A journey between midwives from Iceland and the Netherlands
“The meeting of two personalities is like the contact of two chemical substances: if there is any reaction, both are transformed.” -Carl Gustav Jung
“This magazine tells the story of a journey of a three-year twinning collaboration between twenty eight midwives, fourteen from Iceland and fourteen from the Netherlands. These midwife ‘twins’ worked together to generate positive change in maternity care in their respective countries. They did this by strengthening and profiling midwives and midwifery as key to humanising and optimising pregnancy and birth for women and their babies and families.
The evidence shows convincingly that midwives play a key role in providing women and their families the right care, in the right place and at the right time. Midwives, when trained to international standards, provide high quality and respectful evidence based care before, during and after pregnancy and birth, as well as advocate for the rights of all women to sexual and reproductive healthcare, leaving no one behind. Midwives are instrumental in reducing both unnecessary over- and under medicalisation. As an example, midwives can positively impact the prevalence of over medicalisation, such as the high caesarean section rates that we see in many high income countries. Indicators of under medicalisation, such as high maternal mortality rates, more common in middle and low income countries, is reduced by employing and supporting continuity of care by midwives.
Twinning is defined as ‘a cross-cultural, reciprocal process where two groups of people work together to achieve joint goals’ (Cadee et al. 2016). Using the twinning method with reciprocity and equity at its core, participating midwives committed to achieving common goals by collaborating on the projects described in the pages that follow. In addition, they took part in exchanges and joint workshops aimed at developing their transformative leadership skills.
All midwives were matched one to one based on their interests and expertise, such as students to students, researchers to researchers, teachers to teachers and practising midwives to practising midwives. As ‘twins’ they shared skills, experiences and inspiration with the aim to generate positive change in each other as well as for birthing women in their communities.
We share our results with pride. Enjoy!”
Franka Cadée, Project Manager, Twinning Up North
A personal, reciprocal relationship with any like-minded person can give us life lessons like no other. When this person arrives from a different culture and context, she is then not just a person, but a human door to a foreign world full of surprises, in the form of new knowledge, learnings and practices. Every conversation brings us one step closer to each other, and every meet-up builds new inspiration.
The Twinning Up North project is a cultural exchange that brought together midwives from two northern countries- Iceland and the Netherlands. According to a research by Franka Cadée, the Project Manager, “Twinning is a cross-cultural reciprocal process where two groups of people work together to achieve joint goals.” The midwives from the two countries were paired with each other to work on a joint project in a three-year long journey. Each of the twins’ journeys had their own smooth and rough moments; filled with experiences that were both sweet and sour.
The project team was brought together by: Áslaug Í. P. Valsdóttir, LMFI President; Franka Cadée, Project Manager; Edythe L. Mangindin, Project Coordinator, Iceland; Liselotte Kweekel, Project Coordinator, The Netherlands.
In English, ‘midwife’ means ‘with woman’. However, in Dutch and Icelandic, the word has different denotations. The word for ‘midwife’ in Icelandic is ‘ljósmóðir’, which means ‘mother of light’. In Dutch, the original word is ‘vroedvrouw’, which means ‘wise woman’.
Amidst multiple cultures, traditions, languages, characters and personalities, there was one thing in this project that united everyone, and that is midwifery. Midwives love their job, and when midwives come together, they feel excited to talk about midwifery and their passion for this profession. For them, midwifery is not just work, but a big part of themselves.
The Dutch word ‘vroedvrouw’, being a word associated with women, excludes the minority of men who also work as midwives. Therefore, this word was gradually replaced by ‘verloskundige’, which means ‘the ability of freeing someone’ (from a baby). According to Franka, this word is void of any deep feeling and emotions, and she personally prefers to use 'vroedvrouw'.
In the past, two more twinning projects took place. The first one was between the Netherlands and Sierra Leone, and the second one between the Netherlands and Morocco. Recently another twinning project between Ghana and Sierra Leone was stopped, after agreement of all involved.
What are the challenges?
Franka describes that twinning between the high and low income countries brought forward a couple of ‘brilliant failures’.
