NML-ISSUE 3 VOL.2

INSIDE THIS ISSUE PG. 1 Editorial By Dr. Safinah Museene PG. 3 Article: A Call to Improve Health Care for Pregnant Women and New-borns by Irene Atuhairwe PG.6 Prioritise Midwives—by Lillian Luyima PG.8 Shaping the Future of Midwifery—by Kusaasira and Nakatudde PG.11 Nurses and Midwives: Heroes

NMLTT NEWSLETTER Issue 3 | Volume 2 Aug 2023

PG. 14 Midwifery Leaders at the ICM

1 EDITORIAL: SHAPING THE FUTURE OF MIDWIFERY IN UGANDA AND SUB-SAHARAN AFRICA Midwifery has long been a cornerstone of maternal and newborn healthcare, playing a vital role in ensuring safe pregnancies, deliveries, and postpartum care (pre, intra, and postnatal services). In Uganda and across SubSaharan Africa, midwives are essential frontline healthcare providers, always providing critical service but also often working under challenging conditions to save lives and promote the well-being of mothers and infants.

As we visualize the future, it becomes evident that the landscape of midwifery in Uganda and the great African region is poised for transformative changes that will revolutionize maternal and neonatal care.

The future of midwifery in Uganda and SubSaharan Africa is marked by a convergence of emerging trends and ongoing challenges.

Rapid population growth, limited resources, high numbers of teenage pregnancies, inadequate infrastructure and machinery for midwifery services, and geographical barriers and transportation limitations have historically posed obstacles to the effective delivery of maternal healthcare services. In response, governments, organizations, and healthcare professionals are coming together to innovate and address these challenges head-on. Governments and their partners are putting in place strategies to improve the referral systems, human resources, stock management and supplies, and information systems management and utilization of such information.

One of the most promising developments in the future of midwifery is the integration of technology and telemedicine. Mobile health (mHealth) applications and teleconsultations hold tremendous potential to connect midwives with expectant mothers, even in remote areas. This digital revolution allows midwives to provide crucial guidance, monitor pregnancies, and offer postpartum support from a distance. By extending the reach of midwifery services, technology is helping bridge the gap between urban and rural healthcare. However, appropriate skills are required for the operation of this wonderful advancement in technology and telemedicine.

As the Health sector looks into infrastructure improvement to accommodate such, universities and educational institutions

2 should embrace innovative curricula that cater to such advancements.

Investing in the education and empowerment of midwives is a key focus for shaping the future. Enhanced training programs, continuing professional education, and capacity building are all contributing to a more skilled and competent midwifery workforce. Governments and international partners are recognizing the need to elevate the status of midwives, ensuring they have the necessary skills to handle complex cases and provide comprehensive care.

Community-based approaches are gaining traction, fostering a sense of trust and collaboration between midwives and the communities they serve. Midwives are not just healthcare providers; they are also educators, advocates, and supporters. By involving local communities in maternal health initiatives, midwives are able to address cultural norms, improve awareness, and promote healthy practices.

The future of midwifery relies on robust policy frameworks, improved financing for maternal and child health, and advocacy efforts.

Governments and stakeholders are increasingly recognizing the pivotal role midwives play in achieving Sustainable Development Goal 3 - ensuring healthy lives and promoting well-being for all at all ages. By advocating for increased investment in

midwifery services and policies that prioritize maternal health, the trajectory of care delivery can be transformed.

As we look ahead to the future of midwifery in Uganda and Sub-Saharan Africa, a sense of optimism prevails. The convergence of technology, education, community engagement, positive political will, and advocacy is propelling midwifery into a new era of excellence and positive impact. By embracing innovation, prioritizing empowerment, and fostering partnerships, we can work together to ensure that every woman, adolescent, child and expectant mother receives the care and support they deserve, regardless of their location or circumstances. The future of midwifery is a future of hope and happiness, where every birth is safe, every mother is empowered, every newborn has the opportunity to thrive and every teenager and adolescent has an opportunity to visualize the future family and childbearing positively. As we read this issue 3 volume 2 of the MMLTT Newsletter, I encourage you to think of how better we shall have the best midwifery services in our country and beyond.

Dr Safinah K Museene (PhD) Chairperson: Nurses and Midwives Leaders Think Tank (NMLTT)

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A CALL TO IMPROVE QUALITY OF CARE FOR PREGNANT WOMEN AND NEWBORNS On May 5, we celebrated the International Day of the Midwife, and the extraordinary contributions of midwives across the world towards the health of women, their new-borns, and entire families. It is no doubt that midwives have and continue to play a critical role in bringing life to this world and this contribution cannot be understated.

