Maternity service of Dubai Hospital on safer childbirth 15

o 08 Assessment of awareness regarding legislation of abortion among doctors, staff nurses, pharmacists and women in selected areas of New Delhi 16

o 09 E-learning training for midwifery tutors 17

o 10 Capacity building of midwifery faculty to implement a 3-years midwifery diploma curriculum in Bangladesh: A mentorship programme 18

o 11 What prevents midwifery quality care in Bangladesh? A focus group enquiry with midwifery students 19

o 12 Group antenatal care: the best way forward 20

o 13 Effect of normal childbirth promotion plan in Iran 21

o 14 Do women who access midwife-led care in low-and middle-income countries receive quality services? 22

o 15 Utilization of the community midwife services by women of Khyber Pakhtun Khuwa province, Pakistan 23

o 16 Expansion of essential RMNCAH services through Midwifery-Led Health Facilities called Family Health Houses (FHHs) in rural remote areas of Afghanistan 24

o 17 The realities of modern midwifery in the remote communities of Myanmar 25

o 18 Positive outcomes of Twinning Project between Mongolian Midwives Association & Japanese Midwives Association using First Nationwide Survey 26

o 19 History of midwifery education in Iran after the advent of Islam 27

o 20 Mindfulness-based program on the mental health of postpartum women – a randomized control trial 28

o 21 abstract Withdrawn 29

o 22 How do we measure what we don’t count? Sustaining rural maternity units in two Australian states 30





o 23 Active learning in midwifery: use of low-cost innovative hand-made teaching learning strategies 31

o 24 The challenge of implementing “My midwife system”: advocating for continuity of care in Japan 32

o 25 Provision of ultrasound therapy for lactating mothers with mammary blocked ducts 33

o 26 Midwifery Model Birthing Center in TU Teaching Hospital, Maharajgunj – A three years of service experience in Nepal 34

o 27 Effective interventions to reduce disrespect and abuse during childbirth in health care facilities: a mini review 35

o 28 Time and the woman-midwife relationship in Japan: a hermeneutic phenomenological study 36

o 29 Assessment of practices adopted with regard to respectful maternity care by health professionals in labor rooms of hospitals, New Delhi 37

o 30 Sarah’s birth. How the medicalisation of childbirth may be shaped in different settings 38

o 31 The effectiveness of lower back massage on reducing labor pain for primiparous at Maternity and Children’s Hospital 39

o 32 Competencies of professional midwives in Davao City, Philippines: A partial basis for an adoption of the National Competency-based Standards for Midwives (NCBSM) 40

o 33 Concerns during Clinial Placement: The CONDUCT project 41

Ws 01 Story telling – A useful skill for midwives 42

Ws 02 Sepsis – silent but deadly. Innovative practical workshop designed to introduce new ideas and concepts to support successful sepsis management 43

o 34 Core competencies: Basis for midwifery education in Lebanon 44

o 35 Women-clinicians’ relationship during birth is the key factor for better birthing experiences: mixed method questionnaire 45

o 36 The impact of mentorship on clinical practice sites for preservice midwives in Bangladesh 46

o 37 Skin-to-skin and Kangaroo Care – Changing practice, saving lives 47

o 38 Midwife role in the effectiveness of cervical cancer screening using visual inspection with acetic acid (VIA) for women in Indonesia 48

o 39 Maternal & newborn outcomes of community midwives’ services in Pakistan: A retrospective analysis of management information system 49

o 40 The analgesic efficacy of diclofenac suppository in parturients after caesarean section 50

o 41 Audit of pharmacological and technical interventions in spontaneous vaginal births 51

o 42 Episiotomy: Views and perceptions of Saudi women experiencing episiotomy 52

o 43 Strengthening evidence based normal birth care through mentorship at selected sub district hospitals of Bangladesh 53





o 44 ‘Wait for White’ – a successful midwife-led model for implementing evidence-based birthing practices 54

o 45 abstract Withdrawn 55

o 46 Relationship between eating culture with anemia among postpartum mother in Majalengka, Indonesia 2017 56

o 47 Assessment of knowledge and attitude of nurse educators regarding simulation and to develop an informational CD about simulation in midwifery 57

o 48 Reduction of anxiety level in IVF pregnant patients post educational classes in first trimester 58

o 49 The effect of midwifery based counseling on perceived infertility-related stress and outcome of assisted reproductive technology in infertile women 59

o 50 Strengthening midwifery leadership through twinning professional midwives associations: a case study from Bangladesh and the UK 60

o 51 Birth village natural birthing center – The new religion for autonomous midwifery care in India 61

o 52 Midwife’s needs and expectation in equity of midwifery education level in Indonesia 62

o 53 Midwifery education: Philippine setting – its strengths and effects 63

o 54 Scaling the competencies of midwives though mentoring 64

o 55 What shapes midwives decision-making around the Artificial Rupture of Membranes (ARM) in low risk labour? 65

o 56 Effectiveness of video assisted teaching program (VATP) on knowledge and practice of breast massage to express the breast milk 66





Poster Presentations

P 01 a transition story to Stork, the obstetric module of electronic medical records 68

P 03 Findings related to C-section rates: using Caesarean Indication Classification System 70

P 04 Functionalization of maternal, neonatal and perinatal death review system (MNPDR) in four hospitals in Kabul, Afghanistan. 71

P 05 “Membranes Matter think HALO” – a Human Centred Design innovation to reduce the Artificial Rupture of Membranes in low risk labour 72

P 06 Sharing birth experiences among women through movie viewings in Myanmar, Laos, and Japan 73

P 07 Promotion of in-hospital midwife-led care and in-hospital midwifery clinic 74

P 08 Back massage “URUIK” and water immersion stenochlaena palustris leaf for women with fear of birth is a feasible option 75

P 09 Correlations between pushing skills and pushing perceptions, second-stage labor duration, postpartum fatigue, and birth satisfaction 76

P 10 Using creative education to elevate rookie nurses’ ability to deal with postpartum hemorrhage 77

P 11 Iran midwifery standards for regulation and services 78

P 12 Effects of expectant father’s accompanying birth education program on women’s childbirth stress and self-efficacy in Taiwan 79

P 13 Early detection and right care of Premature Rupture of Membranes (PROM) by midwives got well-health baby and mother 80

P 14 Midwifery update (MU) training maintains midwife competencies to provide quality services 81

P 15 Aromatherapy (inhalation) for pain management in labour 82

P 16 A comparative study of childbirth expectations and experiences for mainland China immigrants and Taiwanese women 83

P 17 Application of art therapy in infertile patients: a narrative review 84

P 18 Strengthening clinical supervision of midwifery students using standard assessment tool 85

P 19 First private sector Midwifery led Centre (MLC) in Bangladesh: Experience from Brac University 86

P 20 Professional midwifery education in Nepal: A changing context for equity and quality of maternal and newborn health 87

P 21 Birth asphyxia among term deliveries, a case-controls study on maternal, obstetric and fetal risk factors in Dodoma, Tanzania 88

P 22 An investigation of maternal health policy-making process in relation to midwife-led care: a comparative case study between England and Japan 89

authors Index 90

Oral Presentations and Workshops

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6—8 september 2018 / Dubai — UaE

Thursday 6 September, 2018, 10:30 – 12:00PS01 – Quality and Advocacy

O 01 Cancer during pregnancy – role of the midwife and midwifery care

A. Strahle 1

1 Dubai Health Authority, Dubai Hospital, Dubai, United Arab Emirates

A diagnosis of Cancer is a sentinel and life-changing event – so is becoming a mother. What happens for women when these two things occur at the same time? How is a woman’s perinatal journey from conception, through pregnancy, to giving birth, and doing the work of early mothering, impacted by a diagnosis of cancer and its required/suggested treatment? What impact does the combination of cancer and pregnancy have on a woman’s body image, her sexuality and her sense of self as both ‘woman’ and ‘mother’? How can we Midwives help?

Current rates of cancer, and death from cancer, remain relatively low among childbearing women. However, as increasing numbers of women are choosing to delay childbearing until their more mature years, their risk factors for cancer also rise

It is therefore likely that pregnant women with cancer will feature more frequently in both maternity and oncol-ogy practice settings. Developing integrated, multidisciplinary services to support these women will be crucial to ensure the best possible outcomes for them, their babies and their families, and midwives are ideally placed to coordinate and facilitate the woman’s journey through this experience.

this presentation will describe,• current risk factors, and most common types of cancer affecting pregnant women,• fears, facts and fallacies about cancer in pregnancy,• usual treatment modalities offered for the most prevalent cancers in pregnancy,• fertility preservation for pregnant women with cancer,• cancer, childbearing, conflicts of interest and ethical dilemmas,• how cancer and cancer treatment can affect a woman’s transition to motherhood, and why does it

matter?• the key role of midwives in supporting pregnant women with cancer,• the best models for integrated care and best practice in the care of these women and their families,

and• the emerging role of Specialist Centres.

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O 02 Midwifery Helpline

A. M. Faize 1 , B. Ndyanabangi 2 , K. Sharifi 1

1 UNFPA, Reproductive Health, Kabul, Afghanistan 2 UNFPA, Representative, Kabul, Afghanistan

Background /ObjectiveThe objective of MHL is to assist the midwives in informed decision making on complex maternal cases while on duty. It also aims to help the health managers with tailor-made training options for midwives.

MethodsThe MHL is a toll-free helpline functional 24/7 and operates by two gynecologists and two expert midwives at Rabia Balkhi National Hospital. The call center is equipped with guidelines to provide information and counsel-ing to midwives need urgent support. All received calls are recorded and entered into a database. This paper presents a descriptive analysis of data from November 2016 to Dec 2017.

FindingsThe MHL has responded to 3551 calls from the public and private health facilities across the country. 86% of calls was from midwives followed by medical doctors (3.5%), and 10% other health workers. 57% of call recorded during the daily official time while 43% between 05:00 PM - 07:00 AM.

The majority of calls (22%) sought guidance on the management of delivery complications, e.g., prolong labor, malposition of baby, episiotomy, Laceration, and dosage of uterotonics. 5% of calls asked support on the man-agement of Pre-eclampsia and Eclampsia with focus on diluting and the use of Magnesium Sulphate. Another 5% of calls asked support on the management of postpartum hemorrhage and 5% management of incomplete or threatened abortion and post-abortion management. 12% of calls asked support on family planning while the remaining 51% calls requested assistance on other issues such as hemorrhage during the pregnancy, newborn resuscitation, STI/UTI/PID, breast mass, fetal distress and shock management.

ConclusionMHL is useful and quick access to support and guidance for health workers working in remote areas of the country, which guides timely and informed referral of complicated cases. It also guides the annual training plans around the critical needs identified.

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O 03 Creating awareness regarding ICM’s global standards for midwifery education and competencies among midwifery educator/stakeholders in Pakistan: An advocacy project

M. Hashwani 1 , R. Jan 1 , A. Mansoor 1 , K. Mubeen 1 , S. Abbas 1

1 The Aga Khan University, School of Nursing and Midwifery, Karachi, Pakistan

BackgroundIn Pakistan there are currently four midwifery education programmes in place. However, several studies have highlighted gaps in the quality of midwifery education and programmes are not in line with the ICM’s midwifery educational standards and basic competencies for midwifery practice.

ObjectivesThe project aimed to create awareness among Midwifery educators, and stakeholders about ICM’s global stan-dards for Midwifery Education and competencies.

MethodsThis project was based on knowledge assessment and capacity building of midwifery educators and stake-holders regarding ICM’s educational standards and competencies. Two interactive workshops were conducted in two cities of Pakistan, Karachi and Hyderabad. The total of 37 participants were included based on conve-nience. Pre and posttests and post training feedback was obtained from in each training. Verbal consent was obtained from participants and their supervisors. Permission was obtained from Midwifery Association of Paki-stan and other institutions involved in the activities

AnalysisThe scores were analyzed using descriptive statistics. The comparison of mean knowledge score in all six cat-egories of ICM education standards and also competencies were done separately.

Finding Overall the mean knowledge score in all six categories improved in the post-test in both the groups. The dif-ferences in the total scores on the pre and post tests were statistically significant in four categories (p <0.0001) Midwifery Faculty, Curriculum, Resources, facilities and services, and ICM Essential Competencies.

Conclusion and ImplicationsThe project identified a significant gap in the knowledge of midwifery educators and stakeholders regarding ICM’s educational standards. This project was the first point of raising awareness and insight among them. Further efforts are required at different levels to reinforce ICM standards as a mandatory requirement for all midwifery programmes to ensure quality.

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Thursday 6 September, 2018, 10:30 – 12:00PS01 - Quality and Advocacy

O 57 Impact of trained midwives in Somalia: Shifting from traditional birth attendant to skilled midwives

H. Elmi 11 National Midwifery Training School, Principal, Mogadishu, Somalia

BackgroundSomalia remains to suffer high burden of maternal and newborn deaths. The leading factors to this include lack of skilled midwives to respond to the needs of women, families and communities. With certain limited improve-ments, the trend of maternal deaths burden reduced over the last eight years by 39 percent but still MMR is very high 732 per 100.000 maternal deaths. The newborn deaths have decreased only from 45 in 1991 to 40 in 2015.

ObjectivesThe objectives of this study are to identify the knowledge gap between the TBA context and skilled midwife competence, assess client satisfaction and community access to skilled midwives in three selected cities in somalia

MethodologyA cross sectional study that assesses impact of skilled midwives to the families and communities was con-ducted in m Mogadishu, Badio, and Dhusamareb cities in Somalia. The study employed qualitative method by purposive sampling respectively. Interviews to key informant midwives and focus group discussion were used.

ResultsIn the Somali context, the status of midwifery is facing challenges to respond to the population needs due to TBA adaptation among communities, less knowledge capacity, shortage, misdistribution, poor skills, financing limitation and lack of regulations, poor awareness of community, demotivation of skilled midwives, and poor infrastructure

Conclusion To improve midwifery competencies in line with ICM as well as WHO mandates including the development of norms, standards and guidelines, it is essential that tools to strengthen the country response in relation to mid-wifery are in place and adopted by policy makers and programme.

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Thursday 6 September, 2018, 10:30 – 12:00PS02 – Strengthening Midwifery Education

O 04 Introducing standardised methodology and reviewed curriculum in midwifery education: Experience of James P Grant School of Public Health, Brac University

S. Amin 1 , S. Rahnam 1 , R. Khatun 1 , F. T. J. Lopa 1 , M. Jarin 1

1 Midwifery Education Programme, Brac University, James P Grant School of Public Health (JPGSPH), Brac, Ban-gladesh

BackgroundMidwives (MWs) are recognized internationally as the best cadre for addressing reproductive health issues. However, the concept of professional midwives has been introduced in Bangladesh only in 2012. An estimat-ed 21,154 midwives will be needed to meet national standard Government alone cannot produce the recom-mended number of MWs very soon. BRAC family being renowned as early initiator of many changes in Bangla-desh with regard to empowering women, BRAC University introduced the Diploma in Midwifery course to render support to government in producing competent and efficient midwives through standardised curriculum.

ObjectiveTo review the midwifery curriculum and standardise it in reference to International Confederation of Midwives (ICM) and using newer technologies.

MethodologyThe current curriculum, was reviewed and discussed with the faculty. The review kept government curriculum and International Confederation of Midwifery (ICM) recommendations intact, but prioritised use of ICT in teach-ing methodology. In addition, six English modules and six community modules were introduced so that students were exposed to global updates and understand community engagement. Students were also placed in the clinics and community at the time of internship. Moreover, use of ICT in the faculty training was compulsory. Such as Zoom meeting, blackboard use, use of google drive etc. Online resources such as video contents on YouTube were linked up for the students. Most importantly Faculty members accompanied the students at clinical placement to ensure midwifery practices in practical sessions.

FindingsStudents quickly learnt English and used ICT to reach broader arena of learning. Moreover, introducing intern-ship in BRACU programme lead to building confidence by the new MWs. They conducted 40 deliveries and dis-tributed Family Planning methods

ConclusionReview of the curriculum and incorporating new methodologies lead to 99% success in licensing exam, best result in comparison to other MW education institutes

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O 05 Enhancing quality of care – the Midwifery Education Accreditation Programme

M. Michel-Schuldt 1 , A. Hoffmann 2 , L. Bohle 3 , G. Castro 4 , S. Garg 5

1 University of Technology Sydney, Faculty of Health, Mainz, Germany 2 Swiss Tropical and Public Health Institute and University of Basel, Education & Training-Teaching Technologies and Didactics, Basel, Switzerland 3 Swiss Tropical and Public Health Institute and University of Basel, Sexual and Reproductive Health Unit-Swiss Centre for International Health, Basel, Switzerland 4 Swiss Tropical and Public Health Institute and University of Basel, Swiss Centre for International Health-Health Technology and Telemedicine Unit, Basel, Switzerland 5 International Confederation of Midwives, International Confederation of Midwives, The Hague, Netherlands

BackgroundMidwives are acknowledged as key providers ensuring quality maternal and newborn health care globally. Many countries have therefore invested into the midwifery workforce by expanding their midwifery education programmes for example through developing or revising core curricula that meet the standards by the Inter-national Confederation of Midwives (ICM), investing in the capacity of the educators. However, attention must be paid to the quality of education being provided, so that quality of midwifery care can be assured. To address this, some countries in the region have developed strong regulatory mechanisms which include accreditation schemes, but international standards have not been met or are not being implemented.

ObjectiveThis presentation will provide an overview of the Midwifery Education Accreditation Programme (MEAP) devel-oped by Swiss TPH and ICM, based on global standards for midwifery education, and discusses the potential contribution it can make to building capacity and improving quality of care for mothers and their newborns.

MethodsA review of relevant global, regional and national standards and tools informed the development of a set of as-sessment criteria (which was validated through international consultation exercises) and a process for apply-ing these criteria to midwifery schools. The process was pilot tested in two countries and adjusted accordingly.

ResultsThe MEAP is a user-friendly process based on international standards, that allows a midwifery school to prog-ress the accreditation through various steps that include an application, assessment and accreditation phase and after accreditation is granted, continue with a quality improvement phase which leads to potential re-accreditation

ConclusionThe ICM MEAP has the great potential to serve as a strong accountability tool allowing measuring and moni-toring the standards of midwifery education provided. Adherence to the standards will consequently have the potential to positively impact the services provided by midwives, leading to improved health care for mothers and their newborns

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O 06 Strengthening midwifery education for the next generation of a new midwife in Indonesia: findings from a qualitative study

Q. E. S. Adnani 1 , J. McAra-Couper 1 , A. Gilkison 1

1 Auckland University of Technology, Midwifery, Auckland, New Zealand

Midwifery education plays a pivotal role in producing qualified graduate midwives who, if well resourced, can potentially make a difference in maternal and newborn mortality. Although Indonesia has produced a large number of midwives, the maternal and infant mortality rates remain the highest level in South-Eastern Asia.

This abstract is constructed on the central question how can midwifery education in Indonesia be strength-ened and funded by the Indonesian government. The finding study which aimed to explore the experience of those involved in midwifery and what the barriers and enablers are to strengthen midwifery education leading to competent and confident newly graduated midwives are reported.

A qualitative descriptive method was used, and ethical approval was granted from AUTEC, New Zealand and HREC, Indonesia. Data were collected from thirty-seven participants through purposeful and snowballing tech-niques including Indonesian midwives, midwifery lecturers, midwifery students, newly graduated midwives, and obstetricians. The participants were recruited from twelve different midwifery schools and central board of midwifery association in eight cities which situated in six provinces in Indonesia. All transcripts from face-to-face in-depth interviews were coded and analysed thematically.

There were three themes identified, that is midwifery teaching and learning; midwifery clinical experience; and structural and external factors The preliminary findings of this study have been presented in Indonesia, Austra-lia and New Zealand

The findings deepen our understanding of how to strengthen midwifery education in Indonesia. Impact on midwifery education includes improving the midwifery competency-based curriculum. Numerous barriers and enablers to be a competent new midwife in the future include midwifery regulation were thoroughly raised by participants. This highlight the challenges in the upcoming year of midwifery education in Indonesia become more significant to deal with Sustainable Development Goals 2030. This study provides evidence that midwifery education is strengthened by genuinely work together with all parties involved.

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O 07 Impact of introducing PROMPT in Maternity service of Dubai Hospital on safer childbirth

S. Sharifi 1

1 Dubai Health Authority, Maternity, Dubai, United Arab Emirates

BackgroundImproving maternal and perinatal care is a universal concern. WHO has estimated that 1000 women die every day from preventable complications of pregnancy and childbirth. Globally there are about four million neona-tal deaths each year. Most of these death and complications are preventable with quick intervention through well-trained teams. PROMPT (PRactical Obstetric Multi-Professional Training) is a researched based multi-pro-fessional training course for obstetric emergencies. The training course associated with direct improvements in perinatal outcome and has been proven not only improving knowledge and clinical skills of staff but also enhancing teamwork spirit in working place

ObjectiveThe goal is reducing maternal and perinatal morbidity and mortality rate by training workforce who are highly qualified and capable of providing professional cares during emergencies in the context of multidisciplinary teamwork.

MethodsImplementation of ProMPt in Dubai hospital was cost effective and adaptable in our set up, we started our training course with our own facilities.

AnalysisDuring obstetrics emergencies what is happing in reality is knowledge deficit, clinical skill deficit, poor leadership skills, poor communication and Lack of teamwork.

FindingObstetrics emergencies are not preventable but they are manageable through effective multidisciplinary team works. Conducting practical simulation training for maternity staff can prevent many of the complications dur-ing obstetrics emergencies. Pre and post course evaluation demonstrate significant difference in quality of care of patients, Training of the staff can be one of the elements to reduce maternal and infant mortality and morbidity rate.