“I call these failures ‘brilliant’ because what we saw happen were gems! At the time when those projects were happening, there was global religious tension prevalent which was seeping into all sectors of society, giving rise to institutional bias including racism. The Dutch midwives at times portrayed a feeling of superiority, and had discussions questioning the lifestyle and attitude of the midwives from Morocco and Sierra Leone. On the other hand, as a result of hundreds and hundreds of years of colonialism and its after effects, the midwives of Morocco and Sierra Leone had a very humble and submissive attitude. So it was very difficult for us to maintain equity, which is core to twinning. Through this project, we deeply faced the reality of what we have done to humanity.” -Franka Cadée
Liselotte says, “The idea of twinning is a two way process. Both the twins learn and gain from each other.” On a brighter side of the project, there were twins who developed a deep relationship, especially when they got to know each other as an individual human being.
Two extreme situations take place in maternal health care in different parts of the world: Too Much Too Soon and Too Little Too Late. ‘Too Little Too Late’ refers to situations that can take place in low income countries, where necessary care is inadequate, until too late to help, leading to high rates of maternal mortality and morbidity.
‘Too Much Too Soon’ is a situation that is ascribed to high and some middle income countries. According to The Lancet, ‘it includes unnecessary use of non-evidence-based interventions, as well as use of interventions that can be life saving when used appropriately, but harmful when applied routinely or overused.’
“It is true that we need more and advanced medical interventions to be healthy. We need more midwives, doctors, nurses, hospitals, as well as procedures like Caesarian sections and induced labour when needed. But in the Western world, in countries like Iceland and the Netherlands, health is over medicalised. For example, a woman who is 41 weeks pregnant may be advised to have an induction even if it is not absolutely necessary. In the same way, she can also be offered a Caesarian section. When applied to a healthy woman, these medical procedures do more harm than good. There is a lot of evidence to prove that keeping birth normal is the best and safest for women who have good health.” - Liselotte Kweekel
Based on the learnings from the previous projects, it was decided that in order to receive the best outcome from the twinning philosophy, twinning must take place between people who are contextually (geographically and culturally) closer to each other. Some of the priorities were to select a country where people understood and spoke English, and which was located closer so as to be more ecologically friendly. After shortlisting some European countries, Iceland was selected through a scoring system.
The Netherlands is known as a country where many of the normal births take place at home. The atmosphere in hospitals can feel over medicalised. In Iceland, there is little homebirth, yet the hospitals have a more homely atmosphere which does not feel too ‘medical’. This difference is one of the things, among many others that midwives from these two countries wanted to explore together through this project.
The twinning process began with a Call for Applications from midwives who were looking forward to enhancing their leadership skills and exchanging learning about their profession from other countries and cultures. Due to their large population, there was a fair number of applicants from the Netherlands, as they have 3,550 midwives in their country. In Iceland, it was rather more challenging to find a fair number of midwife applicants due to their small population. They have only 290 midwives in their country.
After the midwives were selected, they were matched and paired with each other- one midwife from Iceland and one midwife from the Netherlands formed a pair of twins. These midwife twins began their journey in 2018. Their journey officially ends in December 2020, but for many, this project created a relationship that will last a lifetime.
In this journey, the midwife twins learnt from each other’s culture and profession. They also learnt from each other as an individual. Together, they created products to spread knowledge about midwifery, motherhood and pregnancy. They were in touch regularly, and met twice a year- once in Iceland, and once in the Netherlands. When they visited each other’s countries, they stayed in their twin sisters’ home, met their families and went to their workplaces. For some, this experience was outside their comfort zone, yet everyone enjoyed the challenges and excitement that came along. The products that were created range from animations, testimonial videos, teaching modules and research; all with the aim of reaching out to women, expecting parents and midwives.