This Year’s theme focused on the efforts of midwives and associations to action critical evidence like that of the State of the World's Midwifery report that calls for meaningful change in the midwifery profession and those it cares for. This theme calls us all to go beyond identifying evidence and using this evidence to change practice and improve the lives of mothers and their families under our care. For example, a recent UNFPA report stated that midwives could save up to 4.3 million lives a year by 2035 if they were to work to their full potential. This makes a case for investment in midwifery education and practice.

However, challenges remain, and we still have a high maternal mortality rate(MMR) as a country. There has been an increase in institutional deliveries by mothers currently standing at 74% in Uganda, a great achievement that can be attributed to your work in sensitising and encouraging mothers to deliver at facilities. Despite this great achievement, we still see pregnant women dying every day due to pregnancy-related complications. According to the MPDSR Report for 2021/2022, institutional maternal mortality was at 84 per 100,000 live births, a reduction from 92 per 100,000 from the previous year. We have called mothers and communities to utilize health facilities and ensure childbirth is under a skilled health professional. Why do we see mothers and new-borns continue to die day in and day out? There is growing evidence that these institutional deaths point to challenges in the quality of care that mothers and new-borns receive. Without improving the quality of care for pregnant women and new-borns, it is highly unlikely that we will be able to meet Sustainable Development Goal (SDG) 3.1 which targets a global maternal mortality rate of 70/100,000 live births by 2030.

4 In light of this realisation, the World Health Organisation(WHO) has developed the Vision for quality of Care for pregnant women and new-borns from 2015 onwards that highlights seven characteristics of quality of care for mothers. These characteristics are as below; ● Safety: Is the care we are providing to pregnant women and new-borns safe? Does it minimise harm to users including minimising preventable injuries and reducing medical errors? ● Is it Effective? Are we providing care based on scientific knowledge and evidence-based practice? This includes having an ecosystem that supports the recruitment and retention of highly skilled and knowledgeable health professionals. ● Is it timely: Are we providing timely care to our mothers? Reducing delays in providing and receiving care? Mechanisms in place for quick access to the appropriate level of care for mothers, and timely interventions (diagnosis, treatment, procedures) for mothers and new-borns. ● Is the care we provide efficient?—Delivering care in a manner that minimises resources and reduces wastage? ● Is it Equitable—Delivering care which does not vary in quality because of personal characteristics, geographical location, or socioeconomic status. ● Do we provide a different level of care to our colleagues or people of higher socioeconomic status from what we provide pregnant women who may not be known to us or may be of lower socio-economic status? ● What is the level of care in urban areas such as Kampala compared to rural areas? ● Is our care people/patient centred?—Delivering care which considers the needs of individuals, their culture, and their communities. ● Are we respectful, kind, and compassionate to the mothers we care for? Or are we driving them out of our facilities? This includes privacy, respectful maternity care, informed consent, and health education.

We have the mechanisms and structures in place to see how we are performing and learning from key outcomes such as mortality through quality improvement projects and Maternal and Perinatal Death Surveillance and Response Reports. These mechanisms and structures, if well utilised, enable us as teams to learn from such events and identify ways to prevent reoccurrence. I therefore encourage midwives to embrace and utilize these mechanisms to continuously learn and improve care for our mothers and new-borns. Key to these mechanisms, supporting us to improve the quality of care and maternal outcomes is documentation. Without documentation of simple details such as time of arrival, time of diagnosis and time of treatment administration, and more, it is impossible to know what and why things went wrong.

Documentation is also key in enabling us to identify ways to improve our care, accountability, and learning. Of course, this does not come with its challenges such as patient-midwife ratios,

5 availability of trained health professionals, shortage of supplies, and other key inputs to mention a few. These are system limitations and challenges that all stakeholders including the government need to collaboratively address.

Lastly, I call upon all of us nurses and midwives, the government, partners, and all stakeholders to work collaboratively to address the real reason why mothers are still dying under our care.

Without honest discussions on this, we shall continue to see our mothers walk into facilities alive to bring life into this world and are unable to walk out alive. Only through honest discussions and identification of key bottlenecks, shall we be able to address the whole spectrum of care ranging from having a skilled, motivated workforce to providing the highest quality of care for pregnant women and their new-borns.

Irene Atuhairwe Duhaga Ph.D. Health Policy (S), Stellenbosch University Country Director Seed Global Health

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PRIORITISE MIDWIVES TO IMPROVE MATERNAL AND NEWBORN HEALTH

If you have been keen enough and listened to most of the pregnant women and mothers in urban areas such as Kampala, the majority talk about their personal gynaecologist or doctor. When you further listen critically, very few pregnant women or mothers will mention having a personal midwife. In Uganda, >97% of maternal and new-born health services are provided by midwives. So, this leaves one wondering if the work done by midwives majorly in urban clinical settings is not recognized.

