The International Labour and Birth Research conference is an established event bringing together researchers and clinicians from all over the world. Elizabeth Duff, Freelance writer and International News Editor of Midwifery journal, attended the conference and shares some of the highlights.
The 24th conference in this established series of annual meetings was organised, as before, by the University of Lancashire (UCLAN) in the UK and chaired by Soo Downe, Professor of Midwifery Studies at the university. The theme has been widened this year, with presentations more often exploring deviations from physiological labour and birth.
A truly international cast of speakers came together from Australia, Brazil, Canada, Czech Republic, Ethiopia, Ghana, Hong Kong, Namibia, Nepal, Poland, Tanzania, Uganda, UK and US, as well as nearly every country in western Europe. There were fascinating insights from across the world, with strong themes emerging around the addressing of social inequalities, the benefits of continuity of care and the occurrence of abuse and mistreatment of women in maternity care.
The conference attracted many midwives, but also a strong representation from medical specialties – including public health; anthropology; social science research; and advocates for maternity service users, especially those from marginalised groups who may experience poorer care.
On the opening day, Oona Campbell, Professor of Epidemiology and Reproductive Health at the London School of Hygiene and Tropical Medicine, spoke on ‘Place of birth in LMICs and maternal mortality’, setting out to paint ‘a global picture of where women deliver’ and how it affects birth outcomes. Studying data from low- and middle-income countries (LMICs), Oona investigated nations’ mortality and stillbirth rates, comparing them with fertility rates, institutional birth settings and birth interventions. She noted that, among drivers to reduce mortality (mother and newborn), are: more frequent contact with health services; lower fertility; higher quality care; and significantly, government engagement in improvement of maternity services. Births outside hospital were often associated with poorer outcomes, but these settings were found to be less well staffed and resourced than hospitals, so comparisons are complex. External factors, such as mobile phone availability and road infrastructure, are crucial in the management and transfer of women with complications. Inequality gaps, she noted, were only substantially reduced with near universal health coverage.
This was followed by Dr Scovia Nalugo Mbalinda of Makerere University, Uganda, and Dr Rachel Zaslow, executive director of Mother Health International, speaking on ‘”All of Us or None of Us” how community can transform midwifery care in Uganda and globally’. They described the situation in Uganda following the criminalisation of untrained midwives’ practice in 2008. As qualified midwives then worked mainly in hospitals, seeking care involved travel and costs for pregnant women, as well as facing unfamiliar carers and settings. Many women therefore continued to prefer accessible and respectful care from traditional midwives, in spite of their working illegally. Scovia and Rachel evaluated strategies for community partnerships, midwife mentorship and inclusive birthing environments in order to integrate midwifery models of care into health systems. Reducing social inequalities is a key aspect of their work. They also found the quality of infrastructures important: for example, women known to be at higher risk – e.g. with a twin/multiple pregnancy – can be safely brought to hospital in labour by a trusted attendant, if communication and roads are adequate. Commenting on outcomes, Rachel said that for Black women, Uganda is now a safer place than the US to give birth.
The second conference day began with a focus on continuity of carer (CoC). Chris McCourt, Professor of Maternal & Child Health at City & St George’s in London, UK, described her evaluation of the implementation of midwifery CoC in England. There is a complex mixed picture: among staff reactions, it was noted that in some units, midwives leave because they are expected to offer continuity; in others, they leave because there’s no option to join a continuity team. Some senior managers are supportive, others less so. Low staffing did affect success of implementation, though a majority of units planned to expand CoC in the next two years. Chris identified leadership, information sharing, adequate staff, functioning data systems and ‘model fidelity’ as key to achieving success. Providers in the study described ‘a richer use’ of their time.
Olivia Wiseman, clinical midwife and research fellow at City St George’s, gave a detailed talk on her work to implement and promote ‘Pregnancy Circles’ in antenatal care. Hers was a down-to-earth, no-holds-barred exploration of the many obstacles encountered in establishing group antenatal care, in spite of its being of internationally proven benefit. Challenges from midwives having to learn group management skills to actually finding a physical location for the group were described. Olivia emphasised ‘It is a complex intervention’, yet set out the achievements, with both women and midwives finding greater satisfaction in a more efficient and more empowering model of care. It is hoped that a similar model may be applicable in postnatal care.
Dr Solomon Hailemeskel, Assistant Professor of Midwifery at Debre Berhan University, Ethiopia, spoke on implementation of midwife-led CoC in Amhara State. His study group received maximum care from one midwife or a ‘back-up’, while others saw several midwives. Improved outcomes included more spontaneous vaginal births; higher breastfeeding initiation; better Apgar scores for the babies; and fewer preterm births. Higher maternal satisfaction was also reported.
Jane Sandall, Professor of Social Science and Women’s Health at Kings College London, UK, examined the updated Cochrane review of midwife CoC, looking especially at inequalities and emphasising collaborative care. Among evidence of benefit has been a significant reduction in stillbirth among Black women in the UK and improved rate of early breastfeeding. Women from Arab, Asian and British-Asian backgrounds are more likely to report receiving maximum CoC.
The final conference day saw Mary Renfrew, Professor Emerita, University of Dundee, Scotland, drawing lessons from her 2024 review of maternity in Northern Ireland, calling for ‘evidence-informed, co-created transformation of care and services’. Basing work on the Quality Maternal and Newborn Care (QMNC) model from her 2014 Lancet series, Mary presented graphics capturing frameworks with ‘women, babies, families, community’ always at the centre. She urged changes, including that resource allocation should be considered not by volume of work but by its quality and adherence to standards.
Laura-Rose Thorogood, chief executive of Make Birth Better, talked of her and her wife’s experience of fertility treatment and maternity care over the years they created a family of four children. Both direct discrimination and poorly-informed professionals negatively affected their episodes of care. Laura-Rose has worked relentlessly to influence government policy in enabling safe, compassionate and inclusive care, alongside law reform for all queer families.
There were numerous presentations on the theme of obstetric – and midwifery – violence, abuse and mistreatment, especially affecting women from socially marginalised communities. Saraswathi Vedam, Professor of Midwifery, University of British Columbia, Canada, presented on factors associated with mistreatment and disrespect during pregnancy. Alongside discrimination based on race, there was higher risk for younger women and those birthing in hospital. Dr Bridget Basile from Yale School of Medicine explored different forms of mistreatment in ‘Harm at the hands of the healer’, with evidence of painful procedures, lack of consent for interventions and humiliations such as being ‘scolded’ for bleeding on the floor.
The packed and varied programme closed with Holly Kennedy, Professor of Midwifery at Yale School of Nursing, speaking on ‘The Lancet series – ten years on’, accompanied by Mary Renfrew, Fran McConville formerly of WHO, and Dr Tekla Shiindi-Mbidi, QMNC Research Fellow from Windhoek, Namibia, who answered the question ‘How do we change the world?’ with the legendary response: ‘One random act of kindness at a time’.
Finally, delegates were invited to put in their diaries the 2026 conference, to be held in Berlin, Germany, 21-23 September.
Elizabeth Duff
Freelance writer; International News Editor of Midwifery journal