“After becoming a midwife I realised how political the profession is and how much power we as midwives can have. It's like the power of women they have within. We can change the way people look at women, we can change the way people treat women, we can change the way we see ourselves as women and how we can empower ourselves through the strength of other women being together. I think this collaboration has really shown me the strength of what happens when women come together, and especially midwives because we actually work with women. We see what we and other women go through everyday and see what we can do when we come together and support, learn from and respect each other. I have seen this beautiful collaboration and respect, and strength that comes from within when we come together, and it is really wonderful witnessing that.” says Edythe L. Mangindin
Franka has managed four twinning projects over the last ten years, the most current one being ‘Twinning up North’. While managing these projects she researched the processes and outcomes of twinning and defended her Doctoral thesis named ‘Twinning, a promising dynamic process to strengthen the agency of midwives’ in October 2020. With her anthropological and midwifery background, plus personal experience of living and working across a range of differently resourced countries, she is well aware of the realities of the field and a strong proponent of a human rights based approach to healthcare. Using her expertise in sexual and reproductive healthcare in general and midwifery in particular, with over 30 years of strategy and policy development, advocacy, leadership, research and project management experience, Franka is serving her second term as the President of the International Confederation of Midwives (ICM) (2017-2023). Currently she is a member of the Executive Board of the Partnership for Maternal and Newborn Health (PMNCH) representing the Health Care Professional Associations, a Board member of the ICM WithWomen charity, and a member of the High-Level Commission on the Nairobi Summit on ICPD25 Follow-up as well as a consultant on international collaboration to the Royal Dutch Association of Midwives (KNOV).
Liselotte has been a midwife in independent practise in the Netherlands since 2009. She is a medical anthropologist, an advocate for Sexual and Reproductive Health and Rights (SRHR) and combines her skills in her work as the international policy advisor for the Royal Dutch Organisation of Midwives (KNOV). Liselotte is the project coordinator for KNOV in the Twinning up North Project.
Edythe earned a Bachelor’s of Science in Nursing, a Candidata Obstetriciorum degree in Midwifery, and a Master’s degree in Midwifery from the University of Iceland. Currently, she is a Doctoral student in Midwifery at the same university, and her thesis focuses on immigrant women’s experiences of respect, autonomy and mistreatment in Icelandic maternity care services and culturally competent maternity care. She works as a Registered Midwife at Landspitali University Hospital, Childbirth Educator and Project Coordinator for the Icelandic Midwifery Association in the Twinning Up North Project.
Visualizing tricks of the trade: Empowering maternity care providers to support physiological birth
Hannah has been a midwife for three years, and has done different jobs before she decided to begin her career in midwifery. Hannah initially studied Cultural Anthropology, but was never completely satisfied with her professional life. Later, her partner encouraged her to pursue midwifery as a profession. “We are going to make it somehow,” he said. Today, Hannah says that she is eternally grateful to her partner for pushing her, because she couldn’t have done it on her own. Hannah strongly believes in true autonomy and choice for pregnant women. She believes that it is not right to make statements like ‘You have to go to the hospital.’ Instead she believes in explaining the protocol and possibilities of birth, and enabling women to make an informed choice for themselves.
Ásta too, has been a midwife for three years. She has worked as a nurse in various departments for seven years before starting her midwifery programme. When Ásta was pregnant with her third child, she wanted to have a normal birth. Previously, her two children were born via Cesarean section. After learning that a normal birth won’t be possible this time too, she told her midwife, “I want to have my baby on my chest as soon as she is born, even if the surgery is still happening.” When my baby was born, she was with the paediatrician in a corner of the room. The doctor, who was inexperienced, felt that the baby needed to go to the Intensive Care Unit for an observation period. The midwife could see that the baby was fine, and would be fine with her mother. So she asserted to the doctor, “Now what the baby needs is her mother,” and handed the baby to Ásta. This precious little moment, and the midwife’s empathy and leadership encouraged Ásta to become a midwife so that she could be a positive force in the life of other women, the same way her midwife was a positive force in her life.
Ásta works at a hospital delivery ward with other midwives and healthcare professionals, while Hannah works at a small scale community practice and does home deliveries.
When Hannah and Ásta met, they were both newly graduated midwives who were trying to find their fields in their professional lives. Hannah says,
"When we first met, I felt comfortable immediately. We were matched well as we had so much to talk about. We had wonderful conversations"
One of the most memorable moments for Hannah and Ásta was delivering two babies on the same day in Iceland at Ásta’s workplace.
Hannah always keeps a pair of scissors on her desk. This scissors was gifted to her by Ásta, and is a symbol of a workplace difference between the two countries. Ásta says, “We have very different practices in our professional lives. I have to wear scrubs and carry pens and scissors in my pocket all the time.”