ConclusionWe found that training of maternity staff is definitely required and should be repeated on regular basis. Training improves not only knowledge but also performance. Team working spirit enhanced dramatically after training.

Implications for practicePROMPT is locally adaptable in different set ups. It is cost effective and research based.

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Thursday 6 September, 2018, 13:30 – 15:00PS03 – Capacity Building Midwifery Competency

O 08 Assessment of awareness regarding legislation of abortion among doctors, staff nurses, pharmacists and women in selected areas of New Delhi

M. James 1 , M. Chhugani 2 , R. Rana 2

1 Tutor-Rufaida College of Nursing-Jamia Hamdard, Nursing, New Delhi, India 2 Rufaida College of Nursing-Jamia Hamdard, Nursing, New Delhi, India

BackgroundWorldwide, an estimated 22 million unsafe abortions are performed each year. This is the result of a range of factors including the legal status and social stigma of abortion, and a lack of access to safe abortion services. This has contributed to high maternal mortality rates throughout India, where rates of maternal deaths attrib-uted to complications from unsafe abortions are 8%.

Objectives of the Study1. To find out the number of women who have undergone abortion and assess its outcome.2. Assess the awareness regarding legislations of abortion among doctors, staff nurses, pharmacists and-

women in selected areas of Delhi 3 Determine relationship between awareness and education of the women4. Determine the relationship between awareness regarding legislation of abortion and age of doctors,

staff nurses and pharmacists

MethodsA descriptive survey design using purposive sampling technique was used. The sample size was 400 (100, Doc-tors, 100 Staff Nurses, 100 Pharmacists and 100 Women).

AnalysisDescriptive and Inferential statistics

FindingsThe findings revealed that, out of 100 women 27 had used self-medication, of which 18 had complication like excessive bleeding and pain after self-medication. Most (41%) of the women were highly aware regarding leg-islation of abortion. There was a significant relationship between awareness regarding legislation of abortion and education of women. Majority (81%) of doctor were highly aware regarding legislation of abortion and 19 doctors were moderately aware and there was not a significant relationship between awareness and age of doctors. Majority (57%) of staff nurses were highly aware and (38%) staff nurses were moderately aware, and (5%) were least aware regarding. Majority (42%) of pharmacists were highly aware and (42%) pharmacists were moderately aware, and (16%) were least aware.

ConclusionMedical abortion holds great potential for increasing the accessibility of women to safe abortion services in India. However, the awareness about legislation of abortion is significantly low.

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O 09 E-learning training for midwifery tutors

F. Adnan 1 , S. Shahid 1 , S. Abbas 1 , M. Baig 1 , K. Mubeen 1 , A. Lakhani 1 1 Aga Khan University, School of Nursing & Midwifery, Karachi, Pakistan

BackgroundGlobally, eLearning has been adopted to enhance competency-based education in almost all the educa-tion fields including health. E-learning in midwifery is an effective solution to expand midwifery education to a greater range of midwives in remote areas and can be utilized to develop evidenced based midwifery knowledge, critical thinking and decision-making skills. UNFPA, Intel, Jhpiego, and the World Health Organization (WHO) collaborated to develop nine eLearning modules for health workers to provide the updates on current evidence-based practices

ObjectivesThe training aimed to enhance capacity of midwifery tutors and clinical supervisors to utilize eLearning mod-ules to enhance their midwifery knowledge and skills.

Methods Research DesignA pre and post interventional study design was used.

SettingThe two trainings were conducted at the Aga Khan University School of Nursing and Midwifery (AKU-SONAM) from November 22 to 26, 2016 and December 13 to 16, 2016

ParticipantsTotal 39 participants attended the training in two cohorts. Cohort one comprised of 20 participants, and cohort two had 19 participants. Out of 39, eight participants were doctors and remaining 31 were graduated Commu-nity Midwives, Nurse Midwives and LHVs from variety of clinical settings across the Sindh province.

AnalysisData analysis was done by using SPSS version 6.

FindingsIn cohort one, the overall analysis showed an average score of 71% in the pretest and 92% in the posttest. In co-hort two, the average score was 65% in the pretest 88% in the posttest.

ConclusionThe eLearning training on midwifery modules was a significant effort made to enhance the capacity of mid-wives and midwives educators to use electronic media as a source of self-directed learning to refresh their midwifery knowledge.

Implications For Practice1. This eLearning trainings should be arranged for midwives working in the fields to refresh their knowledge

regarding evidence-based practices.2. It will also provide platform for networking and professional socialization for midwives.

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O 10 Capacity building of midwifery faculty to implement a 3-years midwifery diploma curriculum in Bangladesh: A mentorship programme

K. Erlandsson 1 , S. Doraiswamy 2 , L. Wallin 3 , M. Bogren 4

1 Dalarna University, School of Education-Health and Social Studies, Falun, Sweden 2 Unfpa Country Office Bangladesh, Unfpa, Bangladesh, Bangladesh 3 Dalarna University, Department of Neurobiology-Care Sciences and Society-Division of Nursing, Falun, Swe-den 4 Unfpa country office, Unfpa, Dhaka, Bangladesh

When a midwifery diploma-level programme was introduced in 2010 in Bangladesh, only a few nursing faculty staff members had received midwifery diploma-level. The consequences were an inconsistency in interpreta-tion and implementation of the midwifery curriculum in the midwifery programme. To ensure that midwifery faculty staff members were adequately prepared to deliver the national midwifery curriculum, a mentorship programme was developed. The aim of this study was to examine feasibility and adherence to a mentorship programme among 19 midwifery faculty staff members who were lecturing the three years midwifery diploma-level programme at ten institutes/colleges in Bangladesh. The mentorship programme was evaluated using a process evaluation framework: (implementation, context, mechanisms of impact and outcomes). An online and face-to-face blended mentorship programme delivered by Swedish midwifery faculty staff members was found to be feasible, and it motivated the faculty staff members in Bangladesh both to deliver the national midwifery diploma curriculum as well as to carry out supportive supervision for midwifery students in clinical placement. First, the Swedish midwifery faculty staff members visited Bangladesh and provided a two-days on-site visit prior to the initiation of the online part of the mentorship programme. The second on-site visit was five-days long and took place at the end of the programme, that being six to eight months from the first visit. Building on the faculty staff members’ response to feasibility and adherence to the mentorship programme, the findings indicate opportunities for future scale-up to all institutes/collages providing midwifery education in Bangladesh. It has been proposed that a blended online and face-to-face mentorship programme may be a means to improving national midwifery programmes in countries where midwifery has only recently been introduced

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Thursday 6 September, 2018, 13:30 – 15:00PS04 – Keeping Birth Normal I

O 11 What prevents midwifery quality care in Bangladesh? A focus group enquiry with midwifery students

M. Bogren 1 , K. Erlandsson 2 , U. Byrskog 3

1 Dalarna University, School of Education-Health and Social Studies, Falun, Sweden 2 Dalarna University, School of Education-Health and Social Studies-Dalarna University-Falun, Falun, Sweden 3 Dalarna University, School of Education-Health and Social Studies, Falun, Sweden

With midwives as a new profession in Bangladesh, the objective of this study was to describe the perceptions of future midwives on midwives’ realities in Bangladesh from social, economic and professional perspectives.

Data were collected through 14 focus group discussions that included a total of 67 third-year diploma midwifery students at public nursing institutes/colleges in different parts of Bangladesh. Data were analyzed deductively using an analytical framework to identify barriers to the provision of quality care by midwifery personnel.

The social barriers preventing midwifery quality care falls outside the parameters of Bangladeshi cultural norms that have been shaped by beliefs associated with religion, society, and gender norms. This puts midwives in a vulnerable position due to cultural prejudice. Professional barriers include heavy workloads with a shortage of staff who were not utilized to their full capacity within the health system. The reason for this was a lack of recognition in the medical hierarchy, leaving midwives with low levels of autonomy. Economical barriers were reflected by lack of supplies and hospital beds, midwives earning only low and/or irregular salaries, a lack of opportunities for recreation, and personal insecurity related to lack of housing and transportation. Without ad-equate support for women in general and midwives in particular, little can be achieved to improve the quality of care for women. Strategies need to include women leadership, proper midwifery workforce planning, edu-cation and training, and the effective management of professional midwifery jurisdiction. The findings in this study can be considered a starting point for a discussion that aims to mobilize a midwifery workforce across the continuum of care to deliver quality reproductive health care services, and can also be used as evidence to prioritize equitably costing for the provision of quality midwifery care.

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O 12 Group antenatal care: the best way forward

A. van der Kraan 1 , 2 , M. Rijnders 3 , M. Crohne 4

1 Ministry of Health, Riyadh, Netherlands 2 Academy of Midwifery in Amsterdam & Groningen, Amsterdam, Netherlands 3 TNO Quality of life, Leiden, Netherlands 4 LUMC, Leiden, Netherlands

Content• Introduction group antenatal care• Why and how did we implement group antenatal care (CenteringPregnancy) in the Netherlands in 2012• Why and how introduction of Group antenatal care in the Middle-East Region?

BackgroundCenteringPregnancy (CP) is an evidence -based model of group healthcare. The centering model combines health checks, education and community building to help support positive health behaviors and drive better health outcomes

ObjectivesThe aim of this present study (Connect-In) is to evaluate the effects of CP in the Netherlands in primary health care (low-risk population) as well as in hospital-based care (moderate to high risk population) on neonatal and maternal health outcomes, health behaviors and psychosocial outcomes.

MethodsBetween 2013 and 2016 Rijnders et al. (2017) evaluated the effects of CP in the Netherlands in a general popula-tion of pregnant women (low and high risk) using a stepped wedge cluster randomized controlled trial. Thirteen midwifery practices and two hospitals participated. Perinatal data and questionnaires were collected at four time points during pregnancy. Implementation- and cost data were collected using process evaluation forms and semi structured interviews

FindingsThe control group consisted of 1120 participants, the intervention group of 2571 participants, with 814 participants (31,6%) in the CP care model. At entrance women in CP had less knowledge about their pregnancy, higher scores on stress, depression and coping scales, and had used more (medical) care before the start of their pregnancy.The CP-participants had more knowledge about pregnancy, to less often smoke during pregnancy or to re-lapse after pregnancy. They more often started breastfeeding and less often drank alcohol the first weeks after pregnancy. Primiparae less often used pain medication during delivery and multiparae more often gave birth at home. Furthermore, women in CP showed to be significantly more satisfied with care.

ConclusionCenteringPregnancy has positive effects on health-related behavior and the well-being of pregnant women.

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O 13 Effect of normal childbirth promotion plan in Iran

F. Babaey 1 , Z. Mazaheri 1 , F. Abasi 1 , F. Kaykhosravi 2 , L. Hadipour Jahromy 3

1 Ministry of Health and Medical Education, Midwifery Department, Tehran, Islamic Republic of Iran 2 Ministry of health and medical education, midwifery department, Tehran, Islamic Republic of Iran 3 Ministry of health and medical education, Maternal health, Tehran, Islamic Republic of Iran

BackgroundThe high rate of cesarean section in Iran and its effect in maternal and neonatal health outcome, made the policy makers to take measures to control it. Normal childbirth promotion plan is the most important one which have been started from 2013. This study aims to investigate the components of this plan and the results.

MethodThis is a before and after study comparing the rate of C/s in 2012 with 2017Data was gathered through national birth database. One Way ANOVA and T test were used.

FindingsPlan includes 9 main interventions. Free normal delivery services (In public hospitals), free public childbirth preparation classes to empower expecting mothers , obligatory training courses for midwives and obstetri-cians To empower maternity care providers and lancing natural child birth skill labs, revision of NVD& C/s tariffs, revision of painless deliveries tariffs revision, renovation of maternity wards, facilitation of providing maternity services by private maternity care providers in public hospitals ,considering the decreased C/S rate in the ac-creditation of the maternity wards and hospitals, promotion the culture of normality of pregnancy and birth in the community.The statistical results shows 5.2 % decrease in c/s rate. (P<0.05)

ConclusionThe results of this study shows that the plan was successful to decrease the rate of cesarean section, so the continuity of plan in long-term could lead to logical rate.

Implication for practiceAs the increase in Cesarean section rate is a problem in many countries nowadays, sharing the experiences would help the other

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Thursday 6 September, 2018, 15:30 – 17:00PS05 – Leading the Way for Midwifery Led Services

O 14 Do women who access midwife-led care in low-and middle-income countries receive quality services?

M. Michel-Schuldt 1 , C. Homer 1 , M. Alison 2 , M. Renfrew 2

1 University of Technology Sydney, Faculty of Health, Sydney, Australia 2 University of Dundee, School of Nursing & Health Sciences, Dundee, United Kingdom

BackgroundA model that addresses the needs for health and wellbeing of all women and newborns and initiate special care for the ones with complications is midwifery care and potentially in particular midwife-led care. Rigorous research on this model of care in high-income countries shows that it is effective and that it should be offered to most women as it provides multiple benefits for childbearing women and their newborns.

ObjectiveTo assess if women who accessed midwife-led models in low- and middle-income countries received quality care

MethodsA systematic integrative review has been carried out and findings were analysed using the framework for qual-ity maternal and newborn care of which one aspect is accessibility of care (Renfrew 2014).

ResultsFrom initially 2494 abstracts that were identified, 20 studies were included in this research. Issues around acces-sibility to quality care provided by midwives were reported in numerous studies. Women who were able to ac-cess midwife-led care received health care information that aimed at fostering their decision-making power. Midwife-led care ensured that normal processes were supported and expectant management of labour was applied and that care was women-centred and respectful. Midwives were able to provide first line manage-ment of complications and initiated referral. However, resource constraints and low esteem towards midwives averted accessibility to services. Midwife-led care was fragmented and often care in the post-partum period was absent. User-fees constitute a major barrier to access care.

ConclusionWomen who were able to access midwife-led models of care in low- and middle-income countries often re-ceived the care they want. However, access to midwife-led care alone does not guarantee that women and newborns receive quality care. Massive investment in comprehensive interventions around quality maternal and newborn care is needed to unfold the latent abilities this midwife-led model of care has

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O 15 Utilization of the community midwife services by women of Khyber Pakhtun Khuwa province, Pakistan

A. Mansoor 1 , R. Jan 2 , K. Mubeen 1 , L. Sewani 3

1 Aga Khan University, School of Nursing and Midwifery, Karachi, Pakistan 2 NIHS, School of Nursing, Islamabad, Pakistan 3 Consultaant, Freelancer, Dubai, United Arab Emirates

IntroductionInvesting in midwifery education and producing Skilled Birth Attendants (SBAs) to overcome maternal and neo-natal deaths, can yield a 16-fold return on investment in terms of lives saved. In 2013, The Chitral Child Survival Program (CCSP) began midwifery training program for young girls of Chitral.

AimThe purpose of this three-year longitudinal study was to assess the midwifery knowledge and skills competen-cies of Community Midwives (CMWs) over the three years and the push and pull factors affecting the utilization of CMWs services. The baseline was done at the time of the graduation (before deployment); followed by two consecutive years after of assessment.

MethodologyThe study site was Chitral District of Khyber-Pakhtunkhwa Province, Pakistan. The quantitative data was col-lected by using tool comprised of Multiple Choice Questions (MCQs) and an observational checklist for skills. While interview guides were developed for collecting qualitative data from CMWs, community leaders, and key stakeholders. The quantitative findings showed a progressive improvement in CMWs overall theoretical and skills-based knowledge. The study participants strongly felt that the CMWs were not only competent in handling maternal and neonatal cases, but confident in managing people who are suffering from other minor illness. The CMWs were able to timely assess, refer and follow up complicated cases effectively. The organized and structured support of CMWs supervisors, and community leaders, was widely acknowledged. The participants described cMWs as ethical, trustworthy, and safe practitioner. A health care system of ‘health for communities by the communities’ and in specifically ‘care by the women for the women’ has evolved in this project.

ConclusionTraining healthcare personnel from the same community especially in the rural setup, assures availability, ac-cessibility and sustainability of the services.

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O 16 Expansion of essential RMNCAH services through Midwifery-Led Health Facilities called Family Health Houses (FHHs) in rural remote areas of Afghanistan

A. Molakhail 1 , N. Baryal 2 , M. R. Dadbig 1

1 UNFPA-Afghanistan, Reproductive Health, Kabul, Afghanistan 2 UNFPA, Reproductive Health, Herat, Afghanistan

BackgroundAfghanistan established a network of health facilities under the BPHS since 2003 to ensure equitable access in the country. Despite the innovative approaches, approximately 18% of the Afghan population resides in un(der)served areas mainly due to scattered populations, distance to facility, an absence of female health workers, and cultural limitations. Therefore, UNFPA and MoPH introduced the FHH model.

ObjectivesThe FHH is to ensure UHC in remote areas through the deployment of community midwives in un(der)served area

The methodology of the InterventionFHH was piloted in four provinces of Afghanistan with the aim to expand the essential RMNCH services, in so-called “white areas” through establishing of 123 FHHs covering 360,00 populations-each covering 1,500–3,000 people. The model has five inter-linked components: (a) community engagement; (b) bonded community mid-wifery education (CME) and deployment; (c) 24/7 health service provision; (d) social mobilization and health education; and (d) supervision and monitoring of services

AnalysisThe HMIS data of FHH was analyzed for one year (2017)

FindingsIn 2017, 7,819 women delivered in FHHs and the new-born babies received care; 4,860 CPR generated through the provision of family planning services; 19,904 ANC and 9,792 PNC services. 509,226 U5 OPDs under the IMNCI services. The Mid-term Review (MTR) of the intervention conducted in 2015, showed that FHH is an effective, ef-ficient, and sustainable intervention in line with the national priorities.

ConclusionExpansion of FHH offers a unique opportunity to increase equity in access to essential RMNCH services. Prior to FHH those deliveries were less likely receiving and used to give birth at home. It is realized by all that FHH Model is a strong intervention that could ensure UHC in the country. FHHs are functional even in very insure areas

Implications for PracticeThe practices are planned to be expanded to 7 more provinces and scaled up nationally

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O 17 The realities of modern midwifery in the remote communities of Myanmar

L. A. Dornan 1 , G. Kernohan 2 , M. Sinclair 2 , N. Chaloumsuk 1 , S. Yimyam 1 , M. Haigh 3 , A. A. Thant 4 , M. Parker 5

1 Faculty of Nursing-Chiang Mai University, Department of Obstetrics and Gynaecology, Chiang Mai, Thailand 2 Institute of Nursing and Health Research-University of Ulster, School of Nursing, Belfast, United Kingdom 3 Partners Relief and Development Agency, Health Projects Department, Mae Sot, USA 4 Faculty of Nursing, School of Nursing, Chiang Mai, Myanmar 5 Earth Mission Asia, Midwifery, Kyaukkyi, Australia

BackgroundEquity of access to quality midwifery care is a highly valued global goal which impacts maternal and infant morbidity and mortality rates. This goal is particularly difficult to achieve in remote and conflict communities suffering from increased poverty and marginalisation. Undertaking research to determine the lived-experience of birthing mothers within their culture and identify the contextual issues impacting on care at ground level is critical in the formation of an effective midwife led service

ObjectivesTo identify the risks, challenges and experiences of mothers in remote areas of Eastern Myanmar.

MethodsAn ethnographic style, semi-structured survey was designed to explore communal experiences of mothers in remote areas of Eastern Myanmar. Participants were women aged between 18 – 50, who had given birth within the previous five years. Ethical approval was granted by Ulster University in the UK and by the Karen Department of Health and Welfare.

AnalysisAnalysis was conducted through a qualitative approach to thematic analysis. All data were transcribed and verified by translators fluent in Karen and English.

FindingsTwo key themes were ‘Realities of Birth’ and ‘Modern Midwifery with Traditional Practices’. Sub themes included ‘our own community care’, ‘medics and midwives’, ‘when birth goes wrong’ and’ birthing our way’. Traditional practices included home births with traditional midwives, fundal pushing and breastfeeding as the norm.

ConclusionsRelevant and applicable evidence-based practice delivered within a midwife-led service is vital for women giv-ing birth in remote and conflict areas.

Implications for PracticeMidwives are in a primary position to identify the contextual and cultural challenges facing mothers and enable them to access to appropriate and relevant services with adequately trained practitioners. This must include collaborative partnerships at community and policy level to ensure sustainable and equitable service delivery programmes that will impact on maternal and infant mortality and morbidity.

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Thursday 6 September, 2018, 15:30 – 17:00PS06 – The Third Pillar – Midwifery Associations

O 18 Positive outcomes of Twinning Project between Mongolian Midwives Association & Japanese Midwives Association using First Nationwide Survey

H. Taniguchi 1 , Y. Sato 1 , K. Adachi 2 , D. Serdamba 3 , U. Yamamoto 4 , K. Okamoto 5

1 Kyushu University, Graduate School of Medical Science, Fukuoka, Japan 2 Tokyo Metroporitan University, Midwifery, Tokyo, Japan 3 Mongolian Midwives Association, Midwifery, Ulaanbaatar, Mongolia 4 Japaneses Midwives Association, Midwifery, Tokyo, Japan 5 Japanese Midwives Association, Midwifery, Tokyo, Japan

ObjectivesThe objective of this project was to strengthen the Mongolian Midwives Association (MMA) using the national survey of obesity during pregnancy in Mongolia through the Twinning Project with the Japanese Midwives As-sociation (JMA). This report presents the positive outcomes of the Twinning project.

