D IRECTOR ’ S D ESK Indie Speaks
T HE M IDWIVES AT F ERNANDEZ Midwives being Resilient during Pandemic Times
I NTROSPECTION Trends in Episiotomy
B RIDGING THE G AP Classroom Learning to e-Learning
D IGITAL H EALTH I NITIATIVES Initiatives by the GoI etc. W ELCOMING NEW T ECHNOLOGIES MW Apps and Tech Collaborations National Digital Health Mission
P ROMISING P ROSPECTS Resonating with Research
A D OCTOR ’ S V OICE Dr Jogitha Unni
G ET I NVOLVED
Nurse Practitioner Midwifery Training Programme – An Initiative By GoT Fernandez GLOWs
W E ’ RE H IRING Calling Midwives to Join our Team
A M IDWIFE ’ S S TORY Miranda Speaks Out
A NNOUNCEMENTS The 15 th International Normal Labour and Birth Research Conference
D i RECTOR ’ S D e SK
T HANK YOU for subscribing to the Fernandez Midwifery Newsletter! Through this, we wish to bring out the happenings in the Midwifery department. Educational information, evidence-based practices, announcements, upcoming events, and so on. We will also provide updates regarding the innovations and research projects undertaken by the Department of Midwifery.
T HE NATIONAL midwifery educator’s training has seen the trainees back in their individual states. However, virtual contact has been an innovative method of providing leadership and continued learning. Telangana midwives have been qualified for a year and are changing the landscape of birth in the rural communities in Telangana. They have increased normal births and empowered the community by working with Accredited Social Health Activists (ASHA) workers to further empower women for normal births. Midwifery care should be offered to women across the entire socio-economic spectrum and not just limited to the privileged few who are aware of the services. India is now committed to scaling up professional midwifery training and we are at the beginning of this revolution. The midwifery team at Fernandez has worked hard to provide continuity of care to women from the antenatal review to birth. The team has worked on collaborative care with women who also require inputs from our obstetric colleagues, and ensured they received elements of normality too. Midwifery-led care have been offered to women in two of our three hospitals. We continue to offer women their choices of birth options which include water births and continued support for vaginal births after C-section. Women are allowed one birth companion as per their choice and are encouraged to limit all other visitors. This is discussed during their antenatal review We continue to protect women and their families by minimising their physical visits to the hospital. Antenatal examinations are planned to also include ultrasound scans if needed. Virtual consultations in between help couples and their caregivers to monitor both baby and mother’s well-being. Childbirth education and hypnobirthing sessions continue online by our dedicated team of doulas and physiotherapists During the COVID pandemic, women are afraid if they would be able to birth at the hospital they had chosen. Unlike the National Health Service in the UK, India’s government has chosen dedicated hospitals to care for COVID cases. Transferring care especially at term, causes more anxiety and further exacerbates the fear of the unknown. Women become even more vulnerable.
Inderjeet Kaur MSc, RM, RGN Director – Midwifery Fernandez Foundation
Every pregnant woman will first see a midwife, and only if needed will see an obstetrician
Normal birth continues to be encouraged following global research practices. We believe it is fundamental to keep the mother and baby together.
Fernandez Foundation is working towards training more professionals to enable our vision - “Every pregnant woman will first see a midwife, and only if needed will see an obstetrician”.
Issue 1 | October 2020
M i DWIV e S AT F e RNANDEZ
i NTROSP e CT i ON
Midwives being resilient during Pandemic Times
Trends in Episiotomy
ON 24 M ARCH 2020 , the Government of India ordered a nationwide lockdown for 21 days, limiting movement of the entire 1.3 billion population of India as a preventive measure against the COVID-19 pandemic. The global outbreak strained health systems and dramatically altered the maternal and child health services. While doctors, midwives, nurses, and other healthcare professionals have worked at the frontline, it remained a difficult task for midwives to fully support women through labour and childbirth. For example, the wearing of masks, visors for eye protection and sometimes the Hazmat suit inadvertently increased the “anxiety levels” among women. Facial expressions were hidden! Personal protective equipment has merely restricted the otherwise open, easy communication with the mothers. However, the innate spirit of our midwives and their desire to ensure every mother enjoyed a positive birthing experience, helped them adapt to the “new normal” . With an aim to ensure that mothers enjoyed the continuity of care, Fernandez Foundation set up Tele-consultation services and the midwives provided 85 video consultations so far. Our team of midwives worked together with the obstetricians during the virtual consultations to help address concerns surrounding COVID-19 infection. From April to September 2020, our midwives have supported 996 mothers in birthing. Waterbirths were offered (post lockdown) from the month of May 2020. Eleven mothers enjoyed birthing in water. After the lockdown, the midwifery clinics offering antenatal care, reopened on 19th May 2020, and 316 mothers benefited between the period of 19th May and 2nd October 2020. Our midwives have been christened as our birth warriors!