At their very first conversation, Hannah and Ásta discussed a method of delivering babies that had a cord around their neck, that did not involve cutting the cord before the baby is fully born. This method involved making the baby do a somersault in case the cord was too short. For Ásta, this method was not much of a big deal because according to her, “That’s just something that we do.” For Hannah, this method was revelation, and she desperately wanted to get this knowledge out to the whole world. This conversation further led to developing the idea of having a good visual, an animation to be able to learn this method without someone teaching you.
With this video, Hannah and Ásta intend to reach to midwives, midwifery students, family doctors, doulas, obstetricians and women themselves. The most important message that they strongly want to convey is “DON’T CUT THE CORD!”
Ásta says, “People who don't know a lot about birth, they don't realise the importance of the cord. It is the most important thing in the first minute of a baby's life. It is its lifeline for oxygen and nutrition from the mother. If you cut the cord too soon the baby will have less haemoglobin and less blood in its bloodstream. It is very important and you have to keep it intact. The cord doesn't have to be cut unless the mother wants, or if the baby needs immediate help that is not available at the mother's bedside.”
Hannah says, “In Holland a lot of women ask to cut the cord once it is not pulsating anymore. In the beginning it is still pulsating, blood is still being transferred to the baby, that's when it's full and you can see the blue veins. At some point it just goes limp and it's white, there's no blood in there anymore. That can be an appropriate moment to cut it. Sometimes that's after a minute, sometimes it takes half an hour.”
Visit somersaultbirth.com to learn more about somersault births.
Midwives With Midwives
Loa has been a midwife for 10 years on the Eastern side of Iceland. She worked in a large area where some women and families had to travel a long way for her services. She has now moved to Reykjavik where she will continue working as a midwife at the University Hospital. Loa is a mother of three boys, the eldest one being 19 and the youngest one 8. Loa wanted to become a midwife from a very young age. Loa got devastated when she first didn’t get accepted to Midwifery school. She was then working as a nurse at the pediatric hospital in Reykjavík but in Iceland one first must become a nurse before they can become a midwife. One day, an elderly woman and a good colleague of Loa, who knew more than most people and had a very spiritual way of thinking, said to her, “Don’t worry Loa, you will get in for the next semester.” Only a few days before school started, she got a phone call and was told that she got the opportunity to study midwifery.
Edda graduated from midwifery in 2019. She lives in Reykjavik with her partner and newly born daughter. Seeing her mother work as a nurse and staying busy all the time, Edda never wanted to become a nurse. “But look at me now,” she smiles. While she was studying Spanish at her university, Edda got a job at a natural birth ward where she cleaned rooms after deliveries and made food for the parents. One day, she was present during a birth. That day, not only a beautiful baby was born, but she also made up her mind about her career. Today, Edda works at the labour and delivery unit at the University Hospital of Iceland. She says,
"This is truly the best job ever, and I couldn’t imagine myself doing anything else. It's a privilege!"
Jolene is still a student and is in her last year of studying midwifery. She lives in the South of the Netherlands with her partner who is also a midwife. Jolene was 10 years old when her mother became pregnant. The very thought of a tiny human inside her mother’s tummy fascinated the little girl back then. She sang to her mother’s belly every night, and sang the same songs again after her brother was born to see if he recognised those songs. ‘Midwife’ literally translates to ‘with woman’, and Jolene finds it beautiful to stand beside a woman, to support her and to empower her during such a remarkable phase of her life.
Judith was part of the twinning project from April 2018 to April 2020. However, she discontinued at a later stage of the project.
Loa, Edda and Jolene are the only triplets in the Twinning Up North Project. Jolene says that she is lucky to be the only one who has not just one, but two Icelandic twins! She was really impressed to learn about Edda’s project about supporting pregnant drug users. “I was moved to see her compassion for everyone no matter their background, and her willingness to support them in whatever way she could.” Jolene looks at Loa as an inspiration because of her work in the East of Iceland. “Loa does more as a midwife in Iceland than what a midwife in the Netherlands is allowed to do.”