Well, midwifery matters for all childbearing women, their babies, their families, wherever they live in the world, and their circumstances. Available evidence shows that skilled, knowledgeable, and compassionate midwifery care reduces maternal and new-born mortality and stillbirths, keeps mothers, and babies safe, and promotes health and well-being. In so doing, midwifery has a positive impact on the wider health system and the economic sustainability of communities and countries at large.

Midwifery achieves this impact by providing care for all women and babies, both with and without complications and across the continuum from pre-pregnancy, pregnancy, labour, and birth, and in the early weeks after birth. Thus, good quality midwifery care offers a combination of prevention and support, early identification and swift treatment or referral of complications, and respectful and compassionate care for women and their families at a formative time in their lives. Midwives all over the world work to strengthen women’s own capabilities and the normal processes of pregnancy, birth, postpartum, and breastfeeding.

Every year on May 5th, the International Day of the Midwife (IDM) takes place. While you would think it was an incredibly long-marked awareness day, it wasn’t made official until 1992, when it was launched formally by the International Confederation of Midwives (ICM). This year’s theme for International Day of the Midwife is “Together Again: From Evidence to Reality.”. This time of celebration honours the efforts of midwives and their associations to action critical evidence like

7 the State of the World’s Midwifery (SoWMy) 2021 towards meaningful change for our profession and the women and families we care for.

This year’s celebrations took place in Soroti district, Eastern Uganda. The event was organised by the National Midwives Association of Uganda (NMAU) in collaboration with the Ministry of Health (MoH), Uganda Private Midwives Association (UPMA), UNFPA, Seed Global Health, and Uganda among others. Prior to this day, NMAU organised a blood donation drive in the capital city, Kampala which attracted many people, and led to the collection of > 200 litres of blood. The Association also held a midwifery symposium at Akello Hotel, Soroti district which started on 3rd May 2023. The symposium addressed areas in clinical midwifery practice, leadership, management and policy, midwifery education and training, regulation, research and more.

Additionally, midwives from different facilities across Uganda are conducting various activities such as free cervical and breast cancer screening, provision of family planning services, free health education in nutrition, antenatal care, HPV vaccinations, free HIV testing, Hepatitis B and more.

Over the years, midwives and all maternity support workers have met extraordinary circumstances and risked their lives to provide excellent care to women, new-borns, and their families. Now is the time to not only celebrate how they’ve been there for our communities even throughout the pandemic but to show up for them in calls to the government to put money where it counts and invest in midwives and maternal and new-born health at large. Thumbs up to all the midwives for their great efforts in promoting maternal and new-born health.

I thus recommend the Government of Uganda through the Ministry of Health and other nongovernment entities to comprehensively invest in the education and training of midwives, involve midwives in meaningful policy-making and decision-making platforms and positions, and provide adequate tools (supplies, equipment, accommodation) for midwives to ease their work among others.

The author is Ms. Lilian Nuwabaine Luyima; a BSc Nurse and MSN-Midwifery & Women’s Health Specialist and the Heroes in Health Award Winner-Midwife of the year 2021.

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SHAPING THE FUTURE OF MIDWIFERY: ENGAGEMENT OF YOUNG MIDWIFE LEADERS AT THE INTERNATIONAL CONFEDERATION OF MIDWIVES TRIENNIAL CONGRESS IN BALI, INDONESIA (11th - 16th JUNE 2023) The International Confederation of Midwives (ICM) Triennial Congress is a prestigious event that brings together midwives, healthcare professionals, and stakeholders from across the globe to discuss and address key issues in maternal and new-born healthcare. The engagement of young midwife leaders at this congress plays a crucial role in shaping the future of midwifery and advancing the profession.

Uganda as a country was privileged that for the years 2021-2023, two midwives, Anitah Kusaasira and Hadijah Nakatudde from the National Midwives Association of Uganda were selected to be part of the Young Midwife Leaders (YML) programme under the International Confederation of Midwives.

The YML program is a 2-year part-time, online/ in-person learning and professional development experience. Its aims include nurturing the next generation of midwives, strengthening midwifery associations globally, building a global community among young midwives to foster support and learning, positioning and equipping young midwife leaders as advocates for the profession and SRHR, empowering midwives to address some of the biggest global health challenges of today and it's been very impactful. With seed funding from ICM, the YML is implementing a project on advocacy and Respectful Maternity care. As part of the program , the YML had an opportunity to attend the ICM Triennial Congress. In this article, we will explore the significance of the young midwife leader's involvement at the ICM Triennial Congress held in Bali, Indonesia.

Empowering the Next Generation: The ICM recognizes the importance of empowering young midwife leaders and their unique perspectives in driving change within the profession. The Triennial Congress provides a platform for these young leaders to exchange ideas, network, and collaborate with peers and experienced professionals. This engagement not only nurtures their leadership skills but also inspires them to contribute meaningfully to the betterment of maternal and newborn healthcare worldwide.