The current crisis of COVID has limited the number of midwives being posted in different shifts at Bogulkunta (BG) and Stork Home (SH). A comparison of data from April to June 2020 indicated a surge in Episiotomies performed by Midwives at BG. An internal meeting was held to analyse the reasons for the increase during this period and a decision was made to monitor the trends. The indications for an episiotomy were reviewed and a commitment was made by the group to be more vigilant. With the increased efforts by the midwives and a committed team approach there was a 21% significant decline between April and June 2020.
No. of Episiotomies performed by midwives
Issue 1 | October 2020
B RIDG i NG THE G a P
T e CHNOVAT i ONS
Digital Health Initiatives Initiatives by GOI etc. Initiatives by Government of India (GOI) e-Sanjeevini- Stay home OPD The Government has launched a great novel scheme-e-Sanjeevini for all citizens, especially the Senior Citizens. It is a friendly, web-based National Teleconsultation service and aims to provide healthcare services to citizens at home. It enables safe and structured video based clinical consultations. To Know more click the link below: https://www.esanjeevaniopd.in/Home
CLASSROOM LEARNING TO e-L EARNING
T HE LOCKDOWN resulted in shutting down educational programmes nationwide. With the commitment of scaling of midwifery across India, Fernandez Foundation decided to continue the education and training programmes by shifting to online classes. Here is a glimpse of the online activities conducted for the in-house Professional Midwifery Education & Training (PMET) group, Post Basic Diploma in Nurse Practitioner Midwifery (NPM)
and NPM Educator training programme.
WELCOMING N EW T ECHNOLOGIES
MWApps and Tech Collaborations D EPARTMENT OF M IDWIFERY is in process of integrating information Technology in education. To take this forward, Fernandez Foundation has collaborated with partners globally. Here are some of the innovations we are currently working on:
Topics of Online Classes
Midwifery related Antepartum Intrapartum Postpartum Obstetric emergencies Newborn
No. of Online classes conducted 34 No. of Peer discussions done 8 No. of Webinars hosted 6 No. of Journal clubs facilitated 3
peer (P2P) is a learning app that helps follow the midwifery skills in a stepwise manner. It also acts as a guide for both the mentor and mentee.
Health, Sim Capture Pro enables virtual mentoring and helps the mentor to support the students remotely. It is currently in its pilot phase. ECHO Platform We have partnered with ECHO India for virtual mentoring and imparting online classroom for midwifery. It also helps
Midwifery App Developed by Fernandez Foundation, this app is
designed to move towards the paperless initiative. It enables the mentor to assess the clinical competencies achieved by midwifery trainees during their training period. P2P App Designed in collaboration with Laerdal Global Health, Peer to
Aastar Digital Platform This will help us host the Respectful Maternity Care module online. Sim Capture Pro Designed by Laerdal Global
Data pertains from April to October 2020
The topics of online classes were centered around the major functional areas of care apart from midwifery. 36% of the online classes were related to intrapartum, 15% were midwifery related, 14% were related to antepartum, obstetric emergencies and newborn. Only 7% were related to postpartum. We envision digital learning as an integral part of Midwifery Education Training Programmes.
in monitoring the learning outcomes.
Issue 1 | October 2020
T e CHNOVAT i ONS
P r OMIS i NG P ROSP e CTS
Resonating with Research
The current research projects WORKPLACE BULLYING THROUGH THE LENS OF MIDWIFERY with the City University of London. COCOON GLOBAL COLLABORATION - CONTINUING CARE IN COVID OUTBREAK: A Global Survey of New and Expectant Parent Experiences supported by the University of Queensland. IMPROVING MATERNAL NEONATAL OUTCOMES THROUGH IMPLEMENTING QUALITY MIDWIFERY SERVICES IN INDIA: A Case Study of Facilitators and Barriers funded by MRC. DEVELOPMENT, IMPLEMENTATION AND EVALUATION OF MIDWIFERY Fernandez Foundation, in collaboration with International, National, and Local institutes, has undertaken research projects related to midwifery.
National Health Digital Mission O N THE 74 th Independence Day, India has seen a new dawn. The Honourable Prime Minister announced the National Digital Health Mission, a holistic healthcare scheme that will bind the nation together in an integrated digital health ecosystem by partnering with citizens and doctors in creating a digital health ecosystem.
LED UNITS AS A RESPONSE TO HUMAN RESOURCE AND
RESPECTFUL CARE CHALLENGES – A Systematic Review and Situational Analysis in Four Countries with the City University of London.