Edda admires Jolene for her smart and compassionate personality, and for her charity work in Kenya. She says, “Jolene is a true powerhouse.” Edda admires how Loa looks at problems and her ways of solving them. Edda’s best memory with her triplet was after the National Midwives Conference in Iceland, when they were laughing with each other out of exhaustion as well as excitement for their chosen career.
When Loa’s twin, Judith discontinued, she was lucky to have the support of Edda and Jolene immediately. She laughs admitting that she thought she would not get along with Jolene at the beginning. Gradually, she got along very well with Jolene and Edda, and something tells her that their friendship will last a lifetime. The three of them often respond differently to different situations, but that is the beauty of their relationship, and they have already learnt so much from each other.
The triplets often encountered cultural differences affecting the pattern of how they worked. The Dutch like to plan everything in advance, while the Icelandics prefer to work slowly and gradually. “I think they thought I was a little bossy when I was trying to plan ahead and set deadlines,” Jolene laughs. Later, they found a middle ground to adapt with each other when Edda and Loa learnt not to keep things for the last minute, and Jolene learnt to let her deadlines go.
Midwives empower women and women empower midwives. At the same time, midwives need to empower each other. At the beginning of the Twinning project the triplets had many different ideas for their own project, but at the end they decided to focus on midwives themselves. Thinking about it, they all had at some point encountered ‘not so empowering, or negative communications between midwives’. With this project, the triplets wanted to explore whether this was prevalent on a larger scale. To their surprise, a large percentage of midwives admitted that they experienced negative communication from a colleague. The survey of this project was done with a questionnaire which was distributed at the 21st Congress of the Nordic Confederation of Midwives and answered by midwives from nine different countries in May 2019. There were 95 respondents between the ages of 20 to 61+ from student midwives to retiring midwives.
Edda asserts that this project looks at positive communication in addition to communication that can be improved. The triplets wanted to celebrate positive communication among midwives by interviewing several prominent midwives and getting their tips. They want to let women speak about their experiences so that they can talk to, respect and empower each other.
The results of this project will be presented at the International Confederation of Midwives congress in Bali in June 2021. With this conference, the team aims to provide their audience with tools that turn communication barriers into opportunities for better collaboration. These tools come from several influential and prominent midwives that have shared their tips/tricks for positive communication with their midwifery colleagues.
Their research showed that 70% of midwives (from a range of different ages, departments, and countries) have experienced communication and collaboration with other midwives that left them feeling 'powerless'. 40% of midwives reported that these communication barriers affected the care of their patients. 85% also reported having experienced communication/collaboration that was empowering, 100% found the topic of improving intercollegial communication ‘very important’ or ‘important’.
Merel has a diverse professional background. Before she became a midwife, she did her Bachelors in Art History, Masters on Journalism in the Media, and later worked with a Dutch feminist magazine. She has also worked to clean up the Pacific Ocean from plastic for a large project founded by a person in her hometown. Merel started her midwifery education at the age of 30. When she began her studies, she understood that midwives are very passionate and very hard working caregivers, but at the same time, they are afraid to show their presence online.
Harpa became a midwife so that she could be with a woman when they needed someone the most. Harpa continued with her midwifery studies right after graduating from nursing school. She now works with a standalone midwifery practice. Their mission is to practice continued care with parents during the pregnancy, when the baby is born and after delivery. This lets them know the family throughout time even more deeply to help them give better support.
Harpa was unable to go to the Netherlands for their first meeting because she was injured. Before Harpa and Merel met with each other, they already had plenty of conversations over the phone. So their first meeting was rather different from that of the other twins because they knew each other before seeing each other. Merel instantly became a part of Harpa’s family, and she even learnt Icelandic from Harpa's children. They both have dogs, value their family and love to have a walk in the outdoors. They like to explore unusual food from different countries. Once, they cooked butter chicken together, a North Indian cuisine.
Culturally, the Dutch happen to be blunt and direct about how they feel about different things. In their case, Merel says,
"I think Harpa is more Dutch than I am. It’s really nice to work with someone who speaks their mind."
Together, they admit that something extraordinary happened when they worked on their project together face to face, because at that time everything became easier and everything seemed to click.