Sharing Innovative Practices: The Congress creates an environment where young midwife leaders can showcase their innovative practices and research. Presenting their work allows them to gain recognition for their efforts and encourages them to continue pushing boundaries in their respective fields. These

9 presentations offer valuable insights and inspire other midwives to adopt similar approaches, ultimately improving the quality of care provided to women and new-borns.

Networking and Collaboration: The congress provides numerous opportunities for young midwife leaders to network and develop collaborations with experts and leaders in the field of midwifery. These connections foster mentorship, allowing young leaders to learn from experienced professionals and gain insights into policy-making and advocacy. Such collaborations strengthen the global midwifery community and advance the profession by bringing together diverse perspectives and expertise.

Amplifying Voices:

The engagement of young midwife leaders at the ICM Triennial Congress enables them to voice their opinions, concerns, and aspirations for the future of midwifery. Their unique experiences, fresh ideas, and enthusiasm play a pivotal role in influencing policies, shaping strategies, and driving positive change within the profession. By providing them with a platform to address global leaders and decision-makers, the Congress ensures that the voices of youth are heard, acknowledged, and integrated into the broader narrative of midwifery.

Inspiration and Empowerment: The ICM Triennial Congress acts as a catalyst for the personal and professional growth of young midwife leaders. The exposure to a diverse array of topics, workshops, and presentations stimulates their critical thinking and fosters their passion for midwifery. They return to their

10 respective communities not just with enhanced knowledge and skills but also with renewed confidence and motivation to make a lasting impact on maternal and new-born healthcare.

Conclusion: The engagement of young midwife leaders at the ICM Triennial Congress in Bali, Indonesia exemplifies the commitment of the International Confederation of Midwives to empower and recognize the contribution of the younger generation. By providing them with platforms to network, collaborate, and share innovative practices, Congress not only strengthens the profession but also creates a sustainable future for midwifery. The voices, perspectives, and dedication of these young leaders play a crucial role in shaping the trajectory of maternal and new-born healthcare worldwide.

Authors Anitah Kusaasira, Young Midwife Leader /ICM Hadijah Nakatudde, Executive Midwife Leader /ICM

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CELEBRATING HEROES: NURSES AND MIDWIVES The NMLTT celebrated all Nurses and Midwives for the heroes and heroines they/we are! Millions of nurses and midwives around the world create small, and often unnoticed miracles through their skills and competencies, acts of kindness, compassionate caring, quiet strengths, therapeutic touch, whispers of grace and comfort, silent prayers and so on. When our lights dim, nurses and midwives stay by our side. May we always remember how blessed and lucky we are to have nurses and midwives in our world.

The Midwife These eyes have witnessed beauty Which some may never see, Of rawness, power, strength and love, Of two becoming three

The Nurse Life for me could have been worse If it hadn’t been for a nurse, Others gave me a prayer, she gave her care Because of her I am not in a hearse.

These ears have listened carefully To each pure and unique song, When women feel vulnerable But are so immensely strong

Nurses have dangerous and sad jobs But for them no one ever sobs, They have been cursed and bit, and also hit Then they are health with their own stitches and swabs.

These hands have guided soft but firm, And gently rubbed and soothed, From bump to that first draw of breath, The mountains, they have moved

As I was in my hospital bed all alone Unto God my sins I began to atone, I thought I was alone and dying, I couldn’t stop crying Then a nurse’s love and compassion was shown.

This heart has burst a thousand times, With each new perfect birth A miracle, a small shot of joy, A blessing to the earth

It was a nurses that saved my life It wasn’t a doctor, or a sibling, or even a wife, People came and went, my unimportance was a hint Everyone else gets the applause, she gets the strife.

This soul is full of happiness, Though sometimes cries and weeps, For most are born and taken home, But some, we cannot keep

So unto the nurse I will always say a thank you Especially to the lady in blue, I am here today, I never passed away She helped me, and saved me, and led me through.

These eyes have witnessed beauty Which I’ve been blessed to see, Of rawness, power, strength and love Of women feeling free

The nurse was there for me twenty four/seven Because of her I made no trip to heaven, She fought for my living, she was all giving She gave me a refuge, and a safe haven.

--A Poem by Emily Clayton--

--a Poem by Randy L. McClave--

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INTERNATIONAL NEWS CONGRATULATIONS We are delighted to share how many colleagues have taken on the international stage in promoting professional growth for Uganda. Ms. Hadijah Nakatudde, Young Midwife Leader, Ms. Kiconco Peninnah, Young Midwife Leader, and Ms. Likico Emily Opu, a Midwife (Left to right), were selected from Uganda among others from Ethiopia, Malawi, and Kenya to participate in Midwives capacity building training program for Public Health Professionals. This will be done under a collaboration between Karolinska Institute of Sweden and Makerere University Uganda and is slated for September 2023 - February 2024. Congratulations!