MethodsThe Twinning project was initiated in 2015. At that time, we evaluated our association with the Member Asso-ciation Capacity Assessment Tool (MACAT). To strengthen MMA, we used the nationwide survey of Mongolian midwives for mothers who suffered obesity during pregnancy. The nationwide survey was conducted by ques-tionnaire in 2017 and 2018, for midwives and mothers after delivery. The third seminar & workshops were held in Ulaanbaatar for nationwide members of MMA for prevention of obesity during pregnancy. The board members were interviewed as to their perceptions through the project and evaluated using MACAT. This study was con-ducted under approval of IRB of Kyushu University and the Mongolian National University of Medical Sciences.

ResultsThrough the Twinning project, the main four themes of MMA board members were “professional identity” by midwife-led health services for pregnant women; “strengthening midwifery” by necessity of high-quality mid-wifery competency; “advocacy for midwives” by lobbying for the existence and meaning of midwifery in society; and “recognition of midwives as autonomous professionals” independently from the direction of the doctor. They recognized the strengthening of the midwives association through the results of MACAT. DiscussionThe current MMA led by midwives, has been suffering from interventions from previously established OB/Gyn-led group. JMA supported the independence of the MMA, and showed true midwife job descriptions as mem-bers of an experienced professional group. It furthermore served to build professional self-confidence and a sense of self-sufficiency. We were also encouraged by the future-oriented attitudes of the MMA and were very pleased to see their quantifiable achievements through the Twinning project.

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O 19 History of midwifery education in Iran after the advent of Islam

F. Golboni 1 , S. Khosravi 2 , F. Babaey 3

1 Department of Midwifery-Faculty of Nursing and Midwifery-Kermanshah University of Medical Sciences-Ker-manshah-Iran, Department of Midwifery, Tehran, Islamic Republic of Iran 2 Tehran University of Medical Sciences, Department of Community Medicine, Tehran, Islamic Republic of Iran 3 Iran Ministry of health, Midwifery affair, Tehran, Islamic Republic of Iran

BackgroundSignificant progress in midwifery in Iran should be noticed

ObjectivesIdentifying history of midwifery of Iran from the advent of Islam up to now

Methods, analysis We collect all data from Iran national library and historical research in medicine and midwifery development in Iran then we classified all information in several Eras in Iran (midwifery around and advent of Islam, midwifery in AvESINA Era with medical development, Safaviyeh Era with Shia dominance, Qajar dynasty in Full hijab veil on face, Pahlavi Era and then now days midwifery development after Islamic Republic of Iran)

Findings/Conclusion, Implications For PracticeAfter the advent of Islam the womens’ dress and fashion was changed. Their relations with non-husband men and the male physician were forbidden. An exception was the lack of a physician or female midwife and male in those eras didn’t have right to touch not intimate women and so training midwives by physician is very im-portant for saving mothers life!

Midwifery training in Iran has been continually improving since the 1st school of midwifery was established in 1919.There are several types of trained midwives and the duties they are permitted to perform are dependent on their degree of training. In 1971, because of the lack of midwifery 2-year diploma in midwifery was designed. The midwifery school was under the supervision of the faculty of medicine, after Islamic Republic of Iran in 1979 direct-entry midwives course was designed in 1982. In 1985, the master’s degree in midwifery was approved. In 2006 Ph.D. degree as Reproductive health was approved for midwifery and in 2015. Ph.D. degree in midwifery practice was approved. The result showed that midwifery education has good quality and development from the last to now and so we need to develop birth centers to encourage midwives independently to help an en-courage mothers positive child birth experience.

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O 20 Mindfulness-based program on the mental health of postpartum women – a randomized control trial

W. L. Pan 1 , M. L. Gau 2

1 The University of Kang Ning, Department of Nursing, Taipei, Taiwan 2 National Taipei University of Nursing and Health Sciences, Department of Midwifery and Women Health Care, Taipei, Taiwan

BackgroundThe transitions from a woman to a mother is a very stressful period. It was estimated that about 15–85 % expe-rienced postpartum blue or depression ObjectivesThe purpose of this study was to evaluate the efficacy of the Mindfulness-Based Childbirth and Parenting (MBCP) program on psychological health during the postpartum period.

MethodsThis research was a randomized controlled trial with single blinding. Recruitment began only after the research hospital granted formal approval (Institutional Review Board approval number 104-E-20). A total of 74 women between 13–28 weeks gestation was allocated either to a MBCP program (intervention group) or to a traditional childbirth education program (comparison group). The MBCP program, was a series of eight three-hour classes held once per week and one seven-hour day of silent-meditation practice.

AnalysisPsychological health was assessed at baseline and 3 months postpartum. Data analysis was conducted using sPss version 22

FindingsSignificant differences were seen in both groups in terms of change over time in stress, depression and mindful-ness scores. The intervention group had a significant improvement in stress score than the comparison group at 3 months postpartum (F =7.19, p = .009), and depression (F = 7.36, p = .008). There was no significant difference between groups in mindfulness scores.

ConclusionThe MBCP program effectively reduced postpartum self-perceived stress and depression, which is an accept-able and long-term beneficial program for women during pregnancy and the postpartum period.

Implications For PracticeTeach and practice of mindfulness meditation and parenting education during pregnancy may help to reduce stress and depression for pregnant women transition to parents.

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O 21 Abstract Withdrawn





Friday 7 September, 2018, 09:00 – 10:30PS07 – Practical Skills in Midwifery

O 22 How do we measure what we don’t count? Sustaining rural maternity units in two Australian states.

J. Simpson 1 , F. Douce 2 , J. Kelly 2

1 New South Wales Ministry of Health, Workplace Relations, Sydney, Australia 2 Tasmanian Department of Health & Human Services, Office of the Chief Nurse and Midwifery Officer, Hobart-Tasmania, Australia

Whilst Australia has arguably one of the best health systems in the world, equity of access and poorer health outcomes are challenges still to be addressed for rural communities.

Maternity service provision varies across the country and is defined predominately by the acuity of service provided, location and annual birth rate this means that models of care in rural communities where there are fewer births, but on average a more vulnerable population, are themselves vulnerable to closure.

Maintaining local maternity services and striving to provide continuity of care models is key to better health outcomes for mothers and their babies. It also has an impact on the community and the available workforce who may be forced to leave their profession or move elsewhere if they lose the opportunity to work locally.

Sustaining rural health services is a national strategy but how do we measure the workforce required to provide the care in a particular location even if it doesn’t include birthing? Much is said about an existing and worsening midwifery workforce shortage as a major barrier to maintaining small rural maternity services. How do we know how many are needed when these smaller units are staffed on historical decisions that don’t reflect the care they provide in the diverse environments of rural Australia?

This presentation will describe how the implementation of a maternity service specific workforce methodology in two Australian states is using the same principles applied to larger maternity services to sustain rural mater-nity units, drive innovation and support local models of care.






O 23 Active learning in midwifery: use of low-cost innovative hand-made teaching learning strategies

S. Shahid Ali 1 , S. Abbas 1 , F. Adnan 1

1 Aga Khan University, School of Nursing and Midwifery, Karachi, Pakistan

BackgroundCreativity in teaching is encouraged to have an effective learning experience. Midwifery students are adult learners and evidences suggest that adult learners when involved in their own learning, learn more effectively (Knowles, Holton & Swanson, 2011). Today, academicians are excited about the progress with modern high-tech equipment such as high-fidelity simulators that promise to offer quality-learning experience to learners. However, low and middle-income countries often have scare teaching resources; therefore, it becomes chal-lenging to facilitate students by using such mannequins. Midwifery can be taught by using simple handmade low-cost stuff; as, evidence also suggest that low-cost teaching resources are equally beneficial for effective learning (Utz, Kana, & Van Den Broek, 2015).

Learning outcomes This workshop aims to make participants:• Acknowledge the importance of low-cost teaching resources• Identify simple handmade material to design teaching learning aids• Learn the application of low-cost teaching aids in classroom and clinical teaching

Process/activityThe facilitators will:• Provide an overview about using low-cost teaching resources.• Ask the participants to brainstorm and come up with active teaching learning strategies. • Instruct the participants to develop low-cost teaching material by using the material provided.• Facilitate the groups to develop one teaching resource as per their group title and explain its

application

Description of how the audience will participate in the session• The participants will be divided in four groups titled as antenatal, intranatal, postnatal and newborn

group.• Each group will be asked to share examples of handmade models and develop one teaching resource

and explain its use with respect to their assigned group title.

Supporting evidenceInnovative teaching strategies strengthen learners critical thinking skills. Literature suggest that students from low resources settings can learn majority of skills with the help of cost effective low fidelity mannequins (Utz, Kana, & Van Den Broek, 2015; Cohen, Cragin, Wong, & Walker, 2012).






O 24 The challenge of implementing “My midwife system”: advocating for continuity of care in Japan

F. Hinokuma 1 , C. Kota 2 , K. Doering 3 , Y. Akatsuka 4 , S. Hayashida 5 , Y. Hanaika 6

1 Bukkyo University, School of Health Sciences, Kyoto, Japan 2 Japan Maternity Support Council Apple Tree, n/a, Inagawa, Japan 3 Auckland University of Technology, Midwifery, Auckland, New Zealand 4 Yurikago Birth House, n/a, Kakamigahara, Japan 5 National Hospital Organization Kyoto Medical Center School of Nursing and Midwifery, Midwifery, Kyoto, Japan 6 Matui Life Produce, Visit Nursing Station, Chigasaki Kanagawa, Japan

BackgroundWhile the maternal and neonatal mortality rates are among the best in the world, maternal issues, such as postpartum depression and suicide of childbearing women, are serious issues in Japan. The postnatal care is emphasised in the situation, but research shows women’s birth experiences also affect women’s postpartum, including mental health.

ObjectiveThe aim of this case study is to reflect on and enhance an ongoing project to implement the maternity care system of continuity of caregivers in Japan.

MethodThe project was conducted with 25 women and midwives joining the working group between May 2017 and April 2018. The study follows the ethical code of the conduct provided by Japan Society for the Promotion of Science.

AnalysisThis case study analyses the progression of the project by dividing the activities into the stages.

FindingsThe working group took six stages for the project to reconstruct the maternity care policy in Japan. They 1) learned current situations of Japanese maternity care system by inviting guest lectures, 2) discussed a policy supporting women’s positive birth experiences, 3) surveyed the needs of Japanese women, 4) established the idea of “My midwife system,” 5) lobbied for the system, and 6) held events to advocate the system and called out over 300 people. The proposal obtained some approval through the campaign, but the implementation is not easy because of the lack of understandings, budget, and midwives’ competence.

ConclusionMidwifery continuity of care is required to improve women’s birth experiences in Japan. However, there are is-sues needed to be tackled for the implementation.

Implications for practiceFor the next step, the project needs to increase the model cases while involving more women, midwives and policy makers. Strengthening midwifery workforce is also required.






O 25 Provision of ultrasound therapy for lactating mothers with mammary blocked ducts

L. F. Ho 1

1 Princess Margaret Hospital-Hong Kong, Obstetrics & Gynaecology Department, Hong Kong SAR, Hong Kong

IntroductionIn 2015, 82.7% of mothers opted for breastfeeding before birth, but the breastfeeding rates were dropped to 35.3% at 4 weeks after delivery in our hospital. Some of them had experienced painful blocked ducts, which leading to reduction of milk production, and causing premature cessation of breastfeeding. Although there are several studies performed on the effectiveness of using therapeutic ultrasound to manage ductal blockage, there are only limited information on the pain reduction for these mothers.

Objectivesa collaborative pilot service has been started in april 2016, the purposes were to illustrate the pain reduction ef-fect of ultrasound therapy for mothers with problem of blocked ducts; and to manage the problem on blocked ducts earlier, so as to reduce the premature breastfeeding cessation.

MethodologyLactating mothers with the problem of blocked ducts, would be referred to Physiotherapist for ultrasound ther-apy. Pre and post ultrasound therapy on pain score by using Numeric Pain Rating Scale (NRPS) were recorded; milking and hand expression would be performed by Lactation Consultant immediately after the treatment. Phone follow-up done at 4 weeks to complete the evaluation form and Client Satisfaction Questionnaire (CSQ).

Results48 mothers were contacted at 4 months after the treatment. The average post-treatment NPRS (3.77) was markedly reduced when compared with the average pre-treatment NPRS (6.5); it was significantly reduced 44.7% after the therapy. For all the outcome measures the lower 95% confidence intervals for the improvement in outcome exceed zero in intervention group, indicating a statistically significant (p<0.05) improvement from the baseline. 48.2% (27/48) of mothers exclusively breastfed their babies and 19.6% (11/48) of mothers gave breast milk by direct latch on or expressed breast milk. 14.3 % (8/48) of mothers had given formula to their babies. All of them had expressed that the amount of milk production was increased after the treatment.





Friday 7 September, 2018, 09:00 – 10:30PS08 – Respecting the Space for Women

O 26 Midwifery Model Birthing Center in TU Teaching Hospital, Maharajgunj – A three years of service experience in Nepal

P. Shiwakoti 1 1 Tribhuvan uUniversity Teaching Hospital, Mangla Devi Birthing Center, Maharajgunj Kathamandu, NepalParbati Shiwakoti 1 , Kalpana Piya 2 bina Neupane 3 , Kiran Bajracharya 4 §

BackgroundIn order to enhance women centered care based on midwifery model to support the government strategy in developing midwife human resources in the country, Mangala Devi Birthing Centre was established in TU Teaching hospital Maharrajgunj in June 2014.This in- house birthing center is the outcome of global midwifery twinning project with Royal College of Midwives, UK and Midwifery Society of Nepal (MIDSON). It provides care to the low risk women in home like environment, food /drink, music, walk around, presence of their companion and minimal intervention. The center have its own operational guidelines of admission, referral, risk assessment and client satisfaction survey sheets. The annual follow up meetings with UK midwives enhances the quality and inter professional collaboration

ProcessA three year review record was made (2014–17).

FindingsThere were total of 955 women admitted till end of 2017 out of which 789 (82.61%) delivered at the center and 166 women (17.39%) referred at obstetrics lead unit. The causes of referral includes meconium stained liquor, non-progress of labor, prolonged 2nd stage etc. Majority of them 59 %were multigravida and 41% were at the age of 20–25 years. Mode of child birth were normal vaginal delivery with intact perineum, 44.26 % first degree tear and others with second degree tear. Birth weight were 2500- 3500 gm. The mother’s satisfaction survey was filled before the discharge, rated as excellent 49.30% in birth experiences and 60% were happy with midwives support.

Conclusion/implicationsWomen centered care provided by midwives are quality with good outcome. The center serves as role model for new student midwives and need to expand in other government hospitals for respectful care.






O 27 Effective interventions to reduce disrespect and abuse during childbirth in health care facilities: a mini review

M. Hashwani 1 , K. Mubeen 1

1 The Aga Khan University, School of Nursing and Midwifery, Karachi, Pakistan

BackgroundAccess to skilled and quality maternity care at the health care facilities can save lives of women and new-born babies. However, plenty of evidence suggests different forms of disrespect and abuse during childbirth at facility level. Therefore, the notion of Respectful Maternity Care (RMC) was introduced. Many organizations are currently involved in implementing campaigns to promote RMC in many countries. Different interventions have been employed at policy, governance, health system, and individual and community level to overcome this issue

ObjectiveThis mini review aimed to evaluate the effectiveness of interventions, to eliminate disrespect and abuse during childbirth at health care facilities

MethodologyA systematic search of two electronic databases the PubMed and CINAHL were undertaken in October 2016, us-ing RMC and relevant terms as keyword, to identify all relevant studies that assessed the effectiveness of inter-ventions to end disrespect during childbirth. Reference list of all the included studies were manually searched to identify other relevant studies.

ResultsBased on criteria, only two studies were identified that reported effects of interventions. Both the studies were conducted in African countries and shared similar aim and pre and post design. Methodological quality of both the selected evidences was assessed using the checklist by Downs and Black(1998). Both the studies demon-strated that the interventions, Open birth day and health care providers’ workshop along with other integrated interventions proved to be effective in reducing overall disrespect and abuse during childbirth. Despite of some methodological limitations in both studies the findings created an insight of the outcomes of interventions.

Conclusion and ImplicationsFurther high quality research is required to build strong evidence regarding effective interventions to promote RMC. The current review findings suggest that framework of integrated interventions at community, facility and individual level can positively contribute in promoting Respectful maternity care.






O 28 Time and the woman-midwife relationship in Japan: a hermeneutic phenomenological study

K. Doering 1 , A. Gilkison 1 , J. McAra-Couper 1

1 Auckland University of Technology, Midwifery, Auckland, New Zealand

BackgroundResearch shows the relationship between childbearing women and midwives is an integral component of women’s birth experience. While the woman-midwife relationship is well documented in other countries, few studies have explored the experiences of this relationship in the Japanese context

ObjectiveThe Aim of this study is to understand the meaning of the woman-midwife relationship to improve maternity care and women’s birth experience in Japan.

MethodThis study is guided by hermeneutic phenomenology described by van Manen. Hermeneutic phenomenology helps uncover the meaning of a phenomenon, the women-midwife relationship, through the interpretation of participants’ experiences. Interviews were conducted with 14 women and 10 midwives throughout Japan. Ethics approval was gained by AUT University.

Analysisthe stories of the woman-midwife relationship were crafted and interpreted from the transcripts, and themati-cally analysed.

FindingsThe woman-midwife relationship is shaped by three overlapping experiences of time; 1) fragmented time, 2) sharing time and 3) timelessness. Some women describe they did not meet a midwife although physically they met a midwife. The fragmented care affects this relationship. When the women and the midwives have the continuity of care, their relationships become deepened, personalised and holistic since they understand each other and share their values by spending time together. By sharing time, the established relationship brings the women a feeling of safety and trust. It also becomes an ongoing relationship and continues to empower women even after the care the midwives also feel secured in the relationship and care

ConclusionBy being exposed to each other over an extended period of time, a woman and a midwife nurture the relation-ship, which brings a sense of safety, trust and empowerment.

Implications for practiceThe maternity care system need to allow time for a woman and a midwife to build the relationship required to improve women’s birth experience.






O 29 Assessment of practices adopted with regard to respectful maternity care by health professionals in labor rooms of hospitals, New Delhi.

M. Chhugani 1 1 Professor cum Principal-Rufaida College of Nursing-Jamia Hamdard, nursing, New Delhi, India

IntroductionChildbirth is one of the most marvelous and memorable segment in a woman’s life. Respectful maternity care is a universal human right that is due to every childbearing woman in every health system. Women’s experiences with maternity caregivers can empower and comfort them or inflict lasting damage.

Materials and MethodA quantitative non-experimental research, using descriptive survey research design was conducted. Data was collected from sixty-three health professionals from three different health facilities of New Delhi from the month of October –November. Observational checklist was used based on RMC charter to collect the data clinical profile of postnatal mothers and the practices.

ResultThe findings revealed that that mistreatment of patients during labor and delivery (98%), particularly verbal abuse (93%) was relatively common. No women were greeted by the health professionals, 93% were not encour-aged to ask questions by health providers and no privacy or support during labor was provided for 100% and 76% women, respectively. Standard VI – (Left without care) ranked I in terms of not providing respectful mater-nity care or mistreatment, standard II, ranked II, in which right to information was not given, informed consent was not taken and preferred choice was not considered, then standard VII – Detained or confined against will ranked III, standard III – Confidentiality and Privacy ranked IV, standard I – Physical harm or ill treatment ranked V, standard IV – Dignity and Respect, ranked VI and standard V – Provision of Equitable Care, Free of discrimina-tion ranked VII respectively.

ConclusionEfforts to use facility based maternity care for low socio-economic woman are unlikely to achieve the desired gains if there is no improvement in quality of care provided by health professionals for different elements of respectful maternity care. Key wordsRespectful Maternity Care (RMC), health professionals, labour room





Friday 7 September, 2018, 11:00 – 12:30PS10 – Improving Competency in Normal Birth Care

O 30 Sarah’s birth. How the medicalisation of childbirth may be shaped in different settings

R. Altaweli 1 1 East Jeddah Hospital, Nursing Adminstration, Jeddah, Saudi Arabia

BackgroundThe expansion of the medicalisation of childbirth has been described in the literature as being a global phe-nomenon. The vignette described in this paper, selected from an ethnographic study of routine intervention in Saudi Arabian hospitals illustrates how the worldwide spread of the bio-medical model does not take place within a cultural vacuum

ObjectivesTo illuminate the ways in which the medicalisation of birth may be understood and practised in different cul-tural settings, through a vignette of a specific birth, drawn as a typical case from an ethnographic study that investigated clinical decision-making in the second stage of labour in Saudi Arabia.

Methods Ethnographic data collection methods, including participant observation and interviews. The data presented in this paper are drawn from ethnographic field notes collected during fieldwork in Saudi Arabia, and informed by analysis of a wider set of field notes and interviews with professionals working in this context.

FindingsWhile the medicalisation of care is a universal phenomenon, the ways in which the care of women is managed using routine medical intervention are framed by the local cultural context in which these practices take place.

ConclusionIn this article, field note data on the birth of one Saudi Arabian woman is used as an illustration of how the medi-calisation of childbirth has been appropriated and reinterpreted in Jeddah, saudi arabia






O 31 The effectiveness of lower back massage on reducing labor pain for primiparous at Maternity and Children’s Hospital

A. Al-Zahrani 1 , R. Iskandar 2

1 King Abdulaziz University, maternity and child nursing, Jeddah, Saudi Arabia 2 ministry of health, nursing, Jeddah, Saudi Arabia

BackgroundMassage therapy is a non-pharmacological method for reducing labor pain, usually used during the first stage of labor due to its simplicity and most important because it does not have side effects.

