19 Cristina Lumia

Let me introduce you to Christina Lumia which is a midwife and a PhD candidate. Courage to complete it. Christina uh a PhD candidate in nursing in midway free at the University of Milano Boka Italy and she has a solid clinical experience gain across different Italian hospital settings. Her research and knowledge translation activities address uh sexual and reproductive health, cancer prevention and perinatal mental health. Her professional interests focus of on strengthening the integration between clinical practice, research and education in order to improve women's health outcomes. So I'm welcome and I'm pleased to uh to listen to what you want to share with us. So I will um stop the sharing and you upload your own uh your own presentation. >> Okay, perfect. >> Okay, I think you can see the presentation now. >> No problem. >> So hi everyone. Uh thank you Seline for the presentation. I'm from Italy and today I would like to uh share with you the finding of a sping review on medifer practice in perinatal palative care and to present to you a conceptual framework that we developed based on our research. So um let me start with a simple question to all of you. Um why does this topic matter? Um we know that parental palative care is an area that is growing globally. uh more and more families are facing pregnancies complicated by lifetiming fetal conditions or uncertainty um uncertain neatal uh prinosis. Um the situation required um require extremely complex and emotionally intense decision making processes. Uh in this context midwives are always present. We accompany women and families across pregnancy, birth and postnatal period of course and yet despite the central present in care uh our role within the prenatal palative care remains unclear. Uh this leads to what I consider the key message of our study. uh midwives are everywhere in care but nowhere in literature. Uh we already know that uh prenatal palative care is an holistic family centered uh care focus on the quality of life instead than only cure and importantly it is based on a multid-disiplinary approach. So um the philosophical and organizational foundation of perinatal palative care are already well established but uh when we look more closely to the literature a clear gap emerged. Uh most studies are focused on parents experiences and this is very important because we can manage our assistance our care about the expectation of parents and our stud our other studies are focused on physicians perspective and experiences but midwives are often grouped with nurses only or described very generically. within the the sentence health care professionals. This creates an issue. There is a lack of clarity about what midwives actually do in perinatal palative care. For this reason, we designed the study with three main objectives. Uh the first was to map the evidence available on midwives in in perinatal positive care to identify the real gaps in literature and to explore how midwifery practice is integrated in the care pathways. So we conducted a scoping review following the Joanna Bricks Institute uh methodology and the prismoscoping review guidelines. We searched in the measure databases included, enalp, psych info and base and the search was conducted between May and September 2025 and we decided to included only the primary studies. This is the uh Prisma flow chart of the study selection. We initially identify 79 records. We screen uh 57 for title and abstract and then we read the 23 full text and we included 11 studies at the at the end of the the scoping review. These are the uh mainly characteristics of the studies that we included. The first was that we found only uh studies from high income countries published after 2010 because we supposed to have a more interest after this period and in particular in the recent period and they mainly focus on professional experiences of the healthcare in general and they were focused on clinical and organizational framework. works and in particular guidelines. These are the results about our analysis. We conducted a thematic analysis according to uh Brown and Clark and two domains uh emerged. The first was the professional experiences and preparedness and the second was organizational and clinical framework. The main one is quite important. Um the literature outlights that health care providers uh involved in parental quality care sometimes experienced a significant emotional burden, a moral distress and a lack of specific training. This is a very important point in my opinion because um we provide uh PPC the prenatal operative care and in a context that is not only clinical but also very emotionally demanding if if we think about the parents or if we think about the providers too. So professionals often face a healthy challenging situation and may feel unprepared to manage them. At the same times literature shows that some factor can significantly improve the professional experience of those involved in PPC. The first we consider the mentorship. The mentorship play a crucial role. Having the opportunity to work alongside more experienced colleagues allows professional to develop not only clinical skills but also ways of navigating emotionally complex situation. So the mentorship provides a safe a safe place to reflect to have question and to process difficult experiences which is essential in midweery field in general but in this field of