In other exciting news, we are pleased to note that the number of doctorally (any nurse or midwife who holds either a doctoral degree such as a Doctor of Nursing Practice [DNP] or a PhD degree) prepared nurses and midwives is increasing in Uganda. In our last editorial, Associate Professor Rose Clarke Nanyonga posited that: “Health systems strengthening, and achieving Universal Health Coverage in Uganda can both benefit from a growing number of nurses and midwife leaders who have attained advanced training and expertise by earning a PhD. Women leaders in the health sector (the majority of whom are nurses and midwives) are being called upon every day to take a proactive approach to leading change and transformation. However, Uganda, like many other developing countries, faces a critical shortage of skilled nursing and midwifery leaders and policymakers with this level of education. Indeed, the number of PhD-prepared nurses and midwives at last count is less than 18 in the whole country. To address this shortage and strengthen nursing and midwifery leadership and policy,

13 doctorally prepared nurse/midwife leaders can play a vital role and they will remain critical in the future of our healthcare.”

So, we are delighted to introduce a new crop of Ph.D. nurse and midwife graduates who are helping close this gap.

Congratulations to new Ph.D. graduate Dr. Elizabeth Namukobe Ekong (Left in green; The Chairperson Uganda Nurses and Midwives Council). Dr Ekong was awarded a Ph.D. in Nursing Education from the University of Central Nicaragua. Similarly, hearty congratulations to Dr. Caroline Namukwaya (Associate Dean Aga Khan University). Dr. Namukwaya was awarded a Ph.D. in Nursing (Early Childhood Development) from Salford University, UK. Lastly, congratulations to Dr. Catherine Atuhairwe (pictured below) who was awarded a Ph.D. in Midwifery and Psychiatry from Mbarara University of Science and Technology.

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MIDWIFERY LEADERS REPRESENT UGANDA AT ICM June 2023, at the Bali Nusa convention centre in Indonesia hosted by the Indonesian midwives association. Over 2500 midwives delegates and participants attended the congress. Uganda had 20 delegates sponsored by different organisations. I was privileged to attend both council meetings and congress in my capacity as a delegate representing the National Midwives Association of Uganda, a member of the ICM Africa professional committee, and a panellist discussing the twin-to-win concept where Uganda will be twining with Burundi Midwives Association.

The President of the National Midwives Association of Uganda, Ms. Annette Kanyiyuzi shares the highlights of the experience at ICM 2023 in Indonesia, Bali where over 20 midwives from Uganda represented and participated.

The International Confederation of Midwives ( ICM ) is an organisation that brings together all midwifery associations globally. The ICM’s mission is “to strengthen member associations and to advance the profession of midwifery, by promoting autonomous midwives as the most appropriate caregivers for childbearing women, in keeping birth normal, for enhancement of reproductive health of women, and the health of their newborn and their families.

Every triennium, the ICM organises a congress in preselected host countries. This year, the triennial congress runs from the 7th to 15th of

The Bali congress was the first in-person ICM delegates gathering following the Covid-19 pandemic hence the theme ‘’together again from evidence to reality’’. Indeed, it was a thrilling experience, as midwives met as a family; the smiles, cheers, hugs, camera clicks, meeting old friends and making new ones, and exchange of contacts was part of the social side of the congress. The opening ceremonies included the midwives’ dance for empowerment, multi-faith prayers, dinner and Bali night were popular social events in keeping with the need for enabling a relaxing atmosphere. The official opening was led by the outgoing president Franka Cadee, as well as remarks from various speakers that included WHO Director-General Dr. Tedros, and UNFPA executive director, Dr. Kanem who all not only reaffirmed the invaluable role midwives play towards maternal and newborn care but also emphasised the need for investing in midwives to enable the realisation

15 of midwives' potential to reduce maternal and new-born mortality and morbidity.

Preceding the congress, as part of the ICM governance requirements, was the ICM council meeting for selected delegates representing member associations. During the council, the board presented reports and delegates evaluated ICM performance in the preceding years. Critical themes emerging from council deliberations included midwifery-led care, emergency preparedness, and response to humanitarian settings as well climate change in relation to health.

Furthermore, a number of position statements were approved. The bold, open, and objective appraisal and scrutiny of accountability of ICM leadership by the delegates was a key lesson learned that is important for member associations to emulate in order to build strong associations.

During this ICM council meeting the new president of the ICM and regional board members were elected and the tranquil succession of power was another important milestone of the congress. The newly elected ICM president Sandra Oyarzo Torres will lead the ICM for the next three years. On a side event, leaders and executives from the East African Midwives Associations held a meeting, and among the resolutions was to foster partnerships and collaboration to promote the development of the midwifery profession in the community. Monthly meetings will henceforth be held for this cause.