ObjectiveThe aim of the study is to assess the effectiveness of lower back massage on reducing labor pain for primipa-rous

MethodsA quantitative, Randomized Controlled Trial (RCT) study was been used. A visual analogue scale was been used to measure the intensity of pain before and after massage. Moreover, aquestionnaire was been developed based on the literature to assess the satisfaction of the mothers after applying a massage technique. In this study the researcher was used a purposive sampling which selected related to some included and excluded criteria. The sample consisted of 60 mothers in the first stage of labor. ethical approval was obtained to con-duct the study.

SettingThis study carried out in Maternity and Children’s Hospital (MCH) in Jeddah, Saudi Arabia.

AnalysisSPSS was used to analyse the results.

FindingsThe results from this study showed that experimental group had lower pain intensity at 4cm and 6cm (p>0.05) in comparison with control group, but at 8cm no significant difference found between both groups (p<0.05). Mothers in experimental group was more satisfied during first stage of labor in comparison with control group.

ConclusionLower back massage is an effective, non- invasive and alternative intervention, to reduce labor pain and in-crease the level of primiparous satisfaction

Implication for practiceMassage can be considered as an independent simple nursing intervention and can be used as one of labor pain relieving method. Raising the awareness of the labor and delivery nurses about this method is recom-mended. Further research is recommended to be undertaken to assess nurse’s knowledge and conception toward massage therapy.






O 32 Competencies of professional midwives in Davao City, Philippines: A partial basis for an adoption of the National Competency-based Standards for Midwives (NCBSM)

L. M. Fernandez 1

1 PIMSAT Colleges-Inc., Colleges of Nursing & Midwifery, Dagupan City, Philippines

In this 21st environment, midwives must be prepared to re-assess their roles and responsibilities to cater the needs of time for an effective and efficient high-quality midwifery care to all women and their newborns to achieve the 2030 Agenda of the United Nations Sustainable Development Goals. Thus, this study was con-ducted to study the competencies of Professional Midwives in Davao City as partial basis for an adoption of the NCBSM in the Philippines. With the ultimate goal to enhance the quality of professional midwives in promoting their competitiveness, challenges and motivations; and facilitate their mobility across the whole world. That is comparable and competitive to accepted global standards. Hence, Filipino midwives need to realign their competencies. The descriptive-study used the 5-point Likert scale to gather data on the personal and profes-sional competencies of professional midwives; frequency count and percentage for the demographic profile of the 110 respondents from birthing centers of Davao City; AWM to determine the 2 factors (1)the perceived level of effectiveness of management in terms of planning ,organizing, staffing, directing, and controlling;(2) perceived quality of services by areas: pre-pregnancy care, antenatal care, care during the delivery, post-natal care, family planning services; Spearman rho Correlation to test the relationship between the respondents’ profile and the 2 factors. Results revealed that the respondents possess moderate level of personal and pro-fessional competencies, thereby needing intervention measures. Majority of the respondents belong to middle adulthood, dominated by 2-year Graduate in Midwifery and have long-length of service. Respondents per-ceived the effectiveness of the management (AWM=3.38) and quality of services (AWM=3.30) both moderately effective. Results also revealed that age (p=.043<.05) and length of service (p=.045<.05) have significant relation-ships established between the respondents’ profile; and the level of effectiveness and quality of services. The following recommendations are: (1) Professional development plans include pursuant of B.S.Midwifery program and networking with other professional midwives; (2) Appropriate trainings to enable, enhance and empower their skills; (3) Nationwide survey to accurately assess the competencies of midwives throughout the Philippines.






O 33 Concerns during Clinial Placement: The CONDUCT project

R. Elmir 1

1 Western Sydney University, School of Nursing and Midwifery, Sydney, Australia

BackgroundClinical placement experience is an integral component of midwifery programs, and a prerequisite for devel-oping knowledge and skills to achieve professional registration. For successful transition to graduate practice, it is crucial that student learning during clinical placements is optimised (Dafogianni, Alikari, Galanis, Gerali, & Margari, 2015). Nevertheless, the literature continues to report ongoing struggles with a failure to ensuring consistent positive clinical experiences for students (Cooper, Courtney-Pratt, & Fitzgerald, 2015; Vijayananthan, Premkumar, Jesudoss, & Rajan, 2016). With the growth of student diversity in midwifery programs, suboptimal clinical experiences of native-born, as well as students from diverse backgrounds are increasingly being re-ported (Budden, Birks, Cant, Bagley, & Park, 2017; Koch, Everett, Phillips, & Davidson, 2014). In addition to being a barrier to learning, suboptimal clinical experiences during placements may also impact on student retention, progression and negative behaviour or performance during their placements, resulting in negative reports from their clinical supervisor or clinical facilitator (Sealey et al., 2014).

AimExplore the experiences of Bachelor of Midwifery students’ of clinical placement

MethodQualitative research design informed the study using a survey with open ended questions. Twenty-nine re-sponses were received and content analysis was used to analyse the data.

FindingsThree major themes emerged; role model, workplace culture and support. Student midwives felt that midwives were in position of be a ‘role model’ and demonstrating appropriate behaviour and clinical skills. Students expe-riences of the workplace culture was mixed with some students feeling welcomed, appreciated and included in the environment, while others were belittled, precluded from discussions and the staff tea room. Ultimately, students wanted to be mentored, nurtured and supported in their journeys to midwifery.

ConclusionTo support midwifery students learning whilst on clinical placement it is necessary to identify the key recurring issues students encounter whilst on clinical practicum. This identification could enhance the quality of pre-clin-ical teaching to the students including pre-placement expectations, professional expectations and learning outcomes and work with key stakeholder to support students on clinical placement.





Friday 7 September, 2018, 11:00 – 11:45WS05 – Skills Workshop 1: Story-telling – A Useful Skill for Midwives

WS 01 Story telling: A useful skill for midwives

S. Abbas Ali 1 , R. Jan 2 , A. Mansoor 1 , M. Shahnawaz 1 , F. Adnan 1

1 Aga Khan University, School of Nursing and Midwifery, Karachi, Pakistan 2 National University of Medical Sciences, School of Nursing, Islamabad, Pakistan

ParticipantsPracticing Midwives

Logistic ArrangementsNumber of participants: 30. Seating arrangement: Six tables with six chairs at each table

BackgroundStories are acknowledged as being one of the powerful tool to depict emotions along with a creative means to share valuable experiences. In midwifery, the story telling had long been deeply embedded in generating knowl-edge and related evidences. Stories by midwives can be utilized as a strategy to promote maternal and child health practices, to promote learning among students and novice and increase visibility of midwives in media.

PurposeThis workshop aims to enhance the story-telling skills of practicing midwives to promote learning and increase visibility of midwives in media.

Learning outcomes This workshop aims to facilitate participants to:• understand storytelling and its process• discuss importance of Storytelling in midwifery• learn the ‘Art of storytelling’• Create and narrate stories related to women by reflecting on their experiences.

Process/activityThe workshop is based on three activities including introduction of the story telling, its importance, and art of creating stories for future use. • Activity 1: “Everything has a story” (15 mins) Purpose: Introduce participants with storytelling Participants of each group will tell story of item handed over to them • Activity 2: Why stories? (Brain Storming) (10 mins) Purpose: Discuss importance of story telling Participants will discuss importance of storytelling for midwives• Activity 3: Tell a story (Story Circle) (20 mins) Purpose: Facilitate participants in creating story

Participants will draft their stories focusing the purpose of promoting midwifery and midwifery care. Partici-pants will than share within the group their story. Each participant will receive feedback from facilitator and group on their story.

Conclusion (15 mins)At the end of the workshop, one participant from each small group will present their story to the larger group. Feedback will be provided through fish ball activity.





Friday 7 September, 2018, 11:45 – 12:30WS06 – Skills Workshop 2: Sepsis, Silent But Deadly – How to Support Successful Sepsis Management

WS 02 Sepsis – silent but deadly. Innovative practical workshop designed to introduce new ideas and concepts to support successful sepsis management

T. Roake 1 , J. Hubbard 2 , J. Alemao 2

1 Al Zahra Hospital, Women’s Health Department, Dubai, United Arab Emirates 2 Corniche Hospital, Education, Abu Dhabi, United Arab Emirates

BackgroundThis programme aims to invite colleagues around the world to participate in the innovative and creative practi-cal workshop on sepsis. It will initiate another level of team training while providing the participants with easy to use tools, resources and great ideas in the management of sepsis. These tools can be easily implemented and sustained in all healthcare facilities ObjectivesIntroduce easy to use technical and non-technical tools and resources to fight sepsis. Transform the way we management sepsis by a transcendent team training practice session. Share the importance of technical and non-technical skills in sepsis management.

MethodsThere will be three skills stations, first based on technical skills, 2nd on non-technical skills and the 3rd station will bring everything together in a simulated drill scenario. Each station will be approximately 15 minutes. The participants will be equipped with new ideas and knowledge to make a difference.

AnalysisThese concepts have shown to reduce time waste, talent waste and enhance patient safety by providing a process that initiates quick recognition, quick identification and quick management of sepsis. It is an opportu-nity to create awareness of the importance of managing sepsis proactively.

FindingsUtilization of correct resources within the golden hour has shown to enhance outcomes whilst generating an ultimate mindfulness of the severity of sepsis. These tools that will be showcased have been successfully intro-duced into two maternity units in the UAE.

ConclusionProviding clinicians with innovations and idea’s will enhance patient safety and streamline the management of sepsis. Equipping the participants with concepts and blueprints in managing sepsis on another level all to-gether.

Implications for practiceTransform the way we management of sepsis, using the effective toolkit and innovations. Saving lives and en-riching knowledge by training through simulation and creativity. Enhancing patient safety by inventing simple tools and easy to use techniques which support human factors and behaviors





Friday 7 September, 2018, 14:00 – 15:30PS09 – Respectful Maternity Care

O 34 Core competencies: Basis for midwifery education in Lebanon

I. Kanaan 1 , I. Abou Ali 1 , A. Gherissi 2

1 Lebanese University, Doctoral school of literature-humanities and social sciences at the Lebanese University-Beirut-Lebanon, Beirut, Lebanon 2 El Manar University, . Tunis El Manar University-Tunis-Tunisia. Ecole Supérieure des Sciences et Techniques de la Santé, Tunis, Tunisia

Background The 2030 Agenda for Sustainable Development requires that sexual and reproductive health is provided by qualified midwives (UNFPA, 2015). ICM recommends three pillars based on essential competencies to organize the midwife profession in every country. The barriers in Lebanon, include high caesarean section rates and over medicalization of pregnancy and childbirth (DeJong & al, 2010). In addition, there is lack of standardized mid-wifery education, regulation is fragmented and the Lebanese women needs have also changed (MOSA/UNDP, 2006; MICS, 2000).

Purpose/Objective We aim to identify the Lebanese midwifery model including her identity and scope of practice and to translate it into core competencies

Method It is a mixed method research, qualitative and quantitative conducted through a multidisciplinary, exploratory and inductive approach. The data collection is based on individual and group semi-structured interviews with the various actors involved in the profession, including women of childbearing age; on a task analysis with in-service midwives and on a questionnaire with midwifery students 4th year. Quantitative data analysis is done by SPSS and qualitative data by the content analysis technique. Free participation in research, anonymity and confidentiality have been respected and IRB approval has been obtained (RHUH, MGH, SGH/Balamand Univer-sity).

Key Findings This is an ongoing research and final results will be presented at the ICM regional meeting. Preliminary findings show that midwifery students’ initial choice of the profession is mostly not vocational and that, at the end of their studies, they are not motivated. The new graduates are expressing more frustration after their exposure to the workplace. Their social identity is defined by the cultural representations of pregnancy and birth among Lebanese women. The rich women have a preference for the natural process and demand more the midwifery services but for the others, the midwife is the physician›s assistant or his substitute in case of absence.






O 35 Women-clinicians’ relationship during birth is the key factor for better birthing experiences: mixed method questionnaire

I. Jahlan 1 , V. Plummer 2 , M. McIntyre 2 , S. Moawed 1

1 King Saud University, Maternal and child health nursing, Riyadh, Saudi Arabia 2 Monash University, School of Nursing and Midwifery, Melbourne, Australia

Women-clinicians relationship during childbirth has been recognized by several researchers to be the first fac-tor to affect women’s experiences and improve their satisfaction. The literature is virtually silent about Saudi women birthing experiences.

Saudi women’s birthing experiences was uncovered in this study for the first time, in order to explore their sat-isfaction and perception of control, regarding care delivered now in KSA. This was accomplished by exploring the perspectives of women through questionnaire designed to collect both quantitative and qualitative data.

This paper presents the findings of 300 questionnaires completed by women prior to their discharge from hos-pital, describe their experiences, satisfaction, and perceptions of control. The questionnaires were collected in specialized maternity hospitals in three cities in Saudi Arabia: Riyadh, Jeddah, and Dammam.

The findings of this study highlighted that women’s satisfaction and perception of control during birth is signifi-cantly (p < 0.001) associated with the presence of supportive, cooperative, clinicians who are good communi-cators and listeners. In addition, women’s active participation in decision making related to the birth improved their satisfaction and perception of control. Women-clinicians’ relationship was also the main theme identified through women’s words describing their experiences, which has number of sub-themes such as “Cooperative and helpful”, “respectful”, and “attitude”.

In conclusion, women’s birthing experiences and satisfaction could be improved with directing clinicians’ atten-tion to improve their treatment, attitude, and providing continuous support and respect.

The findings are likely to contribute to an improvement in birthing services within Saudi maternity health care system. In particular, the study draws attention to obtaining regular feedback from women to inform the care delivered and makes it of value to educators, researchers, clinicians, and policymakers in the maternity health care system in Saudi Arabia.






O 36 The impact of mentorship on clinical practice sites for preservice midwives in Bangladesh

S. Masud 1 , N. Purno 2 , P. R. Begum 3 , S. Doraiswamy 4 , R. Anderson 2

1 OGSB, Reproductive health, Dhaka, Bangladesh 2 UNFPA, Srhr, Dhaka, Bangladesh 3 OGSB, Obs & Gynae, Dhaka, Bangladesh 4 UNFPA Bangladesh, Srhr, Dhaka, Bangladesh

BackgroundBangladesh has introduced professional midwives who have the potential to make an impact on maternal and newborn health; to optimize their success ensuring adequate clinical experience in evidence-based routine and emergency care is essential.

ObjectiveA mentorship program was implemented at eight medical college hospitals. The mentoring focused on seven interventions: 1) Management of post-partum hemorrhage and eclampsia including triage, 2) newborn resusci-tation in the labor room, 3) supply and storage of oxytocin, 4) partograph use, 5) upright positions, 6) immediate maternal newborn skin-to-skin contact for one hour, 7) delayed cord clamping.

MethodsFour mentors were selected from each facility: two gynecological consultants, one midwife, and one pediatri-cian. All received training on how to mentor. They were instructed to mentor in 2-hour slots twice per week for 6 months. An external supervisor for each facility visited monthly.

AnalysisIf the facility demonstrated proper clinical practice at least 66.7% of times (in at least 4 out of 6 visits), then they were considered to have made significant progress in that particular obstetric practice.

FindingsDuring baseline assessment none of the facilities demonstrated use of upright position, partographs, triage systems, and skin-to-skin contact. Twenty five percent or less facilities demonstrated delayed cord clamping, ambu bag availability and use, and oxytocin supply. After 6 months improvements included triage manage-ment (50%); adequate oxytocin supply (62.5%) upright position (62.5%); delayed cord clamping (75%) and new-born resuscitation (87.5%). However, only 12.5% institutions were properly conducting partographs and practicing skin to skin for one hour.

ConclusionsUse of staff mentors was successful in making significant changes to clinical practices, however practice of skin-to-skin for one hour and us partographs will require further reinforcement.

Implications for PracticeClinical mentorship proves to be a promising approach for transitioning to evidence-based emergency and routine care practice in public health facilities of Bangladesh.






O 37 Skin-to-skin and Kangaroo Care – Changing practice, saving lives

M. Stanley 1

1 Dubai Hospital, Department of health, Dubai, United Arab Emirates

‘Skin-to-skin’ contact is placing the naked newborn prone on the mother’s bare chest. This warm embrace for babies immediately after birth is the most effective low-technology lifesaving intervention.

‘Kangaroo Care’ is a technique where the baby (term, preterm/ low birth weight), is kept in continuous skin-to-skin contact with its mother (or another significant adult). It benefits both mother and baby.

The purpose of utilising skin-to-skin contact is to help provide physiological stability and to promote better be-havioral responses in both the baby and mother. Babies are more comfortable, more likely to latch to the breast and feed for longer, less likely to become hypoglycemic, and are more settled. Skin-to-skin enables colonization of the baby by the mother’s friendly bacteria, thus providing protection against infection. It also stimulates the release of hormones to support sustained breastfeeding and positive mothering. It also helps preterm babies to grow and develop better and improves length of hospital stay.

Skin-to-skin is a core standard of WHO, UNICEF and strong BFHI recommendation. Skin-to-skin contact helps babies cope with painful procedures. There is no negative effect.

This presentation will describe the experience of introducing and embedding the practices of Skin-to skin and Kangaroo Care in one Dubai Hospital over the past six years, including the importance of addressing the cultur-al and professional expectations/needs of midwives, nurses and Doctors, as well as the community of women and their families who give birth in our hospital.

Key strategies leading to the successful implementation of these practices will also be discussed, and how the successful integration of these practices, along with compliance rates maintained at 85–90%, have also served to facilitate other achievements such as BFHI Accreditation, and our new goal of achieving Mother Friendly Ac-creditation





Friday 7 September, 2018, 16:00 – 17:30PS11 – Strengthening Midwives

O 38 Midwife role in the effectiveness of cervical cancer screening using visual inspection with acetic acid (VIA) for women in Indonesia

S. Fatimah 1 , E. Nurjasmi 2 1 Indonesian Midwives Association, Indonesian Midwives Association, Central Jakarta, Indonesia2Jakarta Health Polytechnic III, Jakarta, Indonesia

BackgroundIn Indonesia, midwife association has a very large number of member which could be key to create health movement in supporting Ministry of Health. The number of one of killer disease for Indonesian women, cervical cancer, remain high. The most important and certainly can be done by a midwife is screening through VIA ex-amination. Based on that and to commemorate the International Day of The Midwife, we arranged a simultane-ous VIA examination in the same day with all midwives in 34 provinces in Indonesia.

ObjectivesTo describe the midwife role in the effectiveness of cervical cancer screening using visual inspection with acetic acid (VIA) for women in Indonesia

Methodsa descriptive method with total participant is 91 349 women in 34 provinces in Indonesia

AnalysisWe collected data from 34 representatives in each province in Indonesia. VIA test was performed by trained midwives in the clinics, public health center of various type setting in July 2017.

FindingsA total of 91.349 women, 21.017 midwives, in 3.098 location around Indonesia were included in this study. It shows that women in Indonesia has high believe in midwife to do the VIA test for their reproductive health care.

ConclusionMidwife has a strategic role to approach in a society especially women in their need in reproductive health. In the cervical cancer screening, visual inspection of cervix with acetic acid (VIA test) is simple, low-cost, and effective method for women especially in low-resource areas. Access to a midwife is a big and important issue in sexual and reproductive health care for women and family.

Implications For Practice: Strengthening midwife association through strengthening midwife itself is the key in the empowerment of women in Indonesia and building sustainable societies especially in sexual and repro-ductive health care






O 39 Maternal & newborn outcomes of community midwives’ services in Pakistan: A retrospective analysis of management information system

K. Mubeen 1 , R. Jan 2 , S. Sheikh 3 , Y. Mithani 4

1 Aga Khan University, School of Nursing and Midwifery, Karachi, Pakistan 2 National University of Health Sciences, School of Nursing and Midwifery, Islamabad, Pakistan 3 The Aga Khan University, Research, Karachi, Pakistan 4 Taxes women Hospital, Taxes women Hospital, Texas, USA

BackgroundCommunity midwives (CMW) are considered as skilled birth attendants in Pakistan. The government’s Maternal Newborn and Child Health (MNCH) program maintains an electronic Management Information System (MIS) to monitor the indicators of CMW model across the country.

ObjectiveThe study aims to determine the maternal and newborn outcomes of CMWs services, as recorded in the MNCH-MIs of the sindh province

MethodologyA descriptive retrospective design was used. Since human subjects were not identified, the Aga Khan University Ethical Review Committee determined that formal ethical approval was not required. A consecutive sample of records for the period January 1, 2013 to December 31, 2015 was considered for the study. For data extraction, 200 CMWs were selected via simple random sampling out of total 1470 CMWs available in the province. The out-comes were analyzed using descriptive statistics. The rates and proportions were manually calculated using WHO’s standard formulas.

ResultsThe analysis of data revealed that a total of 1,03,836 antenatal care were attended by 200 CMWs during the pe-riod January 1, 2013 to December 31, 2015. Total 23,296 women were registered for intranatal care, of which 78.3% (n=18, 233) returned to these CMWs at the time of delivery. Live births were 17,849. The still birth rate was 13.4/1000 live births, the abortion rate was 7.3/1000 pregnant women, newborn mortality rate was 12.4/1000 live births, and the maternal mortality ratio was 142.5/100,000 live births. The LBW newborns were 9% of the total live births.

Conclusion & Implications CMWs appear to have potential to increase the uptake of services, identify complications, and avert deaths due to these complications. This study serves as a baseline comparison point for future studies of the impact of to CMWs the broader aspects of the health system. It is hoped the findings and recommendations from this study will make a contribution to improved care.