Media is filled with misinformation on what birth looks like. With this project, Harpa and Merel wanted to encourage midwives to be more present on social media so that they can be the means of sharing and disseminating correct information about birth to women and their families. So they created a social media channel which can be used by midwives to inspire everyone. Their main aim is to promote normal birth.
One of the first exposures that common people have about birth is through movies. It is unfortunate and disturbing that these movies depict a very wrong picture of women giving birth. The worst, in fact, funniest part of this being a random man, who has had zero experience about midwifery and the physiology of birth, delivering the baby and being praised as the hero. Everyone goes “Wow!” The woman who has delivered the baby stays invalid. “It is the woman who is delivering her own baby, and these movies hail the man as a hero,” says Harpa annoyingly. These movies give another misinformation by always showing the birthing process on the bed. So having correct information on social media will make sure that people know what is the right way of delivery and what is wrong. Harpa further says, “We would like to meet these big shot producers and tell them how to do action when you deliver the babies.”
“We are available,” Merel challenged.
Choosing elective induction of labour – an informed choice or a wild guess?
Margretha has been a midwife for 22 years. When she was a child, she wanted to become a vet after being inspired by James Harriot. But she’s so pleased that midwifery stole her heart when she was a teenager. She’s working as a primary caregiver in ultrasounds, prenatal, natal and postnatal care and is very proud of the 60% rate of home births in the Netherlands. She thinks it’s a beautiful thing when career and passion comes together.
Hildur wanted to become a midwife ever since she was a small girl. She was involved with multiple fields before studying nursing in 2009, and then she studied midwifery. She is very happy with her job. She joined the Twinning Up project because she was looking forward to meeting midwives in the Netherlands and learning from them.
Vala is an Icelandic midwife specialized in ultrasound during pregnancy. She works at the Prenatal Diagnostic Unit at the University Hospital of Iceland. When she was 20 years old, she had a dream in which she was a midwife. After that dream, she wanted to know more about midwifery, and learn the differences between a midwife and a gynaecologist. After having done so, she decided to become a midwife. She says,
"The moment I see future parents looking at their baby for the first time on the ultrasound screen, I feel gratitude to be part of this experience."
Lianne has been a midwife for 9 years. She is doing her PhD, and is involved with policy development at the National Association of Dutch midwives. At a young age, Lianne wanted to become a hairdresser or anything that involved flowers and something fancy. Then one day, her Dad introduced her to the midwife profession, and since then, she was increasingly convinced that she really wanted to become a midwife. She works in primary care where she is involved in home births, ultrasound and contraceptive care. She calls herself a ‘midwife maniac’ as she finds herself talking about midwifery all the time.
Margretha and Lianne became direct colleagues during the course of the Twinning project. Margretha has also known Vala for a long time as she has been her trainee twice. She met her twin Hildur through this project. When she first saw Hildur’s picture, she thought of her to be a gorgeous Icelandic model. When Hildur saw Margretha’s picture, the first thing she noticed was her vibrant blue hair. They connect with each other as they both have an extraordinary love for wine, and often joke that maybe this is the reason why they were paired with each other.
Vala was worried and nervous before meeting her twin. She wondered how she would work with her for three long years if she happens to be a bad match. When she met Lianne, she found her to be a bright person with a lot of radiance. Lianne had the same feeling about Vala, and they immediately became friends. Both of them have similar personalities, are organised and are research minded. Previously, Vala had less connection with the postpartum care than the other fields of midwifery, but to her surprise she really enjoyed doing postnatal visits with Lianne in the Netherlands. This was due to the fact that in the meantime she had become a mother herself. During her visit to Iceland, Lianne was fascinated with walking on a volcano, and the experience of sitting inside a hot tub under the night sky.
The team has worked on a project that looked into the reasons why women choose to have their birth being induced. Pregnancy and birth are natural processes. Unless there is no medical reason, it is advised to wait for a spontaneous start of birth. Their initial plan was to interview women who asked for an elective induction, to learn about the reason for this request. In Iceland, however, they were not able to find women for the interviews which led to having a focus group on the topic about general knowledge of induction of labour and how pregnant women would like to receive information about induction if needed.. In the Netherlands, six women were interviewed who requested for an elective induction. Information from the interviews gave useful insights into the reasons why women ask for an elective induction, which information women have about induction of labour and what factors influence their decision.