The second part of the congress was the scientific program that consisted of a plenary session, abstract presentation, workshops for

skills development, panel discussions, as well as exhibitions of technological advances in midwifery. The themes revolved around the pillars of midwifery; education, regulation, and practice, as well as new emerging themes for the revised professional framework that include leadership research, essential competencies and midwifery-led model of care.

Panel discussions revolved around strengthening the midwifery workforce, popular sessions included “realising the top demands of midwives – a pathway towards better pay, and a happier, healthier Midwifery workforce” led by the current chief midwife for ICM Jacqueline Dunkley-Bent “: The last healthcare professionals standing – an exploration of the role of midwives in humanitarian and fragile settings” which highlighted midwives and midwives’ associations play a vital role in humanitarian emergencies and there is need for more resilient health systems with midwives’ voices and leadership at the centre of the planning stage for disaster preparedness. Another session titled “The next 100 years of ICM and midwifery – strategies for ensuring greater support, inclusivity and representation for the global community of midwives” Moderated by Dr. Sally Pairman, Chief Executive of ICM, explored the role of ICM in advancing inclusive midwifery and how ICM can support midwives to deliver the best possible care to women and all community members. The final panel was the PUSH @ Bali: Addressing the world’s most pressing issues through midwifery moderated by the founder of Every Mother Counts, Christy Turlington, midwives

16 demonstrated how, through everyday work and activism, exemplify the potential of the

midwifery scope of practice to extend far beyond pregnancy and childbirth.

Innovative strategies for strengthening associations were presented and discussed.

Collaboration and partnerships both locally and internationally were listed among the effective strategies, a case in point was The Twinning workshop facilitated by Liselotte Kweekel and outgoing President Franka Cadée, and the panel discussion of the twinning project between the National midwives association and Burundi. The discussions emphasised the importance of fostering long-term, trusting, and supportive relationships between midwives and; associations.

services. To effect this, and overcome challenges of organizational capacity, visibility, and credibility with governments and stakeholders, there is a need to break barriers to accessing funding and engagement in policy decision-making, Midwives.

Associations are thus called to continue to innovate and circumvent these perineal challenges.

Another important topic was the aspect of Self-care. Prof. Mary Steen of the University of Northumbria emphasized the need for selfcare among midwives. “We really need to think about self-compassion; “we must recognise our inner critic, and we really can be our own worst enemies. We need to care for ourselves so that we can care for women, babies, and their families.”

Relatedly another emerging theme was securing the future of midwifery at the Young Midwife Leaders workshops where the Young Midwife Leaders (YML) and Executive Midwife Leaders (EML) presented their experiences and showcased the impact of the YML program in developing leadership among young midwives. The need for advocacy featured highly in most sessions. Midwives; associations are expected to play a crucial role in advocating for women’s rights, gender equality, and quality midwife-led maternity

A number of important resources were also unveiled such as the global midwifery hub GMH introduced as a tool that enables midwives to discover data resources, make digital maps and dashboards, create analyses, and connect with midwives working to advocate for improved policies and health practices, ICM also shared the Digital Competencies [earning tool designed to assist midwifery students in gaining confidence and competence in essential job skills. All these tools are available on the ICM website and a link will be available via the NMAU website.

In regard to skills and competencies for midwives; speakers presented valuable insights on improving obstetric care and emergency skills in remote and challenging regions and discussed strategies aimed at enhancing obstetric triage systems to improve maternal and neonatal outcomes.

The emphasis was on innovative approaches and adaptations necessary to provide effective emergency care in areas with limited resources, Midwifery Regulation was another explored area. The presenters reiterated the importance of regulation in

17 relation to midwives' autonomy and definition of the scope of practice. The ICM Global Standards for Midwifery Regulation (2011) was proposed as a guide for amendments to existing legislation and promoting changes for strengthening regulatory frameworks to support autonomous midwifery practice.

Another critical area was the WHO infection prevention and control global strategy as many countries currently face high levels of infection and sepsis, which contribute to a significant number of deaths among women and infants. Presenters emphasised the need for effective infection prevention and control programs to protect women and their babies from healthcare-associated infections.

As reflected during the congress, all pillars of midwifery; education regulation, and association have an important role to play, the need for synergy is paramount to further the realisation of the global midwifery agenda. The Ministry of Health especially the Department of Nursing and Midwifery should consider: secondment and support more midwives to participate in such international conferences and also support professional associations to achieve their set goals such as carrying out research and implementation of change ideas that can be shared globally.

Institutions must prioritise the development of midwives’ capacity; support midwifery-led activities, build capacity for research, writing

and presenting evidence-based quality improvement and assurance works, and also the integration of new learning with departmental and institutional work plans.

Midwifery associations should mobilise and recruit more members for a stronger association, align the professional association’s strategic plan with national and international agenda such as the SDGs, it is also important for associations to lobby for increased compensation and improved working conditions for midwives, women and other marginalised groups Midwives need to unite if a formidable force is to be created.