Friday 7 September, 2018, 16:00 – 17:30PS11 – Strenghtening Midwives

O 40 The analgesic efficacy of diclofenac suppository in parturients after caesarean section

S. W. Ng 1 , H. L. Fong 2

1 1/F-Lot 954-DD 215-Po Lo Che-Sai Kung-New Territories-Hong Kong., Obstetrics and Gynaecology Department, Hong Kong, Hong Kong 2 Princess Margaret Hospital-Hong Kong, Obstetrics & Gynaecology Department, Hong Kong SAR, Hong KongSW Ng, LF Ho, PH Leung, WYJ Ng; Department of Obstetrics & Gynaecology, Princess Margaret Hospital

BackgroundIn the past, opioid (Pethidine) injection used to be the foremost pain relief method for post Caesarean Section(C/S). However, there are well documented negative side-effects, such as sedation, nausea and vom-iting. In order to reduce the opioid usage after C/S, our unit starts to give Diclofenac suppository (NSAID) to achieve the goal of pain relief and minimize the side effect of opioid. Nevertheless, the local experience on the opioid-spacing effect of Diclofenac suppository has not been reported.

Objectives This study aims at evaluating the analgesic efficacy of diclofenac suppository given to parturients after C/S. MethodologyThis was a retrospective study, all the medical records of parturients who had undergone C/S from March to May 2016 were reviewed. Analyses were performed by using SPSS (version 16.0) statistical software. We used Chi-square tests and one-way analysis of variance to assess the relationship between the various variables.

ResultsOf the 154 subjects in this study, there were 31.8% (49/154) and 47.4% (73/154) parturients with and without Diclof-enac suppository, had received opioid injection respectively. The group with Diclofenac suppository was less likely to require opioid injection than the other group without Diclofenac suppository (p=0.001). For those who needed opioid injection, the mean interval between the end of operation and the first opioid injection in Diclof-enac group was 7.72±5.55 hours, and in non-Diclofenac group was 5.28±4.88 hours (p=0.012). The total dosage of opioid injection given within 24 hours was less in Diclofenac group (151.5±65.8mg) than non-Diclofenac group (190.1±98.5mg), and the p value = 0.018.

ConclusionOur result indicated that for those parturients under regional anesthesia with Diclofenac suppository after C/S was effectively in opioid-sparing, delaying the time of injection and reducing total dosage of opioid requested by parturients.

Keywords: pain relief; post C/S






O 41 Audit of pharmacological and technical interventions in spontaneous vaginal births

S. G. 1 , I. Kaur 2 , A. Gokala 2

1 Fernandez Hospital, Obstetrics and Gynaecology, Hyderabad, India 2 Fernandez Hospital, Obstetrics, Hyderabad, India

BackgroundDespite the importance and benefits of physiological birth, the rising rate of interventions in labour and child-birth is a cause for concern

ObjectiveTo determine the prevalence of intrapartum interventions at Fernandez hospital.

MethodsThis audit comprised women who had a singleton spontaneous vaginal birth. The study institute is a tertiary care perinatal centre with professional midwifery support and annual delivery rate in excess of 8000. No formal ethical approval was sought as this was a clinical audit.Phase 1: births from January-February 2017 provided the baseline prevalence of intrapartum interventions.Phase 2: a checklist to identify 9 interventions (2016 RCM survey) was appended to the partogram for births from June-July 2017.Phase 3: births from January-February 2018 with no checklist incorporated.

AnalysisThe primary outcome was the overall prevalence of interventions. The nature and frequency of interventions were compared among the three phases.

FindingThe overall prevalence of interventions in the three phases was 96.9%, 88.6% and 81.9% respectively, the most frequent being bladder catheterization and the least frequent fetal blood sampling. There was a significant reduction in all interventions in phase 2 except augmentation of labour and fetal blood sampling with a further decline in rates of amniotomy, episiotomy and bladder catheterization in phase 3. The usage of cardiotocog-raphy for >1 hour and intrapartum antibiotics increased again in phase 3.

ConclusionIntrapartum interventions are much higher than reported in the UK. They can be reduced by incorporation of a checklist which prompts the healthcare provider to pause and rethink before resorting to an intervention.

Implications for practiceAn ongoing audit may serve to sustain the reduction in interventions. Stating the indication for intervention in the checklist will further help in using interventions appropriately for valid reasons.





Friday 7 September, 2018, 16:00 – 17:30PS12 – Keeping Birth Normal II

O 42 Episiotomy: Views and perceptions of Saudi women experiencing episiotomy

I. Jahlan 1 , K. McCauley 2 , J. Lyneham 3

1 king Saud University, Maternal and child health nursing, Riyadh, Saudi Arabia 2 Massey University, School of Nursing, Melbourne, Australia 3 The University of Newcastle, School of Nursing and Midwifery, Newcastle, Australia:

Maternity clinicians apply episiotomy to facilitate vaginal delivery and prevent severe perineal tears. However, routine or restrictive episiotomy practice in birthing care remains a controversial from the onset of its intro-duction. There is lack of studies reporting women voices and personal experiences of episiotomy. This study explored women’ voices and personal experience and perceptions of episiotomy among Saudi primiparous from the phenomenological perspective. Five primiparous married women aged between 20 to 40 years were non-randomly selected from one public hospital in Riyadh (Saudi Arabia). Upon signing their informed con-sents, the participants were privately interviewed (in Arabic) using semi-structured guidelines. All interview ses-sions were voice-recorded and translated to English by a female translator. Thematic analysis of the collected data revealed that post-episiotomy pain was the most prominent feature of ‘bad experience’ theme among the participants. The perineal trauma reduced mobility and daily activities including dyspareunia. Importantly, they admitted to be glad for having undergone the procedure. Surprisingly, they also highlighted that they were willing to undergo the procedure again for an opportunity to improve the perineum condition to enhance their self-esteem. From the study findings and the available evidence, restrictive episiotomy should be embraced in birthing care to enhance maternal experience and satisfaction. This can be achieved through development of evidence-based guidelines on obstetrics circumstances that necessitate episiotomy procedure. On the other hand, women need to be educated about episiotomy and its health-related indication, advantages and dis-advantages and that it cannot be conducted upon request.






O 43 Strengthening evidence based normal birth care through mentorship at selected sub district hospitals of Bangladesh

I. Chakma 1 , A. Karim 1 , A. Mahamud 1 , M. Yusuf 1 , R. Alam 1 , K. Alam 1 , F. Khan 1 , A. Khan 1 , R. Anderson 2

1 Save the Children International, Strengthening the National Midwifery Program, Dhaka, Bangladesh 2 United Nations Population Fund, Bangladesh, Dhaka, Bangladesh

BackgroundMidwives are a new professional at sub-district hospitals in Bangladesh. At these facilities evidence-based maternity care is limited. Mentoring was implemented to create enabling environments and strengthen the capacities of midwives to facilitate a transition to improved care quality.

ObjectivesTo assess the effectiveness of facility mentoring for sub-district hospitals a with the intention of increasing their practice of evidence based normal birth care

MethodsThirteen female medical graduates were recruited as Clinical Mentors (CMs) in 27 sub-districts. The CMs pro-vided facility mentorship between July 2017 and April 2018. The CMs assessed the gaps in care provision using a clinical supervisory checklist. The mentors then supported the hospital management to create enabling en-vironments, and provided on the job training including low dose high frequency teaching sessions when gaps in knowledge were identified.

AnalysisData was collected by the CMs through direct observation of 211 births divided in two time periods. The baseline (B) was August-September 2017 and end line (E) was March-April 2018. Data was recorded using a dedicated software

FindingsMidwives were more than two times likely to use partograph (B-28%, E-65%), maintain oral hydration and nutri-tion during labor (B-45%, E-97%), and delay cord clamping (B-49%, E-85%). However, most notable increase was observed in provision of skin to skin care of newborn for at least an hour after birth (B-<1%, E-67%). Upright posi-tions for delivery increased 3.6 times (B-17%, E-61%). Routine use of episiotomy decreased significantly, resulting in fivefold increase in episiotomies performed only due to fetal distress (B-5%, E-25%). Women were less likely to experience any potentially harmful practice during childbirth at end line (B-44%, E-17%).

ConclusionOn-site clinical mentoring significantly increases practice of evidence-based care by midwives.

Implications for practiceClinical Mentoring is crucial to translate knowledge into practice of evidence-based care.






O 44 ‘Wait for White’ – a successful midwife-led model for implementing evidence-based birthing practices.

H. El Sayegh 1

1 DHA-Dubai hospital, Nursing/Midwifery, Dubai, United Arab Emirates

BackgroundMany maternity care providers continue to practice immediate cord clamping (ICC) at birth, despite the grow-ing evidence around the many benefits of delayed cord clamping (DCC).

ObjectivesDescribe the physiology of Placental Transfusion and identify major benefits of DCC (as opposed to cord milk-ing/stripping).

MethodIn some cases, the continued practice of ICC is due to a misunderstanding of placental physiology in the min-utes after birth, but human nature also plays a role. Health professionals are often reluctant to change the way they were taught to do things, even in the face of clear contradictory evidence.Despite a lack of strong scientific support for ICC, entrenched medical habits can be glacially slow in changing.This presentation will describe the midwife-led project and strategies that were used in one Dubai Hospital to successfully implement and sustain a major shift in practice and culture around DCC and Cord Milking. This no-cost change-management project was conducted over a 12-month period, with 0% DCC/milking occurring in January moving to rates of 99% DCC for all low-risk Normal Vaginal Births, and 98% DCC/milking rates for Cae-sarean Section achieved by December of the same year.

Analysis & FindingsThis project has had a significant and sustained impact on cord-clamping practices across all disciplines, and has led to a shift in thinking among midwives and doctors. It has also provided a useful model for imple-menting other evidence-based practices to improve outcomes for birthing women and their families, includ-ing a current project to extend DCC to all premature births. In addition, the strategies utilized have also im-proved interdisciplinary collaboration and communication.






O 45 Abstract Withdrawn





Saturday 8 September, 2018, 10:30 – 12:00PS13 – Sexual Reproductive Health Rights and Midwifery

O 46 Relationship between eating culture with anemia among postpartum mother in Majalengka, Indonesia 2017

A. Nurasiah 1 , R. Raodatul Jannah 2

1 Institute of Health Science-Kuningan STIKes Kuningan, Midwivery, Kuningan, Indonesia 2 Institute of Health Science-Kuningan STIKes Kuningan, Midwifery, Kuningan, Indonesia

Culture is a way of life that is developed and shared by a community and passed down from generation to generation. There are several cultures that regulate how to treat pregnant women, postpartum and newborn care. One of the cultures for postpartum women is forbidden to eat some foods that they think will cause a more rancid odor in the blood and itching of the puerperal vagina. In the other hand, the puerperium women need nutriens so that they are not anemic which can affect uterine involution. Anemia describes a condition in which the number of red blood cells in the blood is low. The purpose of this study was to determine the relation-ship between eating culture with anemia among postpartum mother in Majalengka, Indonesia 2017.

This study was an analytical research with cross sectional design study. The sampling technique used acci-dental sampling. Samples were 37 pospartum mother in Majalengka primary health care. Insturments of this study were questionnaire and Hb examination. Ethical clearance was obtained from Institute of Health Science, Kuningan. This study used bivariate analysis.

Based on analysis, 100 % of postpartum mothers were influenced by eating culture. Among all postpartum mothers, 33,3 % of them had moderate anemia and 66,7 % had mild anemia. There was significant assocation between eating culture and anemia upon postpartum mother (p < 0,05).

Midwives should improve counseling on postpartum mother about eating pattern and eating culture in order to prevent anemia occurance among them.






O 47 Assessment of knowledge and attitude of nurse educators regarding simulation and to develop an informational CD about simulation in midwifery

M. Chhugani 1 1 Professor cum Principal-Rufaida College of Nursing-Jamia Hamdard, nursing, New Delhi, India

Objectives:1. Assess knowledge of nurse educators regarding simulation in midwifery education2. Assess attitude of nurse educators regarding simulation in midwifery education3. Correlating knowledge with selected variables like, age, qualification, experience and designation4. Correlating attitude with selected variables like, age, qualification, experience and designation5. Determining relationship between knowledge and attitude of nurse educators 6. Preparing and disseminating the information CD about simulation in midwifery education

MaterialA descriptive survey approach with exploratory research design was used. The study was conducted among purposively selected, thirty nurse educators teaching midwifery in various colleges and schools of nursing in Delhi. Data was collected using a pre – tested, structured knowledge questionnaire and attitude scale.

FindingsMean and median of the knowledge score of nurse educators was 21 and standard deviation (S.D.) was 3.939. Only 30% of the nurse educators have adequate knowledge whereas 70% have inadequate knowledge about simulation in midwifery education, 57% of the nurse educators shows favourable attitude whereas 43% shows unfavourable attitude towards simulation in midwifery. No significant relationship was found between knowl-edge and selected variables such as age, professional education, designation and years of experience at 0.05 level of significance. No significant relationship was found between attitude and selected variables such as age, professional education, designation and years of experience at 0.05 level of significance. The computed Pearson “r” value between knowledge and attitude is found to be statistically significant at 0.001 level of signifi-cance. Thus the result indicated that the knowledge of nurse educators had significant relationship with the attitude of nurse educators ConclusionOnly 8% of the nurse educators have adequate knowledge whereas 22% have inadequate knowledge about simulation in midwifery education, 57% of the nurse educators show favourable attitude whereas 43% unfavour-able attitude towards simulation in midwifery. There was a significant relationship between the knowledge and attitude of nurse educators






O 48 Reduction of anxiety level in IVF pregnant patients post educational classes in first trimester

M. Mohsen 1

1 FakihIvf, Obstetrics and Infertility, dubai, United Arab Emirates

BackgroundSelf-esteem in the early stage of pregnancy, for both women who conceived through IVF and women who conceived naturally, is related to self-reported levels of parenting efficacy. Coaching through antenatal clinics in the early stages of pregnancy should be tailored to incorporate advice regarding self- esteem and for psy-chological well-being (E.Vrtacnik Bohal, 2015: M.Oates, 2006).

Objectives• Reducing the level of anxiety• Education about the physiological and emotional changes.

Methods• This is a quantitative study, prospective from July 2016- December 2017 on 100 patients• Post offering antenatal classes, the GAD-7 questionnaire (RL Spitzer, 2006) for assessing generalized anxi-

ety disorder was administered to determine the patient’s health status, the level of anxiety and the psy-chological well-being status during the first trimester, at 6 weeks and at 12 weeks again and each patient signed consent for acceptance to participate and permission for usage of her medical data.

• Exclusion criteria: patients with mental disorder, multiple pregnancies and with fetal abnormalities.• Data retrieved from encrypted excel sheet

Findings • 70% of the patients showed reduced anxiety level and requested to get engaged in the other classes

sessions covering the whole pregnancy Conclusion and implications for practiceBy implementing the educational program with modification according to the center settings, patients re-ported positive emotions and the midwives were able to support and facilitate the transition to motherhood Antenatal classes had positive impact on IVF pregnant patients and reduced the anxiety level in first trimester.






O 49 The effect of midwifery based counseling on perceived infertility-related stress and outcome of assisted reproductive technology in infertile womenZ. Hamzehgardeshi 1 , F. Yazdani 2 , M. Dayhimi 3 , F. Elyasi 4 , M. Moosazade 5 , K. Samadaee Galekolaee 6 , S. Peyvandi 7 , M. Shahidi 8

1 Mazandaran University of Medical Sciences, RM-Ph.D. in Reproductive Health-Associate Professor-Department of Reproductive Health and Midwifery-Sexual and Reproductive Health Research Center, Sari, Islamic Republic of Iran 2 Mazandaran University of Medical Sciences, Department of Reproductive Health and Midwifery, Sari, Islamic Republic of Iran 3 Mazandaran University of Medical Sciences, Department of Reproductive Health and Midwifery, Sari, Islamic Republic of Iran 4 Mazandaran University of medical sciences, Psychiatrist-Assistant Professor-Department of Psychiatry-Psy-chiatry and Behavioral Sciences Research Center-School of Medicine, Sari, Islamic Republic of Iran 5 Mazandaran University of Medical Sciences, Ph.D. of Epidemiology-Assistant Professor-Health Science Re-search Center-Faculty of Health, Sari, Islamic Republic of Iran 6 Tehran University of Medical Sciences, PhD Candidate Reproductive Health-Department of Reproductive Health and Midwifery, Tehran, Islamic Republic of Iran 7 Mazandaran University of Medical Sciences, Infertility Fellowship-OB/GYN MD-Associate Professor-IVF Ward, Sari, Islamic Republic of Iran 8 Mazandaran University of Medical Sciences, Department of Medical Physics, Sari, Islamic Republic of Iran

IntroductionInfertility is the most stressful event in the life of infertile women that could affect the outcome of assisted repro-ductive techniques. This study aimed to understand the impact of counseling by midwife on stress in infertile women and outcome of assisted reproductive technique.

MethodsIn this clinical trial the number of 50 women who referred to infertility clinic in Sari was randomly assigned in two groups. The program for intervention group was six weekly two-hour sessions of group counseling that has been a consultant by midwife and based on a treatment protocol that was designed by the research team. The control group received only the traditional consulting. Perceived stress of infertility was measured by valid and reliable questionnaire of Newton scale. This questionnaire was used before and after the intervention and then on the day of oocyte retrieval, embryo transfer day and the pregnancy test day. Analysis of data was per-formed using statistical software SPSS (version 21).

ResultsAlthough perceived stress of infertility in both groups before the intervention showed no significant (p=0.749), but after the intervention on the day of oocyte retrieval (p=0.000), day of embryo transfer (p=0/000) and preg-nancy test day (p=0/000) was statistically significant. As well as the consequences of the treatment, in the number of oocytes (p=0/012) and fertility rate (p=0/039) between the two groups was statistically significant. The result of pregnancy test, in spite of spontaneous pregnancy in one person and increase the number of positively in the intervention group, the difference was not statistically significant (p=0.108) but was statistically significant (p=0.000) in next embryo transfer.

ConclusionThe protocol of intervention of this study by a midwife can reduce the perceived infertility-related stress and improve treatment results, including the number of oocytes and fertility rate. So you can use of this protocol in infertility clinic.





Saturday 8 September, 2018, 10:30 – 12:00PS15 – Midwifery Regulation

O 50 Strengthening midwifery leadership through twinning professional midwives associations: a case study from Bangladesh and the UK

J. Kemp 1 , C. Moran 1 , H. Akhter 2 , J. Akter 2 , S. Shobnum Joya 3

1 The Royal College of Midwives, Global Team-External Relations, London, United Kingdom 2 Bangladesh Midwifery Society, Executive, Dhaka, Bangladesh 3 Bangladesh Midwifery Society, Secretariat, Dhaka, Bangladesh

Background Midwifery is new in Bangladesh (Bogren et al, 2017). The Bangladesh Midwifery Society (BMS) was formed in 2010 and twinned with the Royal College of Midwives (UK) in 2017. Twinning is defined as ‘a cross-cultural, reciprocal process where two groups of people work together to achieve joint goals’ (Cadée, 2016). This presentation will reflect on the first year of the project, assessing progress to date against Cadée’s (2018) critical success factors for midwifery twinning projects.

ObjectiveThis project is part of a wider midwifery strengthening programme aiming to reduce maternal and newborn mortality in Bangladesh. The twinning project aims to strengthen BMS to advocate for midwifery and create demand for midwifery services and to capture reciprocal learning to influence midwifery in the UK.

MethodsThe first year of the project combined scoping and measurement of baseline indicators with activities to build confidence and engage stakeholders. Learning from the RCM’s previous twinning projects and other similar initiatives, methods, approaches and tools utilised included action/reflection cycles, appreciative inquiry/dia-logue, MACAT assessment, strategic planning and stakeholder analysis. Key activities comprised leadership development, introducing a new membership database and online voting system, recruiting secretariat, prep-aration for election and media/advocacy training. The Rohingya crisis prompted an unanticipated opportunity to building BMS’ capacity for humanitarian response.

Analysis and findingsTwinning relationships were initiated through pairing UK personnel with Bangladeshi counterparts. Critical suc-cess factors for midwifery twinning projects include equity, management, communication, values/goals and commitment (Cadée et al, 2018). Successes and challenges in each of these factors and reciprocal lessons learned will be explored during the presentation.

ConclusionThere is increasing evidence for twinning as a means to build capacity of midwives associations. Twinning projects can bring mutual benefit but are complex and challenging to manage.

ImplicationsSharing experience of twinning can help others who wish to start their own twinning partnerships.






O 51 Birth village natural birthing center – The new religion for autonomous midwifery care in IndiaP. Idicula 1

1 birthvillage natural birthing center, midwifery, cochin, IndiaBirth village natural birthing center-The new religion for autonomous midwifery care in India.

BackgroundBirth centres have evolved in many developed countries as an important alternative model to hospital- based, obstetric –led care (Rooks et al 1989: Saunders et al.2000: David et al 1999). Birthvillage is free standing natural birthing centre one of its kind in India. It is characterised by four specific pathways, midwife led, holistic ap-proach, ecological and has built its foundations on a social model of care. It works towards re-establishing physiology, in relationship to the woman, involving her in therapeutic decisions through true informed choices. Both clinical and operational guidelines are well developed yet it clearly recognises that women cannot be compartmentalised. An attempt will be made to present its organisational structure, the challenges faced, the services offered and statistical outcomes observed

Objective1) To describe how the birth center was able to provide women centric , baby friendly, family positive midwife

led care 2) To evaluate birth outcomes, medical interventions used and postpartum outcomes.

Research methodologyAll study participants received perinatal and postnatal care and gave birth at the freestanding birth centre birth village located in Kerala. Pregnancy and postpartum outcomes were analysed from 2010–2016.