palative care I think is quite important. Um the second uh was the clinical exposure. Um professional who have more experience with PPC situation tend to report higher level of confidence and comfort like in other activities that we invol we are involved as midwives. uh exposure help transform uncertainty into familiarity and hollow the clinicians, midwives and all the providers to gradually build both competence and emotional readiness. The third is the supportive organizational system which is very fundamental. Um this includes the presence of a clear care pathways, institutional protocol, interdisciplinary uh collaboration and the spaces for the briefing and supporting the emotion. When professional feel the support of their organization, they are better able to provide consistent and compassionate care together. These elements are crucial because they do not only improve technical competencies but also uh strengthened the confidence, the emotional comfort and the resilience of the system and other professionals. And this is particularly important in PPC where professionals are constantly balancing clinical responsibility with deep emotional involvement. The second domain is the organizational and clinical frameworks. Um they are actually welldeveloped in literature. Um but uh there are a clear model of care exist but I want you to remember that we are talking only about the high income countries. So we need to focus in the future to the low middle inome countries for example but uh the clear model uh exist uh they are strongly in focus and emphasizing the quality of life the family centered care and the shared decision making between families and between professionals however despite this well- definfined frameworks midwives are rarely explicitly described often merged with other professional and not uh clearly positioned within the care pathways. So this leads to a paradox in our opinion because midwives are not explicitly recognized in PPC but midwifery values are perfectly aligned with the principle of quality care. For example, if you think about the continuity of care, the relational care, the effective communication and the family centered care. These are the values and the principles of our professional. So these are core elements of midwifery of midwives and at the same times fundamental principles of PPC. To try to address this gap, we developed a conceptual framework grounded in the evidence identified through our scoping review, but also informed by uh midwifree theory and practice. At the center of this framework, you can see that we intentionally place the woman and the family. This reflects a uh a fundamental principle that perinatal pivot care is not organized about the condition about the diagnosis the illness but around the lived experience of the entire family. Around the central core we structure the continuum of care across um the phases the mainly phases of the midwifery practice. So the antennatal, the intrapartum and the postpartum period with the deb care. But this is very important because we don't consider only a single moment but a longitudinal process that unfold over time often across different setting and professionals. Within this continue, the midwives is positioned as a connector across all the faces of care. And this is really the key idea of this framework. Midwives are one of the few professional who can accomp maybe maybe the only we can see together that accompany women and family continuously over the the entire life over the time moving across clinical setting while maintaining our relationship our relational power with the family and with the woman too. If you think about the the the the box number two promotion of sexual and reproductive health. This is important when we consider a woman who experienced before uh a palative care for the newborn. Uh but in the future maybe she could uh think about another pregnancy and we have to support this woman. So um we wants to maintain communication between the professional between midwives support the woman who wants to share their their decisions and try to maintain the con the the coherence into all the pathway all the care experience. So this framework does not introduce a new role for midwives in my opinion but rather makes visible a a role a practice a competence that is already being intacted in practice often implicitly and without a formal recognition. So ultimately it lights how midwifery is not peripheral but central to delivery of truly integrated family centered palative care. These are the main uh implication. Uh if we think about the practice uh we hope for a a clear recognition of midwives that provide prenatal palative care because we we we we do this every day but without formal recognition. Um we can consider implication for education. So maybe we can integrate also this field in the undergraduate or maybe post-graduate uh curricula. And for research of course we need to uh to focus on to focus on studies that are specifically um focus on med midwifery on midwives and the contribut contribution sorry and competencies and the practice of midwives involved in PPC and as said before also for the context of the research because we are talking about only the high income countries. So these are the the take-h home message that I want to share with you. Um and maybe we can discuss together about it about them sorry. So uh PPC is spending all over the world there