Associations should sensitise members on the benefits of associations such as being a member of the midwifery association as well as the ICM. There is more need to create awareness of ICM activities, participate in research, networking and Advocacy for quality maternal and new-born health.

Explore partnerships and collaborations with national and international professional bodies.

I encourage midwives to access the ICM website for a multitude of benefits, and the NMAU website not only for the available resources in relation to the congress information but also for the development of midwifery and maternal and new-born health as a whole.

Stronger together we can champion midwifery with a difference

“It's a delightful and enlightening experience to be a part of the ICM Council deliberating on the

18 global midwifery agenda” Annet Kanyuyuzi, Midwife and President NMAU. Of Uganda’s representation at ICM, Nursing Leader Catherine Odeke wrote: “Wooh, Uganda is very well represented at the 33rd ICM Triennial Congress at Bali. Present are the Young Midwife leaders, Midwives from Public Health Facilities, PNFP, PFP. Presidents from: National Midwives Association Uganda (NMAU) Ms. Evelyn Kanyuyuzi, Federation of Uganda Nurses and Midwives Ms Janet Adong, Uganda Private Midwives Association (UPMA), Ms Sarah Namyalo and General Secretary Uganda Nurses and Midwives Union (UNMU) Ms Judith Kyarisima. Some made very powerful presentations, others were among the panelists in it all, Uganda’s participation is very good. Please network, and keep the flag high, we are happy with you” Uganda delegation of Midwives at ICM led by NMAU president, Annet Kanyunyuzi

19 A group of some Midwives from Uganda who attended the ICM 2023

Fellister Apili and a colleague from Malawi.

Fellister Apilli, Dr. Scovia Mbalinda, and Dr. Mitchell Tefler

(L-R) The Uganda UNFPA Midwifery advisor, Ms Maria Najjmeba, NMAU-President -Ms Annette Kanyuyuzi, Harriet Nayiga, and Scovia Mballinda

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Some of the midwives that represented at ICM: Front row, left to right Hadijah, and Anitah Kusaasirah. Back row: Maria Najjemba midwifery representative for UNFPA in Uganda, Annette Kanyunyuzi President NMAU, Masudio Scovia,midwife MSF, Naiga Harriet midwife CEO MILCOT Uganda, Dr. Scovia Mbalinda midwife, lecturer at Makerere university nursing department

Bottom left: Faridah Luyiga Mwanje ,Advocacy lead ICM was MC. We love it!

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HIGHLIGHTS FROM TAGEYA SOPHIA BRUHAN, MIDWIFE -MASAKA RRH

According to ICM, every woman who is planning a pregnancy should have access to midwifery care for both her and the unborn child. It is crucial to support autonomous midwives as the best careers for women who are expecting children and in sustaining normal birthing practices in order to improve the reproductive health of women, their unborn children, and their families.

ICM aims to support midwives globally so they can deliver high-quality care and enhance the experiences of pregnancy, childbirth, and the postpartum period. Every three years, midwives and other midwifery stakeholders get together at an ICM Congress to present evidence-based midwifery updates, in-depth research, best practices, and technological advancements aimed at enhancing midwifery care.

PRESENTATION ON LABOUR POSITIONS AND BIRTH OUTCOMES With the Canadian team that had been visiting Masaka Regional Referral Hospital to learn together through sharing experiences from the University of British Columbia’s Global Midwifery Programme, we were able to get an abstract for preventing episiotomies and tears through advantageous birthing positions accepted. Based on evidence from studies conducted in the last four decades, alternative upright birth positions and left lateral positions, in comparison to the

conventional supine or lithotomy position, have been shown to reduce pressure on the sacrum and to decrease perineal tears and the need for episiotomies. The surroundings, hands-on or off the perineum, warm compresses on the perineum, and midwives serving as the primary carers present at delivery are other factors that have an impact on the percentage of intact perineum. The likelihood of an intact perineum increases by 47% and the necessity for an episiotomy falls by 38.2% when the baby is born in the left lateral position. When used in conjunction with an epidural, flexible sacrum positions that require removing weight from the sacrum, such as squatting, kneeling, sitting up straight, hands and knees, and a lateral position, reduce the frequency of aided vaginal births and third- and fourth-degree tears. The hands and knees position lowers the incidence of episiotomies and increases the incidence of intact perineums. In the second stage of labour, alternate upright positioning and position changes every 20 to 30 minutes doubled the rate of intact perineum. When a midwife rather than a doctor attended the birth, the percentage of intact perineum was 60% as opposed to 30%.

It has also been demonstrated that a quiet environment, a dependable carer who participates in labour, and the use of warm compresses or warm perineal massage reduces the risk of third- and fourth-degree

22 tears. Research and shared experiences from practising midwives confirm that different upright birthing positions including the left lateral position while allowing the mother to move and position freely in the second stage with a midwife as the primary care provider reduce the incidence of third and fourthdegree tears and the need for episiotomies.