Results

Data StatisticsNatural birth rate 96%Vbac 82%Episiotomy 0.4%IV Line 11.7%Preterm birth 0.7%Exclusive breastfeeding 100%Water birth/water labor 48.6%

ConclusionIt is proven that satisfaction in childbirth as well as positive birth outcomes is the highest with midwives which make birth centers a successful alternative for healthy normal pregnant women. This demonstrates that mid-wives are true leaders in maternity care as they bring in innovative, evidence based yet compassionate solu-tions

Implications for practiceAutonomous midwifery has to capacity to restore kindness and respect to evidence-based care hence it is up to every midwife to take up this public challenge on behalf of the women that they serve.






O 52 Midwife’s needs and expectation in equity of midwifery education level in Indonesia

M. Muchlis 1

1 Universitas Gadjah Mada, Midwifery Program, Yogyakarta, Indonesia

BackgroundMidwifery education in Indonesia has experienced many developments since 1851 ranging from primary train-ing up to now become part of higher education. Nevertheless, compared to other health worker educations level in Indonesia that reach at level 9 (minimum 7), 80% of the education level of midwifery is still at level 5 of Indonesia’s educational qualification framework. IMA with Ministry of Research, Technology and Higher Educa-tion and Ministry of Health currently has developed midwifery education in Indonesia to level 7 and 8. Although that, it still leaves many discussions and some of the views.

ObjectivesThis study explored midwife’s needs and expectancy in development of midwifery education level in Indone-sia

MethodsAn exploratory qualitative study was used. Six clinical midwives from each level of health services, three mid-wives educator, two stakeholder midwives and twelve midwifery students from each level of midwifery edu-cation in Special Region of Yogyakarta were recruited. Data were collected through semi-structured in-depth interviews then were analyzed by the conventional content analysis according to Graneheim and Lundman approach

FindingsMidwives’ needs and expectations were categorized into seven themes: 1) improvement of knowledge and skills, 2) equal ability in teamwork, 3) competency recognition, 4) suitability of education and work-burden with well-being, 5) provision of continuing education level particularly for worked midwife, 6) quality of education provider, and 7) conformity of education level with health service level or scope of work.

ConclusionMidwife education level equality is needed to improve the quality of service and prosperity of midwife as well as the strengthening of the midwife profession. Nevertheless, some need to be taken into consideration in the development of this level of education

Implications for Practicesthis research can be used as a reference for the improvement of quality and equity midwifery education level in Indonesia





Saturday 8 September, 2018, 10:30 – 12:00PS14 – Midwifery Education, its Strenghts and Effects

O 53 Midwifery education: Philippine setting – its strengths and effects

F. Tejano 1

1 Philippine League of Government and Private Midwives, Office of the President, Manila, Philippines

Under R.A. No. 7392, the Midwifery “profession” in the Philippines, was only a two-year college, direct entry pro-gram. But for long, the midwives were allowed to practice their course independently either thru their birthing clinics or at residences upon calls by pregnant mothers. The practices in the far-flung areas are often done without the attendance of medical doctors owing to the scarcity of these professionals. Perceiving the great contribution that midwives can provide against the rising mortality rate of maternal and newborn, the Com-mission on Higher Education (CHED) came up with this circular prescribing a four-year bachelor’s degree in midwifery and allowing the two-year midwifery graduates to upgrade their course thru this new degree. To augment the forces in the maternal and child health care effort of the government, the subject on administra-tion of life-saving drugs and medicines was made as curriculum, thus empowering the midwives to exercise wisdom in the middle of an emergency where medical doctors are unavailable.

The midwives, however, are not without disenchantment, but feel short-changed and discriminated to the extent of regarding this circular as inconsistent to their empowerment and counter-productive to the aim of giving buffer to the government’s health program especially on maternal and newborn care.

It is, thus submitted, that the midwifery profession should be institutionalized in hospitals even in private facili-ties by creating an independent department of maternal and child health care where a midwife supervisor is at the helm. By this setting shift, midwives are given the correct label, authority and recognition with other health stakeholders.

This work, in its substantial sense, will determine the capacity of midwives on their empowerment after com-pleting the four-year bachelorship. It may also rationalize or point possible infirmities in the policy or practice of depriving the midwives from handling deliveries in hospitals.





Saturday 8 September, 2018, 10:30 – 12:00PS14 – Midwifery Education, its Strengths and Effects

O 54 Scaling the competencies of midwives though mentoring

P. Gomez 1

1 Integrated Midwives Association of the Philippines-Inc., Project Management Unit PMU, San Juan City, Philippines

SCALING UP MIDWIFERY PRACTICE THROUGH CLINICAL MENTORING AND COACHING: THE PHILIPPINE EXPERIENCE

IntroductionBetween 2012 to 2015, the Service Delivery Network (SDN) concept was introduced into the Philippine Healthcare System. It focuses on providing facility-based care for pregnant women from the pre-natal to the post-natal period in order to reduce maternal and neonatal mortality rates nationwide. It is designed to provide a seam-less delivery of quality healthcare for its clients.

MethodologyThirteen (13) pilot project sites were selected in areas previously identified to have high maternal and neonatal mortality rates and low prevalence of contraceptive use. From these areas 367 mentors were trained. Trainors were clinical instructors. Training modules used were:

• Counseling• EINC (Essential Intrapartum and Newborn Care)• Post-partum• IUD Insertion / removal• Breastfeeding• antenatal care Initial• Antenatal Care Subsequent

The mentor-trainees were recruited from:• Batangas province (29)• Cavite (22)• Davao del Sur (20)• Iloilo (26)• Leyte (32)• Misamis Oriental (51)

• Naga City (28)• Negros Occidental (21)• Pangasinan (29)• Quezon City (22)• Quezon Province (34)• Taguig City (22)• Zamboanga (1)

Included in the methodologies were:• rapid assessment test• Pre-test and post-test• Observation/ Monitoring of Implementation of

training program (including feedback and actual application of skills learned)

The duration of training was one week with the final day devoted to summary and feedback.

DiscussionAt the end of the project, the number of centers involved went down from 13 to 7. Out of 367 mentor-trainees, 53 were qualified as mentors under IMAP and 20/53 were certified by the Department of Health (DOH).

ConclusionAlthough the evaluation phase is on-going, it appears that the main objectives are being met. Optimum col-laboration with various stakeholders has been positive. This has facilitated sustained progress in the implemen-tation of the training of this eight ( 8) training components in antenatal visits, counseling, Insertion / Removal of IUD, Intrapartum Care, Breastfeeding, Post Natal Care, Care of the Newborn.






O 55 What shapes midwives decision-making around the Artificial Rupture of Membranes (ARM) in low risk labour?

A. Farry 1 , C. Mellor 2 , J. McAra-Couper 3

1 AUT, Midwifery, Auckland, New Zealand 2 Waitemata District Health Board, Midwifery, Auckland, New Zealand 3 Auckland University of Technology, Midwifery, Auckland, New Zealand

Abstract To examine midwifery perspectives about the importance of maintaining the integrity of fetal membranes and to explore the complexity of the decision making around the decision to use ARM in low-risk labour.

MethodologyAn interpretive descriptive methodology six semi-structured focus group interviews.

ParticipantsThirty-eight participants of varied ethnicities, caseloads and years of practice experience evenly represented community and hospital midwifery practice across North and West Auckland, both urban and rural.

AnalysisTranscription and systematic text condensation was employed to draw themes from midwifery discussion.

FindingsParticipants were aware that evidence does not support the use of ARM in low-risk labour. Nevertheless, they identified three pressure points where ARM is more likely to be used in ‘normally’ progressing low-risk labour and five pressure points when ARM is more likely to be used in labour progressing slowly. Adding to the complex-ity participants described different perceptions of both progress and risk depending on ‘place of birth’. Within tertiary facilities participants described membranes being perceived as a barrier to progress, oxytocin aug-mentation, obstetric surveillance and workplace efficiency. In the primary and home environment participants perceived the integrity of fetal membranes to improve the efficiency of labour with the main barrier to progress being perceived to be a lack of maternal sense of safety, security and wellbeing.

ConclusionMidwifery decision making in relation to ARM in low-risk labour is shaped by both social (‘place of birth’, maternal request and practitioner workload) and physiological (‘long’ latent phase, lack of progress in active labour and assessment of fetal wellbeing) variables.

Implications for practiceThese findings give further weight to the argument that low-risk births should happen in primary environments where facility culture holisticly supports birth physiology. Furthermore, they highlight the need for a standardised approach to ARM and practice tools designed to reduce its injuditious use.






O 56 Effectiveness of video assisted teaching program (VATP) on knowledge and practice of breast massage to express the breast milk

S. Raddi 1 , S. Fernandes 1 , A. Bhat 1

1 KLE Academy of Higher Education and Research-Institute of Nursing Sciences, OBG Nursing, Belagavi, India

IntroductionBreast massage significantly improves breast milk production in mothers and also facilitates easy expression of breast milk.

Objectives Are to assess the knowledge and practice regarding breast massage to express the breast milk, evaluate the effectiveness of video assisted teaching and to find the association between pre-test knowledge and practice scores with selected demographic variables.

Material and MethodsA pre-experimental study was conducted on 65 postnatal mothers whose neonates were admitted in the NICU, selected by randomization using the lottery method. One group pre-test post-test design was used for study. Pre-test was taken using structured knowledge questionnaire for assessing the knowledge followed by obser-vational checklist for assessing the practice of the mothers regarding breast massage for expression of breast milk. Video regarding breast massage for expression of breast milk (Marmet technique) was taught to the mothers by the investigator. A post-test was taken using the same questionnaire and checklist.

Results revealed that 61.54% had average, 21.54%had a good and 16.92 has poor knowledge in pre test where as in post-test 100 % of the mothers had good knowledge. Regarding skills in pre test 90.77% had average, 7.69% inadequate and 1.54% had adequate knowledge. But in post test 98.46% had improved to adequate skills and 1.54 had aver-age skills.The effectiveness of VATP was assessed by using paired ‘t’ test which revealed that mean pre-test knowledge score was12.32 ± 3.65 which increased to 23.98 ± 1.93 (t = 29.9, p < 0.05) and the pre-test practice score was 2.17 ± 0.57, which increased to 5.32 ± 0.77 (t = 28.64, p < 0.05) after the intervention.

ConclusionThe study findings concluded that video assisted teaching program was effective to increase the knowledge and practice of the postnatal mothers regarding breast massage for expression of breast milk.

Poster Presentations





Thursday 6 September, 12:45 – 13:30 / Friday 7 September 13:15 – 14:00P01 – Poster Viewing

P 01 A transition story to Stork, the obstetric module of electronic medical records

S. Andrew 1

1 Dubai Hospital-Dubai Health Authority, Maternity Nursing-Dubai Hospital, Dubai, United Arab Emirates

BackgroundInformation technology offers many potential advantages over paper. Switching from manual medical record to electronic improves efficiency, risk management and organizational quality.Dubai Hospital is a tertiary, multispecialty hospital. Each year an average of 22000 outpatient consultations and in- patient services are provided to women by the obstetric department of Dubai Hospital. Handling the manual medical records was a huge task that consumed lot of time, energy and money. Switching to electronic medi-cal record was of prime importance. It was an apt decision of Dubai Health authority to implement a unified electronic medical record system.

ObjectiveThe goal was to facilitate a smooth transition from paper files to a scalable, fast and stable electronic medical record system.

MethodsFormation of teams of subject matter experts and super user teams from different disciplines, training, imple-mentation and monitoring.

AnalysisMissing paper files, delay in receiving the medical records from other facilities and illegibility were always a reality that affected the efficiency and quality of care delivered to our customers. Transition to Stork for sure will help in solving these problems, but the transition process needed a well-planned process map and imple-mentation of the same

FindingImplementation of Epic Stork for obstetric department of Dubai Hospital has improved the safety and quality of the health care provided. It provides customers and health care providers access to medical records through a patient portal and ensure that the records are available across the DHA facilities. The special features and customized flow charts, order sets and reports helps obstetricians, midwives and neonatologists in creating a collaborative plan of care for the moms and newborns

ConclusionA well-structured plan and the preparations before each level of implementation helped in keeping the morale and confidence of end users.

Implication for practiceContinuous monitoring and optimization is mandatory for safety and quality.






P 02 Expected birth choices after obstetric internship among Taiwanese nursing students: a qualitative research

S. W. Chen 1 , J. C. Sun 2

1 National Taipei University of Nursing and Health Science, School of Nursing, Taipei, Taiwan 2 Chang Gung University of Science and Technology, Nursing Department, Taoyuan, Taiwan

BackgroundCesarean section (CS) rate is over 35% in Taiwan. In addition, the average fertility rate for couples in 2016 was 1.17, restricting Taiwan’s population growth. However, little is known about the views of Taiwanese younger genera-tion on birth choices

AimTo explore the birth choices of nursing students after obstetric internship.

MethodsA qualitative approach was used to conduct this research. A total of 25 nursing students were recruited from a nursing university in northern Taiwan. In-depth interviews were applied for data collection within a month after obstetric internship. Comparative analytical techniques were then employed for data analysis.

ResultsBefore their obstetric internship, 16 nursing students chose vaginal birth, 6 chose CS, and 3 were undecided. After their obstetric internship, the nursing students who chose CS all changed to vaginal birth, except for one who was undecided. A positive and safe birth was the core theme of this study. The nursing students made a birth choice from three aspects: avoid risks and pain (i.e. risks of vaginal birth, complications of CS, obstetrician recommendations, fear of pain), experience a natural birth process (i.e. early parent–child attachment, partner involvement and support, empower birth), and give birth in a friendly environment (i.e. free to move, supportive company, non-drug pain relief, accurate information, unnecessary medical intervention).

Conclusion/ Implications for PracticeAfter an obstetric internship, the majority of nursing students expected a vaginal birth. Nursing students expect a positive and safe birth. Midwife-led care can provide a friendly and high quality of birth environment; hospitals should reduce unnecessary medical intervention and provide accurate information regarding birth choices in taiwan






P 03 Findings related to C-section rates: using Caesarean Indication Classification System

A. M. Jacob 1 , S. Tanvir 1 , M. Chhugani 1 , M. M. James 1

1 JAMIA HAMDARD, RUFAIDA COLLEGE OF NURSING, NEW DELHI, India

A retrospective study to assess the Indications of C-section using Modified Cesarean Indication Classification System (CICS) among Health Facilities in selected areas of New Delhi. Caesarean section is one of the com-monly performed surgical procedures in obstetric and certainly one of the oldest operations in surgery. Aim of the study was to find out the number of C-section and the indications based on absolute and non-absolute indications by using modified cesarean indication classification system. As the nursing perspective about the hospital birth, nurses are the major and the central part for the management of the labor and delivery units. Nurses are the administrator, decision makers and can assess for indications of C-Section. Data was collected from the medical records of mother who had undergone C-section between January to September 2017 in four health facilities of New Delhi The study findings of the present study revealed that the average rate of C-section among four health facilities was 20.9%. Among the absolute indications, obstructed labour ranked first and maternal distress ranked the least, and among the non – absolute indications, fetal compromise ranked first and Rhesus Incompatibility ranked the least. Out of the 3365 C-sections assessed 27 women had undergone C-section without taking Consent. Study results suggested that increased standardization in indicator terminol-ogy is needed to enable meaningful monitoring and comparison of trends using an indication system. Nearly all files included in this review had a recorded indication; however, many indications were difficult to categorize because of the limited information included. Analysis of these data was also complex because of the varying terminologies across settings. Periodic reviews (quarterly/annually) of Cesarean Indications should be a core component of quality improvement efforts in safe motherhood. Strategies should be adopted in health facili-ties to charge the same amount for C – sections and natural deliveries.






P 04 Functionalization of maternal, neonatal and perinatal death review system (MNPDR) in four hospitals in Kabul, Afghanistan.

F. Darkhani 1 1 Afghan Midwives Association, secretariat, Kabul, Afghanistan

BackgroundReducing maternal and newborn deaths is an integral part of the global agenda to achieve the Sustainable Development Goals; recent data have shown that the majority of maternal and neonatal deaths occur in de-veloping countries. In Afghanistan, after initial progress in reducing maternal and newborn mortality, maternal mortality has risen significantly while neonatal mortality rates have stagnated, and much work is needed to achieve the goal of ending preventable maternal and neonatal deaths, (MNPDR) approach is a method to un-derstand gaps and delays in the system by examining the causes of death. AMA started an MNPDR program to review the existing system in four hospitals in Kabul.

MethodsProject designed to assess the existing MNPDR review system and identifying gaps by providing constructive recommendations and supporting hospitals review committees to conduct regular review meetings for each death case and investigate direct and indirect causes of death include using the MNPDR guideline to report and take action on maternal or neonatal death.

FindingsTotality 19 Maternal deaths and106 neonatal deaths has reviewed at four hospitals, based on finding from the reviewed cases the below main finding highlighted;• Death notification system in place, but not reported timely • Lack of supportive supervision from MoPH side the reporting, record keeping and filing system has nega-

tively affected due to fear of blame• Because of high turnover of staff the member didn't aware about the recording and reporting system The most referred cases from other facilities were end stage with no refer sheet

ConclusionMNPDR review system a continuous cycle of notification, review, analysis, and response. It works to increase the avoid-ability of preventable maternal mortality by involving stakeholders in the process of identifying maternal deaths

Implications for PracticeThe data and recommendations produced by this approach will support health managers and planners to have focused interventions in Afghanistan to prevent maternal and neonatal deaths in health facilities.






P 05 “Membranes Matter think HALO” – a Human Centred Design innovation to reduce the Artificial Rupture of Membranes in low risk labour

A. Farry 1 , C. Mellor 2

1 AUT, Midwifery, Auckland, New Zealand 2 Waitemata District Health Board, Midwifery, Auckland, New Zealand

BackgroundFetal membranes have a number of important roles in physiological birth. Artificial rupture of membranes (ARM) is an intervention which is usually done with the aim of augmenting and shortening labour even though this is not supported by evidence. An audit of clinical notes over 2 months at a New Zealand maternity hospital revealed that 34% of women presenting in spontaneous low-risk labour with a singleton cephalic presentation experienced an ARM (n=45), with almost all occurring within 2 hours of admission.

ObjectiveTo develop an innovation that will standardise the approach to ARM in low-risk labour.

MethodsHuman-centred and co-design principles were used to create an innovation. Forty-eight participants (38 mid-wives of varied ethnicities, caseloads and years of practice experience) and 10 mothers having recently given birth and experienced ARM in low-risk labour.

AnalysisSystematic text condensation of transcribed focus groups and 1:1 interviews. This project received localities eth-ics approval

FindingsMidwives described seven pressure points where they were more likely to use ARM in low-risk labour and ways they have learned to avoid these pressure points. Women described their experiences of ARM. These ‘key mo-ments’ were used to create an innovation “Membranes Matter- Think HALO”. “Membranes matter” is a 10-minute educational documentary and “HALO” is an acronym incorporating the latest relevant research. The innovation brings together women’s experience and the protective principles and practices midwives reported using to avoid arM

ConclusionThere is varied appreciation of the role of membranes in physiological labour. “Membranes Matter- think HALO” advocates for fetal membrane integrity.

Implications for practiceThis innovation may help to standardise the New Zealand midwifery approach to ARM in low risk labour by cel-ebrating best practice and membrane physiology. Rather than being seen as a barrier to progress fetal mem-branes are represented as vital to physiological birth.






P 06 Sharing birth experiences among women through movie viewings in Myanmar, Laos, and Japan

M. Hashimoto 1 , M. Oguro 2 , K. Shimazawa 3 , Y. Watanabe 4 , N. Arimor 5

1 St. Luke’s International University, Graduate School of Nursing Science, Tokyo, Japan 2 Tokyo Healthcare University, Chiba Faculty of Nursing, Chiba, Japan 3 Kobe City College of Nursing, College of Nursing, Kobe, Japan 4 Shizuoka General Hospital, Shizuoka General Hospital, Shizuoka, Japan 5 Niigata University, School of Health Sciences Faculty of Medicine, Nigata, Japan

BackgroundWe conducted a project that created opportunities for women from Myanmar, Laos, and Japan to discuss their own birth experiences; that placed value on the national and individual aspects of women’s birth experiences (Toyota Foundation International Grant Program). As part of this project, we created a movie about women’s birth experiences in these 3 countries and held viewings in each country.

ObjectivesTo have women watch the movie “Please tell me about your birth experience”, in which women from Myanmar, Laos, and Japan talk about their experiences; and to clarify the thoughts and feelings this generated through post-viewing discussions.

MethodsData were collected through interviews conducted after the viewings in Myanmar, November 2017, in Laos, March 2018, and from written comments provided by midwives, midwifery students, and all other women in Japan, 2016 and 2017. For ethical considerations, the women received an explanation of the study and provided consent to participate. They were informed orally that participation was of their own free will and that their pri-vacy would be protected.

AnalysisThe women’s thoughts and feelings after watching the movie were extracted from the data; this content then underwent qualitative descriptive analysis.

FindingsThe subjects were 7 from Myanmar, 5 from Laos, and 113 from Japan. Four categories were shared between all 3 countries: “joy of sharing birth experiences,” “discovering commonalities regarding childbirth,” “discovering dif-ferences regarding childbirth,” and “hope about childbirth.”

ConclusionSharing birth experiences through a movie could offer women from Myanmar, Laos, and Japan the chance to discover commonalities and differences in birth experiences, and provide them with hope about childbirth

Implications for practiceThese results suggest that viewing a movie about women’s birth experiences could facilitate to recognize di-verse value of birth experience and to have hope about childbirth for women






P 07 Promotion of in-hospital midwife-led care and in-hospital midwifery clinic

H. Hayakawa 1 , M. Yamanishi 1 , C. Nagatomo 1 , M. Muranaka 2 , K. Yoshikawa 3

1 Japanese Nursing Association, Health Promotion Policy, Tokyo, Japan 2 Japanese Nursing Association, Health Promoition Policy, Tokyo, Japan 3 Japanese Nursing Association, Management, Tokyo, Japan

The number of births in Japan is generally declining, and 99% of births take place in hospitals and medical clin-ics. Some 85.7% of midwives work in hospitals and medical clinics, while midwives working in maternity homes account for 5.6% of all midwives.