Issue 1 | October 2020
A D OC t OR ’ S V O i CE
G e T I NVOLV e D
Nurse Practitioner Midwifery Training Programme
Initiative by Government of Telangana (GOT)
“ N URSE P RACTITIONER M IDWIFERY (NPM) T RAINING PROGRAMME ”, an initiative by the Government of Telangana was launched on 15 th September 2020, with an aim to reduce Caesarean section rates through capacity building of professional midwives who would deliver maternity services with compassion, dignity, and respect in the state-run hospitals. Telangana government has collaborated with Fernandez Foundation to train 60 nurses as professional midwives through an intensified 18-month training programme based on clinical competencies of global standards.
One month of online theory sessions have been completed.
T HE 2020 G LOBAL W OMEN ’ S R ESEARCH S OCIE T Y (GLOW) Conference 2020 was hosted virtually by Liverpool School of Tropical Medicine on 10 th and 11 th September 2020 with the theme “ Implementing Respectful Care:
The Science and the Practice ”. Ms Inderjeet Kaur , Director of Midwifery was one of the key speakers for the sessions. Her topic was Building Midwifery Care into a Global Movement and Achieving Positive Childbirth Experiences. Two posters were presented by our Fernandez team, under the abstract theme “ Implementation Research ”. Dr Raga Sudha , Ms Inderjeet Kaur , and Ms Kalavathi submitted a poster on “ Introduction of Breech Clinic in a Tertiary Care Centre to Aid Informed Decision Making in Mothers with Breech Presentation ” and a detailed presentation was made. Ms Sheetal Samson CP , Ms Swecha Chamarthy , Ms Inderjeet Kaur , and Dr Radha Reddy submitted a poster on “ Feedback of Women on Satisfaction with One-to-one Professional Midwifery Care during Labour and Birth at Fernandez Hospital, Hyderabad, India ” under the abstract theme “ Respectful Care ”.
Issue 1 | October 2020
W e ’ RE H i RING !
A M IDWIFE ’ S S TORY
Miranda Speaks Out
Miranda is a midwife from the US, who joined our team just when the Covid pandemic began. It was an uncertain time, and a sense of panic prevailed everywhere. Her arrival was a breather as it instilled hope and enthusiasm in the team. Here's what she has to say... I came to Fernandez right around the peak of the Covid-19 crisis here in India. As a midwife, I am passionate about a woman’s right to have a gentle and positive birth experience - global pandemic or not. I have been so pleased to see the ladies that come to Fernandez are treated warmly and with respect. They are offered the utmost care no matter what their situation might be. Working together with the midwives and the midwifery students has been an incredible opportunity for me to build on my skills as well as share some of my personal experience. We are all eager to learn from one another and strategize ways in which we can improve, especially during such uncertain times. I’m truly proud to be a part of the lovely Fernandez family.
Are you up for a challenge, India?
Calling all experienced clinical midwives to join our team
Miranda Jean Stull ASM, BA, MSc Ohio, USA
If you have at least 5 years midwifery experience and an aptitude to work alongside midwifery trainees in public/private institutions, send us your resume at firstname.lastname@example.org
As a midwife, I am passionate about a woman’s right to have a gentle and positive birth experience - global pandemic or not.
Issue 1 | October 2020
A n NOUNCEM e NTS
W ELCOME TO THE 15 TH INTERNATIONAL NORMAL LABOUR AND BIRTH RESEARCH CONFERENCE, HYDERABAD, INDIA Theme: Pandemic-Pregnancy-Positive birth T HE COVID-19 PANDEMIC threw out of gear and confined us to the protective cocoons of our homes. All journeys were put on hold – except birth.
Pregnant women during the pandemic have faced a variety of challenges during childbirth. Women have experienced disrespect and discrimination, and sadly in some countries, were offered no care at all. Maternal deaths and a rising number of C-sections has also been recorded. It is under these difficult circumstances, UCLAN and FHERF with the support of UNICEF decided to host the 15 th
International Normal Labour and Birth Research Conference as a
virtual event. The theme “ Pandemic- Pregnancy-Positive birth ” was chosen accordingly. Come join us for this global conference, where midwives, childbirth educators, doulas, lactation consultants, obstetricians, policy-makers and birth activities come together to share, discuss and learn to help make pregnancy and childbirth a safe and positive experience.
The last date to submit your abstract is 25 th October 2020 Registration is free but mandatory.
Click here to register https://www.nlbcindia2020.com/registration/
Click here to read the abstract guidelines and to submit your abstract https://www.nlbcindia2020.com/abstract-guidelines/
Issue 1 | October 2020
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