are clear recognition of the palative care in general as a a primary care priority. So we have to be involved in PPC very clearly because we are central but we don't have to be under recognized in the future. So we need to make their the role visible structured supported and because I truly believe that midwives all over the world are already doing this work every day. uh the challenge now is not to invent a new role but to recognize to name to support what is already happening in practice. So uh if you are interesting in the um entire in the full article sorry uh you can read it in woman and birth in the last issue and if you have question we can talk together now or maybe this is my personal email if you wants to uh to exchange some opinions or discussion and thank you so much for your attention. Uh Christina, thank you so much. which it's an important uh message to take home and to be conscious about the the the importance of the the the presence of the midwife, the consciousness in the moment and the paliotative care with the ch children and babies. Um was was there is there any uh question or commentary? I wrote things but uh yeah it's time to ask question. Uh let me see if I if you can unmute yourself. Can you uh let me see? Oh boy. >> Oh there are Oh okay. This a real problem. >> Hello. >> Ah >> hello. >> Hi. Hello. Thank you for the presentation. >> Uh I wanted to ask if um perinatal palative care is actually well established in Italy because it's not you know it's not like a widely recognized and widely um accept like established concept all over the world. I mean I know there are pockets of good practice but um there often aren't like specific teams or named professionals who lead on that care. So I think that's part of why midwives are not recognized for it either because it's generally a concept that's not so well known. >> Oh yeah, I agree with you. Sometimes the teams are very uh different in professionals and in some part of the world midwives are included. In Italy we have differences in the regions. For example, if we think about the north, we have one hospital with a specific protocol in which midwives are involved. For example, when the woman decide to uh to donate the the milk for example or um because sometimes the palative care uh occur after uh a starting of the breastfeeding for example. Our another situation is in the center of the Italy uh in which midwives are starting to be involved but is quite difficult because is not highly recognized as a skill of the midweery in particular but also for only sorry for uh nurses or pediatric nurses because in Italy we have differences in professional we midwives, nurses and pediatric nurses. So it's not easy to to have a particular recognition of the world of the role completely and universally in all the the the all the nation. I don't know if I answer. Thank you. And I I like Christina that you uh insist that to to u distinct nursing from midway free because they are two unique and distinct professions and you claim something clearer and uh to to uh assume as a professional identity of of unique about midwife. lives and not not mixed up with nurses. >> Yeah, I know that this is not a situation of all the countries in the world because for example maybe the colleagues from the US are better informed than me but sometimes midwives and nurses are the same professionals. In Italy, we have a clear recognition of the roles of the competencies and identity of the nurses and of the midwives are different but strongly independent. Um, and we recognize the midwives as a a key role for support the woman in the entire life, the woman and the family. This not means that nurses are outside the clinical pathway. Of course, but maybe midwives is quite prepared from the curricula, the from the university curricula to be involved mainly in woman life and in woman health. >> That's good to know. Uh, is there another commentary? Yeah. I I wonder for uh I have a question for you. I wonder how can uh teacher or information for student midwives. What would be a good thing to help a midwife to feel like confident to be in that part of you know welcoming life when the baby is crying but welcoming like life when you know that the baby will go. Uh was there any special courses or Yeah. what what is your experience? >> Um there's no specific course but the idea of the of this research came from one of my students. This is the I supports the her bachelor thesis uh because she went to um a conference in Italy in which the neonatal palative care where was introduced to the audience and she comes in the university said okay I just wants to improve my knowledge because I think that um is something very important for the future Maybe the the courses or the the bachelor degree is not clearly focused in this field but however the students are curious. So uh maybe it will be an idea to improve the uh this field also in the future. So we care about to publish as a to publish this re this research to uh to greeting for Sara. They had they had the the mainly idea but also for give an an idea of all over the world to the importance of this of the research in this field or the midwives all over the world. H well yeah thank you. Uh yeah um was there any uh sharing discussion with people uh not specialized but experience in palative care for adults but what it is about working in paliotative moments. Uh so for adults and for babies or