At maternity homes, midwives take responsibility for continually providing maternity care to normal pregnant and parturient women and their families In hospitals and medical clinics, on the other hand, care is provided in cooperation with obstetricians to pregnant, parturient, and puerperal women and their families, including ab-normal cases. However, in the context of an increase in high-risk pregnant and parturient women, team-based medical care is being further promoted as role sharing between obstetricians and midwives.

Midwives have responsibility for autonomously caring for normal deliveries, and in-hospital midwife-led care and in-hospital midwifery clinic are promoted as systems in which midwives working at medical institutions can autonomously provide care. However, while the number of facilities offering in-hospital midwifery clinic increased from 894 in 2011 to 947 in 2014, the number of facilities offering in-hospital midwife-led care remained mostly level, going from 160 in 2011 to 166 in 2014. Also, given the need for standardization of in-hospital midwife-led care and in-hospital midwifery clinic, the Japanese Nursing Association produced “Guidelines for In-Hospital Midwife-Led Care and In-Hospital Midwifery Clinic, 2018.”

It is hoped that in-hospital midwife-led care and in-hospital midwifery clinic that adheres to these guidelines will increase in the future, leading to the provision of care that respects the wishes of pregnant, parturient, and puerperal women and their families






P 08 Back massage “URUIK” and water immersion stenochlaena palustris leaf for women with fear of birth is a feasible option

R. Hevrialni 1 1 Riau Health Polytechnic of Health Ministry Republic of Indonesia, Midwifery Department, Pekanbaru of Riau Province, Indonesia

The maternal mortality rate in Indonesia reached 359 / 100,000 Living births. It caused by helping birth by the traditional birth attendant (TBA). Selection of TBA is because their culture back massage named «uruik» and water immersion Stenochlaenapalustris leaf used by TBA to reduce labor pain and accelerate the delivery that makes women choose deliver with TBA. This culture can be utilized by midwives to attending births in partnership with TBA to help normal delivery. The aim was to test a modified the partnership model of midwife and TBA with a back massage «uruik» and water immersion Stenochlaenapalustris leaf to provide continuity of care in reducing labor pain and accelerate delivery. This study was a pre and post test control design with back massage “uruik” and a water immersion Stenochlaena palustris leaf to women who were divided into 4 groups from May until November 2016 with a purposive sampling and assessed pain intensity scale and length deliveries with partograph. Data was analyzed by using Annova test. Etichal clearance was obtained from the Research Ethics Committee of the Ministry of Health of the Republic of Indonesia. The result find 76 women had a normal birth, back massage “uruik” intervention group and water immersion Stenochlaena palustris leaf is the largest group with the lowest pain intensity, and accelerate cervical dilatation in 3.15 hours. Most women reported that their fear of the birth pains disappear Partnership midwives and tba more better the model of partnership between midwife and TBA with back massage “uruik” and water immersion Stenochlaena palustris seems to be a feasible option for women giving birth with a high level of fear childbirth and reducing labor pain and accelerate the delivery time. women are satisfied with the partnership model and with the efforts of non-pharmacological given during childbirth.






P 09 Correlations between pushing skills and pushing perceptions, second-stage labor duration, postpartum fatigue, and birth satisfaction

Y. C. Huang 1

1 Chang Gung Memorial Hospital, Obstetrics and Gynecology, Taipei, Taiwan

Background Delivery bridges the antepartum and postpartum period. Subsequent fatigue can affect indices, including postpartum recovery and life quality. Milk secretion, breastfeeding quality, and newborn participation may be compromised. Correspondingly, using proper pushing skills during the second stage of labor has the potential to effectively reduce postpartum fatigue and enhance birth satisfaction in new mothers.

PurposeTo compare the effects of using different pushing skills on maternal pushing perception, postpartum fatigue, and birth satisfaction

MethodologyThe present study used a descriptive research approach and recruited 382 participants from a medical center in northern Taiwan. Data were collected using a structured questionnaire, which included a demographic and obstetrics information datasheet, the Labor Pushing Experience Scale, a fatigue scale, and a birth satisfaction scale

Research resultsUsing pushing skills (including upright position [t = 2.28, p< .05] and delayed pushing [t = -1.98, p<.05]) during the second stage of labor was shown to enhance birth satisfaction in participants. Additionally, open glottis push-ing ( t = 5.46, p＜.001) resulted in a mean duration of second-stage labor that was 17.67 minutes less than that achieved using Valsalva pushing. Moreover, a better perceived pushing experience was associated with lower perceived postpartum fatigue (r = -.22, p < .05) and higher birth satisfaction (r = .46, p < .05). Finally, postpartum fatigue perception was negatively associated with birth satisfaction (r = -.16, p < .05).

Conclusion and clinical applicationThe findings suggest that midwives should advocate that women adopt upright positions, delayed pushing, and open glottis pushing during the second stage of labor in order to enhance their birth satisfaction.






P 10 Using creative education to elevate rookie nurses’ ability to deal with postpartum hemorrhage

S. J. Kao 1 , T. H. Kao 1

1 Taipei City Hospital, gynecological unit, Taipei, Taiwan

BackgroundIn 2016,an invesigation to rookie nurses of postpartum unit reveals that their knowledge of postpartum hemor-rhage only got 67 points as average，and the satisfactory investigation only got 69.05%.

ObjectivesPostpartum hemorrhage is one of the common complications during delivery, andits assessment is essential for every gynecological nurses. Every detail should not be neglected or delayed, that is why the advance of medical care appears to be crucial.Therefore we hope that creative education will make an improvement on rookie nurses ability to deal with post-partum hemorrhage.

MethodsThe design of this essay is under the use of Filped Classroom, Cloud Video system and give creative hints for education. Otherwise utilizing Situated Simulation Teaching and repeated discussions to strengthen learning experience. Last but not least using Socrative Interactive Response System to realize the outcomes.

FindingsSocrative Interactive Response System reveals that rookie nurses` knowledge and assessment of postpartum hemorrhage make an improvement from 67 points to 98 points, also the satisfactory investigation elevates from 69.05% to 95 .00 %

ConclusionWith the use of creative education, there is an elevation of rookie nurses` ability to deal with postpartum hemor-rhage cases. We expect future cooperations with schools to cultivate students` basic knowledge about Gyne-cology, as it is beneficial for their future internship and clinical practice.






P 11 Iran midwifery standards for regulation and services

N. Khodakarami 1 , F. Babaei 2 , L. Hadipour Jahromy 3

1 Iran Scientific Association of Midwifery, Midwifery, Tehran, Islamic Republic of Iran 2 Ministry of Health, Midwifery, Tehran, Islamic Republic of Iran 3 Ministry of Health, Matrnal Health, Tehran, Islamic Republic of Iran

BackgroundIran midwifery is strong and has made excellent progress over the last decades.

ObjectiveThe aim of this study was developed midwifery standards of practice, introduce model of care and accredita-tion of midwifery services for Iran

MethodsMethods used to carry out this standards included review of the Iran midwifery history of education and prac-tice and ICM new midwifery standards.

ResultsMedical professional regulation law made by Perelman in 1987, according of this law the regulation and regis-tration of Midwifery make by Iran Medical Council.

The legal recognition and regulation of midwifery is as recent as 1915. Indeed, rules and regulation for licensing of midwives which Parliament passed on 1955 as a medical certification Act. Finally in 1987 Parliament passed a law as Iran Medical Council Law, according this law, midwifery licensing making by IRMC. The midwifery stan-dards developed according ICM standards for regulation and accreditation. Iranian Midwives working at public health clinic, hospital, and Private sector. The best model of midwifery care is privet midwifery services in clin-ics and counselling services that have been established providing women with care and access to education, especially about normal vaginal birth, reproductive health and women health.

The counselling center is an impressive services of education and support, is clearly highly valued by the wom-en and meeting an important aim of provision women with information about normal birth, This is providing antenatal and postnatal care, family planning counselling and services, infertility and menopause counselling with access to diagnostic tests with the scope of practice and good referral networks to the local hospital and obstetricians. In order to practice privately, midwives must be registered with the Iran Medical Council. About 20000 midwives work in public hospitals, their own privet clinics instructor and lecturer at public universities or as a researcher at different research centers






P 12 Effects of expectant father’s accompanying birth education program on women’s childbirth stress and self-efficacy in Taiwan

S. C. Kuo 1

1 National Taipei University of Nursing and Health Sciences, Department of Nurse-Midwifery and Women’s Health, Taipei, Taiwan

BackgroundSupport for expectant fathers is an important issue in the maternal and perinatal health-care system. However, researches on the evaluation of prenatal childbirth education for partners of pregnant women remain limited.

ObjectivesThe objective of this study was to evaluate the effects of expectant fathers’ accompanying birth education program on women’s childbirth stress and childbirth self-efficacy.

MethodsThe experimental study design was used. The subjects were recruited from a northern regional hospital in Tai-wan. The study consisted of approximately 88 first-time expectant fathers and mothers; the control group consisted of 42 couples and the remaining 46 made up the experimental group. The expectant fathers of ex-perimental group positively participated in the four hours expectant fathers’ accompanying birth education program. The expectant fathers of control group received standardized care.

AnalysisOne-way ANCOVA was used.

ResultsOur results showed that there were no statistically significant differences between the experimental and con-trol groups of expectant mothers in stress of childbirth and self-efficacy and outcome expectancies in prenatal period. After one-way ANCOVA was applied, the effect of the expectant fathers’ accompanying birth education program was significant for the mothers’ level of stress (F = 5.31, p = .02) at the second day after birth. In addition, the results of the study also showed that the women in the experimental group exhibited a significant higher self-efficacy (F = 4.27, p = .04) and outcome expectancies (F = 6.63, p = .01) than the control group women at two-day postpartum. ConclusionsResults suggest that providing expectant fathers’ accompanying birth education program during pregnancy may contribute to reductions in mother’s childbirth stress and improved childbirth self-efficacy.

Implications for practiceThis expectant fathers’ accompanying birth education program provides health care professionals with an evidence-based intervention






P 13 Early detection and right care of Premature Rupture of Membranes (PROM) by midwives got well-health baby and mother

I. Kurnia 1

1 Indonesian Midwives Association, Technical Team, Jakarta, Indonesia

Preterm labor is a dangerous complication with significant effect to mothers and newborns. 60–80% of world-wide neonatal morbidity and mortality caused by Preterm Labor. Indonesia has approximately 19% incidence of preterm labor, the major cause of perinatal mortality. The cause of preterm labor is still not sure, it is estimated by multifactorial.

The problem that discussed on this study is the incidence of preterm labor didn’t significant decrease from year to year. In 2008 (10.15%), in 2009 (9.67%), and in 2010 (9.77%). Many evidence stated the cases due to PROM will continue with delivery process (30–40%). This study was conducted to determine the relationship PROM with preterm labor in Dr. M. Soewandhie Hospital.

This study with case-control design on 268 mothers who gave birth in delivery room of Dr. M. Soewandhie Hos-pital from January to June 2011. The sample consisted of 134 cases and 134 controls. Cases are mother who gave birth to a premature baby, controls are mother who gave birth not premature. Medical record used to obtain information about study variables. Data analysis in univariate and bivariate.

The results showed the incidence of PROM is related to Preterm Labor. PROM can cause preterm labor. The sta-tistic result told OR values = 1.981, 95% CI = 1.105 to 3.551, p = 0.030. Women who labor with PROM has 2x greater risk for preterm labor compared to women without ProM

The quality of midwifery care should be improved especially in prevention or handling of factors causing pre-term labor. The diagnosis of PROM as early as possible, appropriate and rapid treatment according to gesta-tional age, monitoring of the mother and fetal condition should be done as well as possible to reduce the risk, especially infection and preterm birth and other compilations so that the outcomes of well- health baby and mother can be achieved






P 14 Midwifery update (MU) training maintains midwife competencies to provide quality services

I. Kurnia 1

1 Indonesian Midwives Association, Technical Team, Jakarta, Indonesia

The success of health development is determined by the quality of health providers. Midwives are one of im-portant and strategic health providers in Indonesia. The number of Indonesian registered midwives are 590,920 (MTKI, December 2017). The task of midwife is to provide quality services for community, to improve mothers, children health status, women’s reproductive health and family planning. Basic Health Research (Riskesdas) in 2013 stated that most people choose midwives as their health provider (88% ANC, 87.1% INC, 59.6% family plan-ning). Therefore it must be ensured that midwife are qualified and competent.

This is literature study through stages: data collect, theories collect, conceptualization, analysis, conclusions and implementation suggestions.

The qualifications to be fulfilled by midwife is have a registration certificate (STR) and license (SIP). STR and SIP are valid for 5 years and may be re-registered upon completion of the requirements. Requirement for re-reg-istration among others a professional organization recommendation which Indonesian Midwives Association (IMA) is the one and only that organization. IMA has representatives in almost all parts of Indonesia.

IMA’s recommendation accordance with Continuing Professional Development (CPD) guidelines. Each midwife must collect 25 credits within 5 years. 25 credits can be obtained through 5 component activities : midwifery services, continuing education, community service, professional development, and research. Continuing edu-cation are non-formal education likes symposiums/ seminars/ workshops/ training. Must follow midwife train-ing is Midwifery Update (MU) training. MU training conduct 20 hours, 25–30 people, topics: policy, current issues, ethicolegal, integrated ANC, Normal Birth Attendance (APN), Contraceptive Technology Update (CTU), monitor-ing of infant and toddler growth, and maternal-neonatal emergency helping. The trainers are senior midwives, pediatricians, obstetricians

Midwife re-registration application can’t be processed without IMA’s recommendation. Midwives who finished MU training can be given IMA’s recommendations. MU training can maintain midwives competencies and im-prove the quality of midwife’s services.






P 15 Aromatherapy (inhalation) for pain management in labour

O. K. Lai 1 , S. L. Or 1 , S. W. Sin 1 , W. H. Sin 1 , W. Y. Ng 1 , L. F. Ho 1

1 Princess Margaret Hospital, Department of Obstetrics & Gynaecology, Hong Kong, Hong Kong

BackgroundAromatherapy was first introduced to maternity care in the early 1990s. Researches had been done and revea-led that the use of aromatherapy may shorten the duration of labour. Women had self-reported favorably on using aromatherapy to reduce anxiety, fear and pain.

Objectives1. To provide guidance for practicing Aromatherapy safely and effectively2 to provide informed choice for women to cope with labour pain3 to promote positive experience in labour

Methods & Analysis Aromatherapy, for low risk labouring women >37 weeks of gestation, as a labour pain relief method was launched in July 2015 in the delivery suite. Both the maternal and baby outcomes were monitored and Women’s Satisfac-tion Survey was collected after delivery. The effectiveness of the program was evaluated by using SPSS 16.0.

FindingsFrom July 2015 to December 2016, there were 645 women used aromatherapy as labour pain relief which ac-counted for 8.7% over total deliveries of 7389. There were no significant adverse maternal and baby outcomes noted among the cases. From the feedback of women, 171 women (26.5%) reported lesser pain, while 28 (4.3%) expressed that it was very useful for relieving labour pain and 138 (21.4%) expressed that the effect was moderate. Moreover, 57 (8.8%) women commented that it was very useful for alleviating anxiety and 60 (9.3%) women reported that it was very useful for relaxation

ConclusionAromatherapy, as a non-pharmacological pain relief method, is valuable for labour pain relief.

Implications For PracticeMeanwhile, there are some limitations in the program still. We started with a limited choice of Essential Oils in-cluding Neroli, Sweet Orange, and Bergamot. Moreover, we use the inhalation method only.In future, to enhance the effect, more varieties of Essential oils and methods in use could be considered of course, more training on the effects and safety precautions on various essential oils, should be conducted to all staff members






P 16 A comparative study of childbirth expectations and experiences for mainland China immigrants and Taiwanese women

Y. Lin 1

1 No.6-Ln. 163-Sec. 4-Sanhe Rd., Sanchong Dist., New Taipei City 241, Taiwan

BackgroundAmong immigrants women from mainland China have to receive prenatal care and delivery at their own ex-penses. Because of the low prenatal care rate, most of them want to deliver health babies smoothly.

ObjectivesThis study explored the impact of specific demographic and obstetric factors on childbirth expectations and experiences for mainland China immigrants and Taiwanese women.

MethodsComparative correlational descriptive research design was applied for this study. Prospective data was col-lected between November 1, 2013 and May 1, 2014. At the first stage, we finish prenatal and childbirth expecta-tions analysis. One hundred thirty-nine of Taiwanese and 46 of mainland China Immigrants were enrolled to this study. At the second stage we finish post-partum and childbirth experience analysis in 113 of Taiwanese and 44 of mainland China Immigrants, so rate of loss of follow up is 15%.

AnalysisA demographic data form and the Childbirth Expectations Questionnaire and the Questionnaire Measuring At-titudes about Labor and Delivery Experience were used to collect data.

FindingsThe scores of childbirth experience correlated positively to childbirth-related pain expectations in mainland China immigrants. In Taiwanese group the scores of childbirth experience correlated positively to the control and participation. Predictive factors of childbirth experience for planning to be pregnant woman significantly higher than non-planning in mainland China women. The patients who did vacuum delivery with episiotomy were significantly lower than the childbirth experience of those who did vaginal delivery without episiotomy. The patients who completed Birth plan sheet were significantly higher than the childbirth experience of those who didn’t complete.

Conclusions/Implications for PracticeAccording to this study, we recommend the women who plan to be pregnant woman to complete Birth plan sheet. Professionals should improve current protocols to help women better confront and management and to decrease childbirth pain, discomfort, and fear that should be positive their childbirth experience






P 17 Application of art therapy in infertile patients: a narrative review

F. Najafitirtashi 1 , Z. Hamzehgardeshi 2 , M. Dayhimi 3

1 Islamic Azad University-Sari Branch, MA in Art Research-Technical Engineering Faculty-Department of Archi-tect, Sari, Islamic Republic of Iran 2 Mazandaran University of Medical Sciences, RM-Ph.D. in Reproductive Health-Associate Professor-Department of Reproductive Health and Midwifery-Sexual and Reproductive Health Research Center, Sari, Islamic Republic of Iran 3 International Branch of Shahid Beheshti Medical University, MSc in Midwifery-Department of Midwifery, Tehran, Islamic Republic of Iran

IntroductionReducing infertility stress can be effective in improving quality of life among couples as well as enhancing out-comes of assisted reproductive techniques. To this end, the use of art therapy in infertile patients was explained in this review study.

Materials and MethodsThis study was in the form of a narrative review. Searches were performed in the databases of Irandoc, Iranme-dex, SID, and Magiran, PubMed, UpToDate, Google Scholar, Scopus, and Web of Science using of keywords: art therapy, infertility, and infertility stress no time limit.

ResultsFindings of this study showed that art therapy, among many therapeutic methods, was a creative and new technique which could be performed individually or in group. Art therapy also referred to use of different tools by someone to express their anxiety and to refine their feelings in terms of dealing with their emotional conflicts.

The role of an art therapist in art therapy sessions was found to support and direct individuals on the path to treatments. During this process, an infertile person felt that they were not well understood and even their feel-ings were judged incorrectly. The results of this feeling could be isolation, anger, and depression; but creative expression could help an individual to adjust all these excitements. Reducing anxiety, moderating grief and sadness, increasing awareness and self-acceptance, enhancing con-fidence, communicating with oneself and others, expressing feelings in a safe manner, providing growth op-portunities, raising hope and positive choices, and encouraging a healthy lifestyle leading to physical and psy-chological domination were among the benefits of creative art therapy for infertility.

ConclusionArt therapy could be effective in reducing mental health problems associated with infertility, so it could be used as a complementary and alternative therapy along with classic methods of infertility treatment.






P 18 Strengthening clinical supervision of midwifery students using standard assessment tool

R. Shehzadi 1 , A. Parveen 2 , A. Mansoor 3 , S. Abbas 3 , M. Baig 3

1 Nursing Examination board-Lahore, Exam Board, Lahore, Pakistan 2 THQ Ahmad pur East, Tertiary public hospital, Bahawalpur, Pakistan 3 Aga Khan University, School of Nursing and Midwifery, Karachi, Pakistan

In 2007, Government of Pakistan initiated 18 months Community Midwife (CMW) program to provide the MNCH services to the community. However, research has shown that these CMWs have failed to establish midwifery practices, because most of them lack competency in skills and confidence to conduct safe births (Mumtaz et al. 2014). One of the reason identified is lack of clinical supervision skills of the midwifery teachers. Evaluation of clinical competency is a center part of maternity care instruction (Morrow, J.et al. 2016). In 2016, we did a project on clinical assessment and evaluation. We grouped 20 midwifery teachers from 20 districts of Punjab (one of the province of Pakistan) and interviewed them regarding clinical supervision followed by pre-test. It was re-vealed that 18 out of 20 teachers were not following any tool to assess the student’s performance during the clinical. In response to this assessment, we gave five days’ workshop on clinical teaching and supervision to the entire group of teachers. After the workshop, we set in groups along with the participants and developed a clinical evaluation tool based on thorough literature review. We choose five teachers to pilot the tool in their respective schools. The teachers were facilitated by at the clinical site to utilize the tool. After a month, the feedback was received and some modifications were made to the tool. Once the tool was finalized, the head of the midwifery schools for the entire Punjab, adapted the modified clinical evaluation tool for all the midwifery schools and subsequent trainings were provided to other teachers to utilize the tool to assess and monitor midwifery students’ progress.