At Masaka Regional Referral Hospital, we make use of the left lateral position but we have been practising the supine positions

partly due to limitations in knowledge and skills, lack of flexibility and the nature of our birthing facilities. We had practical sessions for our presentations and we exchanged experiences with midwives from different countries. I also attended different research presentations and midwifery practices during the conference days and I appreciated more midwifery knowledge and skills I didn’t have before that expanded my confidence and commitment to continuous quality improvement.

My plan of dissemination and implementation of the new skills I got includes: • • • •

Report writing and sharing our experiences with the senior hospital administrators and the departmental team during meetings.

Present during continuous professional development sessions to the OBGYN team.

Assess our birthing facility for any possible adjustments to allow flexibility in using other birthing positions and increase client satisfaction with our services.

Promote teamwork where we all achieve as a team through the introduction of daily morning meetings for the whole team other than small unit meetings.

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CONGRATULATIONS NURSES AND MIDWIVES

Rotary Club of Kampala recognised a midwife who we featured in Issue 2: for climbing a ladder to reach her clients in Sironko. Prof Omasswa and the Vice President of the Federation were present.

Ms Winfred Nakamanya was offered a scholarship to pursue a graduate certificate in Global Health Research at Oxford University beginning October 2023 reporting September 2023.

Congratulations to our very own Ms Elizabeth Pearson who graduated with MBA (Health and Social Care) from University Anglia Ruskin University, UK on 24th July 2023. Her research studies are centred on the Integration, Retention, Diversity and inclusion of Black and Ethnic Minority health care professionals working and living in the UK. We are so proud of you; the sky's the limit!

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Congratulations Ms Lillian Nuwabaine upon being awarded the Award of Excellence by the Agha Khan University East Africa, 2023, this was during the Faculty Retreat in Zanzibar, Tanzania.

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USEFUL CONTACTS

Please find below a list of useful contacts to forward your concerns appropriately.

UNMC queries:- info@unmc.ug UNMU:- info@unmu.ug CPD APP concerns: martin@unmc.ug National organisations Education and training Standards:- Department of Nursing at Ministry of Health Health Education and Training (Min of Education and Sports) QUESTIONS? CALL: 0417-893600 (PRO) Mobile 0777108170 Benevolent fund: - Department of Nursing at Ministry of Health, Uganda Some of the associations AGNMU: graduates@agnmu.org Critical Care Association:president@ccnau.org Midwifery Association: nationalmidwivesassociationug@gmail.com Nursing and Midwives Society: info@nursesandmidwivessociety.org Emergency Care Society of Uganda:- admin@ecsuganda.org Palliative care Association of Uganda:- pxau.admin@pcau.org.ug Others NMLTT (Think-Tank Leaders):- uganursemidwife.leaders@gmail.com Writing articles for publication on NHCC Uganda website:editors.nhccuganda@gmail.com Global networking Nursing Now Campaign Uganda:- nursingnowuganda@gmail.com

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ACADEMIC RESOURCES Access to Health Care journals (Discounted at 30%) In partnership with UGANDA NURSES and MIDWIVES ASSOCIATION UK (UNMA-UK), Markallen group UK (https://www.markallengroup.com/ma-healthcare/) has offered a 30% discount on their online subscriptions (MA Healthcare titles only) for UNMA-UK members. This has also been extended to Nurses and Midwives in Uganda as per UNMA-UK mission.

Use the confirmed discount code [UNBA30] to access a range of their healthcare journals.

The Think Tank Newsletter editing team accepts articles on a rolling basis under the sub-themes below. ● ● ● ● ●

Research and Innovation Continuing Professional Development (CPD) Policy Leadership/Governance Clinical Practice Covid Response.

The Think Tank is committed to supporting nurses and midwives through strategic advocacy. Advocate for Nurses and Midwives. Please send us your current email address to be included on our mailing list.

Our faith in you is steadfast. May you continue to rise up to the challenge in this international year of the Health and Care Workers by WHO - 2021. More than ever, this nation needs you. We thank you, and May God bless you.

Copy to:

The Hon Minister for Health The Permanent Secretary, Ministry of Health The Permanent Secretary, Ministry of Education and Sports Commissioner Nursing Services, Ministry of Health Commissioner Health Education & Training, Ministry of Education and Sports The Chairperson, NATIONAL TASK FORCE COVID 19 The President of the Uganda Medical Association All Nurses and Midwives in Uganda

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Informed disclaimer:- All editing team members are Nurses, and they are all volunteering their time and expertise. However, the views expressed in the articles are of the authors or writers solely. Although the editing team does its very best and is responsible for vetting the information, the authors’ opinions remain. it is, therefore, upon the authors to make sure that what they submit is referenced appropriately and accurately