International Council on Women’s Health Issues (ICOWHI) 15th International Congress – Sao Pedro, SP, Brazil

Source: William F. McCool and Mamie Guidera

The ICOWI congress on Women’s Health, Culture, and Society in Sao Pedro, Sao Paulo was attended by Midwives, Nurses, Physicians, Anthropologists and women’s health care workers from around the world. Five faculty and staff members from the School of Nursing attended to present papers, take part in panel discussions, network, and plan for educational exchanges directed at the reduction of maternal and perinatal mortality and morbidity. Although many countries were represented, the Women’s Health and Social Issues of Brazil were predominant. Brazil, with a current C-Section rate of 48%, is experiencing a feminist resurgence that would remind one of the 1970’s in the United States. Unfortunately, many of the same concerns that Brazilian women have today continue to exist in the United States and around the world.

The predominant themes of the conference, conveyed in presentation, research, poster, and conversation were:

• The humanization of Birth
• Treatment of women in the workplace
• Violence toward women
• The professionalization of nurses, birth attendants, and Midwives in the Americas

William McCool, CNM, PhD and I met with many Midwives from around the world; perhaps the most interesting connections were those made with Dr. Marcos Bastos Diaz, Minister of Women’s Health in the city of Rio de Janeiro, Heloisa Lessa, Director of Midwifery at the Rio Birth Center, and Octavia M. Vargens, obstetric nurse and professor at the University of Rio de Janeiro.

Dr. Diaz has been charged with the task of developing Birth Centers staffed by Midwives and Enfermage Obstetrecias (obstetric nurses educated as Midwives) in an effort to humanize the birth process, decrease the C-section rate, and improve birth outcomes. The current C-section rate in Brazil has lead to increased prematurity and morbidity. Both Dr. Diaz and the Midwives from the University of Rio de Janeiro are interested in training and educational assistance from the Midwives in the United States. Seeds for cultural and educational exchange were planted and a dialogue for future collaboration will continue.

A synopsis of the papers and panel discussions presented follows.

Respectfully submitted by Mamie Guidera, CNM, MSN

Barriers to Practice – The Effect of Poor Childbirth Outcomes on the Ability of Midwives to Work. William F. McCool, CNM, PhD

Abstract

As with most practitioners who care for pregnant women, midwives are usually involved in the excitement of birth and expanding families. However, poor or unexpected outcomes are a reality that everyone working with pregnant women must face. Midwives’ reactions to loss or poor outcomes can range from disappointment and sadness to the actual leaving of the profession. These varied reactions are best explained using the concepts of Critical Incident Stress (CIS), Critical Incident Stress Management (CISM), and Post Traumatic Stress Disease, theoretical notions used to attempt to understand and explain how health care professionals deal with perinatal or maternal loss. This presentation will acknowledge the difficult subject of discussing poor outcomes and critical incidents in midwifery care. Techniques for recovering personally and professionally from less-than-optimal outcomes, for dealing with the possibility of litigation or loss of license, and for addressing this very real issue overall as a profession are presented.

Women’s Experiences of Perinatal Loss – A Multicultural Perspective.
William F. McCool, CNM, PhD & Mamie Guidera, CNM, MSN

Abstract

Support, caring, and clinical competence are fundamental components of women’s health care. In the majority of cases, this care is provided to support women and their families through such joyous events as childbirth. However, in some cases this process culminates in stillbirth, neonatal, or maternal death. This outcome can be traumatic and devastating to the family, as well as to the health care provider (HCP) who cares for them.

Unexpected outcomes, such as perinatal loss, and the subsequent grieving that takes place, occur within a cultural context. As global borders dissolve, and HCP work with women from a variety of cultures, knowledge of how different cultures deal with grief and bereavement becomes increasingly important. Current practices to promote healing after loss tend to be based on the viewpoints of the dominant culture in any particular nation. However, these practices may not be relevant or suitable to various ethnic minority populations that increasingly populate most countries of the world.

Through the use of literature review, storytelling by midwives, and video-taped interviews of midwives working with various cultural groups, this presentation explores how women of different cultures cope with perinatal loss. This information is used to initiate development of strategies to promote healing and recovery within a context of cultural sensitivity.