whatever it may be the attitude or virtues or ethics of that can be shared and be making clear as well as you know it can be for adults but it can be for uh for midwives. >> Yeah. And um I think that sometimes when the population and the society thinks about a midwives only think about the the beautiful moments, the most important moments of happiness and but sometimes we are clearly involved also in very sadly periods, sad moments. So for adults maybe is quite accepted maybe uh but for babies is something very hard to to understand to accept but is is in this point that our communication the importance of relationship that midwives has with the the family with the woman with the entire community that we can try to support this particular sadly moments. So um it's very good to say that we are not here just when is sunny outside but also when the moment is quite hard and that's why I very caring of this I'm caring of this research because I want to share with other colleagues that we have to improve the communication the decision making with women with families also when it's not sunny outside. So, it's very important for us as a professional in the community. Thank you. We certainly midwives need to um cultivate humility of the impossibility to control everything and to be responsible for life and you know all things but and help parents to to to live with that uh uh powerlessness. >> Yeah. Uh and you know it's it's painful and it's sad and it's fear. We fear this and we don't want this. Nobody want that. So wow. And yeah maybe values of our society uh help doesn't help us to be prepared for that. But so that's why prepared midwives would be so important. >> Important. Yeah, of course. >> I think there is um a question from Wilson. Uh do you think this concept can work in low middle income countries? Oh yeah, absolutely. Uh if I can answer Seline, I can say that um the studies are uh probably um from high income countries because in my experiences I think that in the uh high income countries the conception of debt is hard to accept than in the uh low middle income. countries. Um that's why this is something culturally mediated I think because when a baby die in a high income countries is something that you say no why because I have the possibility to to to do my best but I think that in the low middle income countries this is quite important too because we have rates of death of women and and baby too that are very very very high. But it doesn't mean that we don't have to be compassionate or prepared to understand also the suffer of a woman that culturally accepts the death better than another woman. So I think this concept may be uh culturally mediated of course also for the low middle inome countries and is it will be an idea to um to have some research in this context and understand if women has the same experiences the same feelings of the others. So thank you Wilson for the question and I don't know if I if I answered Well said. Thank you. [clears throat] >> And Katherine, do you have a a question? No. Okay. >> I just liked it. >> I appreciate it very much. It's I think it's such a gift that we can be there for families in this way. >> I agree. Thank you so And if we're ready, we can really transform someone's experience and someone's and then how they enter into their entire future relationship with their family, future children, and and and their ability to um to still live a meaningful and powerful life full of autonomy and potential power, joy, and find joy. like still put it somewhere but still maintain joy. >> Yeah, I agree. >> I like that you talk about joy and we can talk about love, you know, all all in in life of of families. Thank you. Is there any one more question or commentary? That was so it was powerful and it uh yeah yeah yeah it puts >> yeah I I I agree that sometimes we are invisible in some situation this morning I was talking about with a colleague for the uh the cancer assistance to women and she said uh I I think that women appreciate more the compassionate care of a midwives also during the chemotherapy for example uh because it's something very close to our identity to be in relationship is our is our power we I don't want to be mean with other professionals but I understand that we have a very good power in many fields. So I think the palative care is one but maybe we can talk about the oncology. So I I want to empower all the colleagues to not being visible. Absolutely we are visible. We are here. We need to be more visible as as midwife and not just as what I say good good girls you know conform to protocols and algorithm and guidelines and all that but it's it's more than that it's not just doing it's being so >> it's not only practice >> it's not only doing things but very be >> uh compassionate be present >> sometimes with silence but be present be here be there for women and for families. I know that uh from the woman that I met in my career >> also to take an end was a a power. >> So without any words or without discussing but just to take a day at the end. So uh we have to be conscious of our power. >> Yeah. Thank you for talking about the you know the presence in Quebec where I practice as midwife. We're talking about holding space you know. >> Yeah. protecting. There's something precious, important and deep that has to be, you know, uh, guardian in our consciousness about what's happening for people. >> Absolutely.