P 19 First private sector Midwifery led Centre (MLC) in Bangladesh: Experience from Brac University

S. Amin 1 , S. R. M. Mail 1 1 , Midwifery Education Programme,Brac University, James P Grant School of Public Health (JPGSPH), Brac, Ban-gladesh

BackgroundMidwifery care is a new concept in Bangladesh. With the development of strategy related to midwives, the con-cept of midwifery led care center emerged. As 53 percent deliveries are still taking place at home, BRAC Univer-sity decided a MLC to be established in the community. This centre will ensure 24-hour availability of midwives and provide family-centered respectful maternity care for women before, during, and after delivery and will also will provide family planning. It will be managed and led by midwives alone. The satisfaction of the mothers will lead to reducing unnecessary caesareans section which is alarming 31 percent in Bangladesh!First model MLC has been established by BRAC University in January 2018.

Objectives1. To provide respectful maternity care to the pregnant mothers and ensure normal vaginal delivery (NVD)

as long as it is indicated.2. To provide the faculty an opportunity to experience first-hand midwifery-led-care so that they can

imbibe this in their teaching,3. To demonstrate a typical MLC to raise awareness of policy makers in this regard.

Design and methodologyThe MLC was established at one BRAC centre which covers around 58000 population. Four diploma midwives were recruited and trained. The MWs started providing round the clock services, visited community and en-sured services in four major areas including exercises and improved access and availability of birthing options such as using birthing chair, continuous counselling and providing quality time.

FindingsIn four months’ time 31 percent of vaginal deliveries have been conducted on birthing chair and 72 percent pregnant mothers used ball for exercise. No death in the MLC. Eighteen percent cases were referred. Such as Placcenta previa

ConclusionThe model MLC proves that it is getting popular and normal vaginal delivery is possible with respectful mater-nity care which ultimately will lead to reducing unnecessary caesarean section.






P 20 Professional midwifery education in Nepal: A changing context for equity and quality of maternal and newborn health

K. Bajracharya 1

1 Tribhuvan University Institute of medicine, Midwifery department, Kathmandu, Nepal

BackgroundThe midwives are the primary providers of health care for childbearing women around the world. The type and level of maternal care provided by trained midwives is often similar to that provided by obstetricians and family physicians, where such professionals are available. For Nepal it is a newer milestone, stated in 2016 after policy decision of need of professional midwives based on ICM core competencies and lesson learnt from Sri Lanka and thailand

ObjectiveTo describe about the milestones of midwifery education in Nepal

MethodThe retrospective and ongoing reports, minutes and policy statements are archived from the Ministry of health, midwifery schools, nursing council, UNFPA Nepal and midwives association are the sources of information with permission

FindingsThe three years post registration education was started from two universities back up by two midwife teachers from abroad to teach midwifery knowledge, skills and behavior. Regulatory mechanism is in place for quality and twelve days teachers training conducted to build capacity. Perhaps midwifery service framework is new for the country, two advocacy events were carried out. The midwifery model clinical sites for the students are lacking hindering the role as autonomous practitioner. The group of three pillars of midwifery had visited Ban-gladesh to observe midwifery.The policy level task force group is working for strengthening midwifery. Further support is providing by UNFPA, GIZ and Real Medicine Foundation for skill lab equipment and faculty. New diploma level midwifery education is in progress for community level.

Conclusion and ImplicationsIf the midwives are well trained they can bring tremendous results in MNH. The education must be well sup-ported with scholarships, midwifery model of practice and deployment plan at the earliest. Inter professional collaboration to be in place for shared responsibilities to meet What Women Wants, a respectful maternity care meeting the SDGs.






P 21 Birth asphyxia among term deliveries, a case-controls study on maternal, obstetric and fetal risk factors in Dodoma, Tanzania

L. Suleiman Msisiri 1 1 University of Dodoma, School of Nursing and Public Health-College of Health sciences, Dodoma, United Re-public of Tanzania

BackgroundBirth asphyxia remains a serious condition which significantly contributes to global neonatal morbidity and mortality. In Tanzania, 26% of all neonatal deaths are due to birth asphyxia. The objective of this study was to determine maternal, obstetric and fetal risk factors for birth asphyxia in Dodoma, Tanzania

MethodsA matched case-control study of 400 randomly selected neonates conducted from May to August 2017 in three selected hospitals in the Dodoma region, Central Tanzania. Cases were neonates with an Apgar score < 7 at 5th minute after birth, and the controls were those with >7 Apgar score at 5th minutes post delivery. 300 Controls were matched to 100 cases by birth weight and gestation age (1:3). Data was collected using a comprehensive questionnaire and RCH card number 4 to explore maternal, obstetric and fetal risk factors. Both descriptive and inferential analyses were employed to determine the association between independent variable and the outcome variable

ResultsAlmost all neonates 392 (98.0%) were born at term with the mean gestation age of 39.3weeks (SD 1.36) and the mean birth weight was 3.307kg. (SD 0.509) Multiple logistic regression analysis showed that Maternal risk factors of birth asphyxia were; being born to a mother aged < 20 years (OR 1.986 95% CI 1.378–4.965 p<.05), residing in rural areas (OR 1.692 95% CI 1.032 -2.775 p< .05), maternal anemia (OR 1.856 95% CI 1.023–3.367 p<.05) and the use of herbal medications during labor (OR 2.713 95% CI 1.037–7.102 p<.05). Obstetric factors were; newborns born to mothers with a history of complicated previous pregnancy (OR 0.30195% CI 0.113 -0.802p <.05), prolonged labor (OR 5.588 95%CI 2.626–11.892p <.001), presence of meconium stained amniotic fluid (OR 27.667 95% CI 9.131–83.828 p<.001) and section birth (OR 21.176 95% CI 8.517 52.654 p<.001).

ConclusionsMaternal and obstetric factors contributing to birth asphyxia are preventable. The findings highlight the impor-tance of expanded safe motherhood services including effective pregnancy monitoring and patient education.






P 22 An investigation of maternal health policy-making process in relation to midwife-led care: a comparative case study between England and Japan

M. Matsunaga 1 , M. Scamell 2 , C. McCourt 2 , Y. Kataoka 1

1 St. Luke’s international University, Women’s health and Midwifery, Tokyo, Japan 2 City-University of London, Centre for Maternal and Child Health Research-School of Health Sciences, London, United Kingdom

BackgroundIn England, continuity-based midwifery models of care have been endorsed in maternal health policy since 1993. However, this has not been the case in Japan.

AimThis study aimed to identify similarities and differences in policy-making process between England and Japan in relation to midwife-led care, primarily focusing on the contributions of two key stakeholder groups – service users and midwives

MethodsThis study employed a comparative qualitative approach using two data collection methods: policy document review and in-depth interviews. Policy documents were retrieved online, and participants were selected by pur-posive sampling. To direct the analysis of both data sets, the policy triangle framework (Walt and Gilson, 1994) was adapted and tested through the framework approach developed by Ritchie and Spencer (1994).

FindingsMaternal health policy in England is strongly informed by service users’ voices, and midwives’ evidence-based approach, enabling them to have significant influence on policy-making. However, in Japan, policy engage-ment is considerably limited, and obstetricians exert substantial influence on policy-making. Regarding Eng-land, the recognition of the importance of midwifery, and positive perceptions of its safety and reliability, have increased the promotion of midwife-led care at the policy level. Turning to Japan, these same elements are not always perceived positively or are underestimated. Furthermore, midwifery is not as autonomous as in England. This represents a major barrier to the promotion of midwife-led care.

ConclusionThis study identified characteristic differences in policy-making and its context between both countries. For Ja-pan to create a maternal health policy prioritizing midwife-led care, three lessons drawn from England are pro-posed: 1) to establish a system for service users to inform health policy, 2) to introduce a more evidence-based approach by midwives to further recognize the role of midwifery, 3) to increase autonomy among midwives in maternity service with an appropriate underpinning regulatory framework.

Authors Index





AAbasi F. / O 13 . . . . . . . . . . . . . . . . . . . . 21abbas ali s / WS 01 . . . . . . . . . . . . . . . 42abbas s / P 18 . . . . . . . . . . . . . 10, 17, 31, 85abou ali I / O 34 . . . . . . . . . . . . . . . . . . 44adachi k / O 18 . . . . . . . . . . . . . . . . . . . 26Adnan F. / WS 01 . . . . . . . . . . . . . . 17, 31, 42Adnani Q.E.S. / O 06 . . . . . . . . . . . . . . . . 14Akatsuka Y. / O 24 . . . . . . . . . . . . . . . . 32Akhter H. / O 50 . . . . . . . . . . . . . . . . . . 60Akter J. / O 50 . . . . . . . . . . . . . . . . . . . 60alam k / O 43 . . . . . . . . . . . . . . . . . . . 53alam r / O 43 . . . . . . . . . . . . . . . . . . . 53alemao J / WS 02 . . . . . . . . . . . . . . . . 43alison M / O 14 . . . . . . . . . . . . . . . . . . 22altaweli r / O 30 . . . . . . . . . . . . . . . . . 38amin s / P 19 . . . . . . . . . . . . . . . . . . 12, 86anderson r / O 43 . . . . . . . . . . . . . 46, 53andrew s / P 01 . . . . . . . . . . . . . . . . . 68arimor N / P 06 . . . . . . . . . . . . . . . . . . . 73BBabaei F. / P 11 . . . . . . . . . . . . . . . . . . 78Babaey F. / O 19 . . . . . . . . . . . . . . . . 21, 27Baig M. / P 18 . . . . . . . . . . . . . . . . . . 17, 85Bajracharya K. / P 20 . . . . . . . . . . . . . . . 87Baryal N. / O 16 . . . . . . . . . . . . . . . . . . . 24Begum P. R. / O 36 . . . . . . . . . . . . . . . . . 46bhat a / O 56 . . . . . . . . . . . . . . . . . . . . 66Bogren M. / O 11 . . . . . . . . . . . . . . . . . 18, 19Bohle L. / O 05 . . . . . . . . . . . . . . . . . . . 13Byrskog U. / O 11 . . . . . . . . . . . . . . . . . . 19Ccastro G / O 05 . . . . . . . . . . . . . . . . . . 13Chakma I. / O 43 . . . . . . . . . . . . . . . . . 53Chaloumsuk N. / O 17 . . . . . . . . . . . . . . 25chen s W / P 02 . . . . . . . . . . . . . . . . . 69Chhugani M. / P 03 . . . . . . . . . 16, 37, 57, 70crohne M / O 12 . . . . . . . . . . . . . . . . . 20DDadbig M.R. / O 16 . . . . . . . . . . . . . . . . 24Darkhani F. / P 04 . . . . . . . . . . . . . . . . . 71Dayhimi M. / P 17 . . . . . . . . . . . . . . . 59, 84Doering K. / O 28 . . . . . . . . . . . . . . . .32, 36Doraiswamy S. / O 36 . . . . . . . . . . . . 18, 46Dornan L.A. / O 17 . . . . . . . . . . . . . . . . . 25Douce F. / O 22 . . . . . . . . . . . . . . . . . . 30EEl Sayegh H. / O 44 . . . . . . . . . . . . . . . 54Elmir r / O 33 . . . . . . . . . . . . . . . . . . . . 41Elyasi F. / O 49 . . . . . . . . . . . . . . . . . . 59Erlandsson k / O 11 . . . . . . . . . . . . . . 18, 19

FFaize A.M. / O 02 . . . . . . . . . . . . . . . . . . 9Farry A. / P 05 . . . . . . . . . . . . . . . . . . 65, 72Fatimah S. / O 38 . . . . . . . . . . . . . . . . 48Fernandes S. / O 56 . . . . . . . . . . . . . . . 66Fernandez L.M. / O 32 . . . . . . . . . . . . . . 40Fong H.L. / O 40 . . . . . . . . . . . . . . . . . . 50GG s / O 41 . . . . . . . . . . . . . . . . . . . . . . 51Garg S. / O 05 . . . . . . . . . . . . . . . . . . . . 13Gau M.L. / O 20 . . . . . . . . . . . . . . . . . . 28Gherissi a / O 34 . . . . . . . . . . . . . . . . . 44Gilkison A. / O 28 . . . . . . . . . . . . . . . . 14, 36Gokala A. / O 41 . . . . . . . . . . . . . . . . . . . 51Golboni F. / O 19 . . . . . . . . . . . . . . . . . . 27Gomez P / O 54 . . . . . . . . . . . . . . . . . 64HHadipour Jahromy L. / P 11 . . . . . . . . . 21, 78Haigh M. / O 17 . . . . . . . . . . . . . . . . . . 25Hamzehgardeshi Z. / P 17 . . . . . . . . . 59, 84Hanaika Y. / O 24 . . . . . . . . . . . . . . . . . . 32Hashimoto M. / P 06 . . . . . . . . . . . . . . . 73Hashwani M. / O 27 . . . . . . . . . . . . . . 10, 35Hayakawa H. / P 07 . . . . . . . . . . . . . . . . 74Hayashida S. / O 24 . . . . . . . . . . . . . . . 32Hevrialni R. / P 08 . . . . . . . . . . . . . . . . 75Hinokuma F. / O 24 . . . . . . . . . . . . . . . 32Ho L.F. / P 15 . . . . . . . . . . . . . . . . . . .33, 82Hoffmann A. / O 05 . . . . . . . . . . . . . . . . 13Homer C. / O 14 . . . . . . . . . . . . . . . . . . 22Huang Y.C. / P 09 . . . . . . . . . . . . . . . . 76Hubbard J. / WS 02 . . . . . . . . . . . . . . . 43IIdicula P / O 51 . . . . . . . . . . . . . . . . . . . 61Iskandar R. / O 31 . . . . . . . . . . . . . . . . . 39JJacob a M / P 03 . . . . . . . . . . . . . . . . . . 70Jahlan I / O 42 . . . . . . . . . . . . . . . . 45, 52James M / O 08, P 03 . . . . . . . . . . . . . . . 16Jan r / WS 01 . . . . . . . . . . . . . 10, 23, 42, 49Jarin M / O 04 . . . . . . . . . . . . . . . . . . . 12Kkanaan I / O 34 . . . . . . . . . . . . . . . . . 44kao s J / P 10 . . . . . . . . . . . . . . . . . . . . 77Kao T.H. / P 10 . . . . . . . . . . . . . . . . . . . . 77karim a / O 43 . . . . . . . . . . . . . . . . . . 53Kataoka Y. / P 22 . . . . . . . . . . . . . . . . . 89kaur I / O 41 . . . . . . . . . . . . . . . . . . . . . 51Kaykhosravi F. / O 13 . . . . . . . . . . . . . . . 21Kelly J. / O 22 . . . . . . . . . . . . . . . . . . . 30kemp J / O 50 . . . . . . . . . . . . . . . . . . 60





kernohan G / O 17 . . . . . . . . . . . . . . . . 25khan a / O 43 . . . . . . . . . . . . . . . . . . 53Khan F. / O 43 . . . . . . . . . . . . . . . . . . . 53khatun r / O 04 . . . . . . . . . . . . . . . . . . 12Khodakarami N. / P 11 . . . . . . . . . . . . . . . 78khosravi s / O 19 . . . . . . . . . . . . . . . . . . 27kota c / O 24 . . . . . . . . . . . . . . . . . . . 32kraan van der a / O 12 . . . . . . . . . . . . . 20kuo s c / P 12 . . . . . . . . . . . . . . . . . . . . 79kurnia I / P 14 . . . . . . . . . . . . . . . . . . 80, 81LLai O.K. / P 15 . . . . . . . . . . . . . . . . . . . . 82Lakhani A. / O 09 . . . . . . . . . . . . . . . . . . 17Lin Y. / P 16 . . . . . . . . . . . . . . . . . . . . . 83Lopa F.T.J. / O 04 . . . . . . . . . . . . . . . . . . 12Lyneham J. / O 42 . . . . . . . . . . . . . . . . 52MMahamud a / O 43 . . . . . . . . . . . . . . . 53Mail s r M / P 19 . . . . . . . . . . . . . . . . . . 86Mansoor a / WS 01 . . . . . . . . . 10, 23, 42, 85Masud s / O 36 . . . . . . . . . . . . . . . . . . 46Matsunaga M. / P 22 . . . . . . . . . . . . . . 89Mazaheri Z / O 13 . . . . . . . . . . . . . . . . . 21Mcara-couper J / O 55 . . . . . . . . 14, 36, 65McCauley K. / O 42 . . . . . . . . . . . . . . . 52Mccourt c / P 22 . . . . . . . . . . . . . . . . 89McIntyre M. / O 35 . . . . . . . . . . . . . . . . 45Mellor c / P 05 . . . . . . . . . . . . . . . . . 65, 72Michel-schuldt M / O 14 . . . . . . . . . . . 13, 22Mithani Y / O 39 . . . . . . . . . . . . . . . . . 49Moawed s / O 35 . . . . . . . . . . . . . . . . 45Mohsen M / O 48 . . . . . . . . . . . . . . . . 58Molakhail A. / O 16 . . . . . . . . . . . . . . . . 24Moosazade M / O 49 . . . . . . . . . . . . . . 59Moran c / O 50 . . . . . . . . . . . . . . . . . 60Mubeen k / O 39 . . . . . . . . 10, 17, 23, 35, 49Muchlis M / O 52 . . . . . . . . . . . . . . . . 62Muranaka M. / P 07 . . . . . . . . . . . . . . . 74NNagatomo C. / P 07 . . . . . . . . . . . . . . . 74Najafitirtashi F. / P 17 . . . . . . . . . . . . . . 84Ndyanabangi B.¨/ O 02 . . . . . . . . . . . . . 9Ng S.W. / O 40 . . . . . . . . . . . . . . . . . . . 50Ng W.Y. / P 15 . . . . . . . . . . . . . . . . . . . 82Nurasiah a / O 46 . . . . . . . . . . . . . . . . 56Nurjasmi E. / O 48 . . . . . . . . . . . . . . . . 48OOguro M. / P 06 . . . . . . . . . . . . . . . . . . 73Okamoto K. / O 18 . . . . . . . . . . . . . . . . 26Or S.L. / P 15 . . . . . . . . . . . . . . . . . . . . 82PPan W.L. / O 20 . . . . . . . . . . . . . . . . . . . 28Parker M. / O 17 . . . . . . . . . . . . . . . . . . . 25

Parveen a / P 18 . . . . . . . . . . . . . . . . . 85Peyvandi S. / O 49 . . . . . . . . . . . . . . . . 59Plummer V / O 35 . . . . . . . . . . . . . . . . 45Purno N / O 36 . . . . . . . . . . . . . . . . . . 46Rraddi s / O 56 . . . . . . . . . . . . . . . . . . 66rahnam s / O 04 . . . . . . . . . . . . . . . . . 12rana r / O 08 . . . . . . . . . . . . . . . . . . . . 16raodatul Jannah r / O 46 . . . . . . . . . . 56renfrew M / O 14 . . . . . . . . . . . . . . . . . 22Rijnders M. / O 12 . . . . . . . . . . . . . . . . . 20Roake T. / WS 02 . . . . . . . . . . . . . . . . . 43SSamadaee Galekolaee K. / O 49 . . . . . . 59sato Y / O 18 . . . . . . . . . . . . . . . . . . . 26scamell M / P 22 . . . . . . . . . . . . . . . . . 89serdamba D / O 18 . . . . . . . . . . . . . . . 26Sewani L. / O 15 . . . . . . . . . . . . . . . . . . 23shahid s / O 09 . . . . . . . . . . . . . . . . . . 17shahidi M / O 49 . . . . . . . . . . . . . . . . . 59shahnawaz M / WS 01 . . . . . . . . . . . . . 42Sharifi K. / O 02 . . . . . . . . . . . . . . . . . . 9Sharifi S. / O 07 . . . . . . . . . . . . . . . . . . 15shehzadi r / P 18 . . . . . . . . . . . . . . . . 85Sheikh S. / O 39 . . . . . . . . . . . . . . . . . . 49shimazawa k / P 06 . . . . . . . . . . . . . . 73Shiwakoti P. / O 26 . . . . . . . . . . . . . . . . 34Shobnum Joya S. / O 50 . . . . . . . . . . . . 60simpson J / O 22 . . . . . . . . . . . . . . . . 30sin s W / P 15 . . . . . . . . . . . . . . . . . . . 82Sin W.H. / P 15 . . . . . . . . . . . . . . . . . . . 82sinclair M / O 17 . . . . . . . . . . . . . . . . . 25Stanley M. / O 37 . . . . . . . . . . . . . . . . . 47strahle a / O 01 . . . . . . . . . . . . . . . . . . 8Suleiman Msisiri L. / P 21 . . . . . . . . . . . . 88sun J c / P 02 . . . . . . . . . . . . . . . . . . . 69TTaniguchi H. / O 18 . . . . . . . . . . . . . . . . 26tanvir s / P 03 . . . . . . . . . . . . . . . . . . 70Tejano F. / O 53 . . . . . . . . . . . . . . . . . . 63thant a a / O 17 . . . . . . . . . . . . . . . . . 25WWallin L. / O 10 . . . . . . . . . . . . . . . . . . . 18Watanabe Y / P 06 . . . . . . . . . . . . . . . 73YYamamoto U / O 18 . . . . . . . . . . . . . . . 26Yamanishi M / P 07 . . . . . . . . . . . . . . . 74Yazdani F. / O 49 . . . . . . . . . . . . . . . . . 59Yimyam S. / O 17 . . . . . . . . . . . . . . . . . 25Yoshikawa K. / P 07 . . . . . . . . . . . . . . . 74Yusuf M / O 43 . . . . . . . . . . . . . . . . . . 53

midwives 46 relationship between eating culture with anemia among postpartum mother in majalengka,...

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