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INTERNATIONAL NEWS CONGRATULATIONS

by Nurses and Midwives Leaders Think Tank Ug

A CALL TO IMPROVE QUALITY OF C...

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, 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.

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

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.

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

A number of important resources were also unveiled such as the global midwifery hubGMH 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 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 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

A group of some Midwives from Uganda who attended the ICM

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 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.

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!