WEBVTT

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The Lancet Series On
Midwifery is a series

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of four papers looking, using
a different range of research

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methods, at the strong evidence
now that we know that underpins

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the importance of midwifery.

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For mothers, for
babies, for families,

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for communities in low
and middle and high income

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countries across the world.

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We've looked at the
impact it will have.

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We've looked at how it
can save lives and help

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improve health and well-being.

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And we've looked
at how to implement

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that in a health system.

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And so it can be used
now by decision makers,

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whether those are
policy makers, ministers

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of finance and health.

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Or whether those are health
professionals themselves.

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Or indeed women
themselves, in helping

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to develop health
systems that will

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be effective and efficient,
and good for women and babies.

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Every now and then, something
very special comes along.

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And this is an extremely
special series.

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It's challenging, it's
creative, and it's constructive.

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This morning was
very interesting.

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Particularly interesting
was the framework

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for midwifery services.

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Because it not only describes
the different components

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of the services that
are needed, but gives

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an idea of who can provide
those different elements

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of the midwifery services.

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And the importance of the
midwife within that context.

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When it comes to putting
a programme together

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and convincing government,
and harnessing political will,

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first question they always
ask is where's the evidence?

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And so even though we all
had pockets of excellence

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and we knew the solutions,
The Lancet Series

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is now harmonising all
that evidence for us,

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and making sense of it,
and extrapolating it.

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So we at WHO think this
Lancet Series in Midwifery

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will make a
significant difference,

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because it really
focuses the attention

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on the quality of
rights based care

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from the perspective
of women and newborns.

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And for the first
time in decades,

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it provides the
evidence that we need

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for a quality of care maternal
newborn health framework.

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That will enable
donors and others

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to invest in
strengthening the quality

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of midwifery services provided.

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The job of the first
paper in the series

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was really to set the scene.

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It was to start the analysis
of existing evidence of what

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midwifery is.

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Of how to describe
it and really to look

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at why it matters to
women and to babies.

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And so we had to start by
actually defining midwifery.

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Which might sound strange, but
because midwifery varies right

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across the world.

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Some countries it's
provided by midwives.

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Some countries it's provided by
a mix of nurses, and doctors,

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and community health workers.

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And so we actually had
to describe midwifery

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as women and babies need it.

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And that was the
very first step.

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So we did that.

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And then we went on to look at
what components of care women

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and babies need.

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The whole focus of paper one
was to look from the perspective

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of women and babies.

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Any mother, any baby
across the world.

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What do they need.

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And we used a lot of
existing evidence.

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Hundreds of existing reviews
and studies of women's views

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to characterise what would
make a difference to women.

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And we established a framework.

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Now this framework is becoming,
if you like, a stable basis

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for analysis, but
it's also becoming

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a stable framework for how you
might design a health system.

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Or how you might
educate students.

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Or how you might
monitor and assess

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how a health system is working.

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And it's got a number
of elements to it.

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So if I just take a few
minutes to describe it.

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The first top element of
the framework, if you like,

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is to stress that all
women and infants need

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certain kinds of care.

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And then this additional care
that women with complications

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need.

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So that's not a low
risk, high risk split.

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That is that all women
need certain kinds of care

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and others need an
additional set of care.

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Moving down the framework, the
first line is about practise

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categories or interventions.

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What specific things,
tasks, do women

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need from the health system.

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All women need three
different sets of things.

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They need education,
information,

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and health promotion.

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The need assessment,
screening, and care planning.

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And they need first line care.

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The care that will
keep them normal,

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but will prevent
complications happening.

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So everybody needs that.

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Then women with complications
need possibly two other things.

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One is first line management
of those complications.

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Again, to try and prevent
them from getting worse.

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And then finally, they'll
need specialist medical care

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if they have an emergency or
a serious medical obstetric,

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or indeed neonatal problem,
if the baby is very sick.

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The rest of the framework
takes through the way

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in which that should happen.

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So not just what should happen,
but how it should happen

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and who should provide it.

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So the how it should happen, in
terms of organisation of care

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for example, is that continuity
really matters between where

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the women and baby are,
where the family is,

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and the facilities or hospitals
that they might be using.

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So the community
through to the facility.

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And also that those services
are accessible and acceptable

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to the local community.

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There is then, if
you like, the values

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set in which that care is
given, so it's respectful.

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So it's tailored to
women, and babies,

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and families needs individually.

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There's then the
philosophy of care

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and really importantly, that's
about really helping women

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to optimise their own strengths.

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So trying to promote
normal process

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is not interfering too soon,
not interfering at all.

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If in fact, the mother can
manage to give birth herself,

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to breastfeed herself,
without additional extra help.

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To strengthen women's
own capabilities.

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And then the final
element of the framework

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is the characteristics
of the care providers.

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Obviously they need to
be competent and skilled,

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but they also need
a good skill mix

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integrated with
other care providers

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across different professions.

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And they need to provide
culturally sensitive care.

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So they're not just doing
a one size fits all.

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So that's the framework.

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And that framework is being
taken by all the other papers

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to really help them analyse
and understand other elements

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of care.

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What we then did was we used
that framework for analysis.

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And we took out of the
literature, an understanding

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of all of the outcomes that
midwifery would then improve.

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And we found an
amazing 56 outcomes

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in the existing literature.

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And we've measured those
and we've laid them all out.

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And they include saving
lives, saving mothers,

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and babies lives.

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Preventing stillbirths through
a number of clinical outcomes,

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but also looking at
maternal infant attachment.

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At psychological
outcomes, social

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outcomes, and indeed
at saving costs.

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And reducing health
service involvement.

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So it's very, very
broad and very important

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that those outcomes
can be improved.

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And finally in the
paper, we really

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looked at the literature around
care by midwives and care

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by other people.

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And what we found
was really important.

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That midwives practise the
whole scope of midwifery,

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not surprisingly.

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And the other less
skilled workers

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can do components
of it, but that it's

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likely to be more fragmented and
not so comprehensive, and not

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so effective.

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