With this project, the team wants to make sure that accurate information is available for pregnant women and prenatal care givers, so that they can make an informed decision. One of the findings of this project is that women often choose induced labour because of fear. Another finding is that women have little information about induction of labour. The team wants to provide easy understandable information, so women can make an informed choice.
During the project the interaction between the different countries was a great learning experience about cultural differences, differences between health care systems, and differences in de maternity care systems. According to Margretha and Lianne, the project could be improved on the content of the workshops. They also felt that knowledge about transformative leadership was missing.
No Pain No Gain
Nathalie has been working as a midwife since 2011. Before becoming a midwife, Nathalie worked at an insurance company in Amsterdam. One day, during a presentation at a management course in London, she realised that the purpose of her hard work was just to keep a few share-holders satisfied.
"At that moment, the concept of ‘shareholders-value’ really got me by my throat,"
she says. She thought that she would rather do something meaningful with her life so that she could make a difference for herself and other people. When she became pregnant, she visited an independent midwife at her hometown and enjoyed visiting her for prenatal consultations. “I was jealous of her profession,” she says. Gradually, she found out the ways to become a midwife, and succeeded to get into the midwifery academy. Today, Nathalie has her own midwifery practice in Holland.
Gulla completed her midwifery education from Denmark, and has been working as a midwife since 1998. She currently works at a midwifery led unit in Keflavik with eight other midwives. Her unit provides services on consultation, birth and afterbirth; and has arrangements for unplanned visits. Previously, she used to have a firm where she offered all kinds of products and services for pregnant women, including 3D scans, various treatments and courses. Gulla is also an aromatherapist and acupuncture specialist. She often uses the procedure of acupuncture on women during their pregnancy, birth and afterbirth.
Gulla and Nathalie’s first meeting was rather “awkward” says Nathalie. She first thought that she was paired with another midwife, while sitting next to Gulla, they engaged in a delightful conversation. Soon, her name was announced with Gulla as her twin. The two of them laughed about the incident, and quickly became friends. They both agreed that the event where they first met was rather too formal and controlled, so they were able to open up later as soon as they were with each other at Nathalie’s house.
The Dutch and Icelandic cultures are not very different from each other. However, little differences popped up when Nathalie and Gulla worked closely together. Regarding their work lives, Nathalie has her own practice where she attends home births. In Gulla’s case, women visit her institution for giving birth. Gulla, pointed out another difference, that in the Netherlands, a maternity nurse visits the homes of the new mother to help her with taking care of the baby for the next eight days after birth. In Iceland, midwives visit the new mothers too, but in Holland, the service is comparatively better.
Nathalie’s favourite moment in this journey is laying inside a hot tub in Krauma, under the starry sky with a nice glass of wine. The same is Gulla’s best memory as well. She has been at Krauma several times, yet the time she spent there with Nathalie was her favourite. Nathalie says that her concept of a swimming pool was something rather different from the pools in Iceland. When she first dipped her feet, she immediately felt relaxed and destressed. It was a cosy hot tub, and they even had steam cabins, dry saunas and ice baths.
Gulla and Nathalie had an awesome journey with each other, became each other’s dear friend, and often wondered how the project team managed to make such a perfect pair!
Gulla and Nathalie wanted to create something that addressed women’s labour pain during birth. Together, they have made an animation video with the help of Nathalie’s friend who has a film production company. One of the major challenges they faced was funding their video as making an animation is very expensive. However, Nathalie’s friend was really enthusiastic about this issue, therefore she offered a lot of discount to make this video for her.
This video has been made for young women, and pregnant women, to tell them that they should not be afraid of labour pains. It will inspire them to have trust and confidence in their own bodies and ability to undergo the birthing process as a woman.
Gull and Nathalie would like to thank ‘REDRUM Film and Animation Studio’ for their support.
How personal views and experiences of midwives’ influence women to have a normal birth
Sigrun used to work at a farm when she was in her teens. The farmer’s wife who was living at the farm was a midwife, and she taught Sigrun how to deliver lambs. “I learned from her how to deliver lambs and that was the beginning,” she says. Sigrun wasn’t exactly thinking of studying midwifery after graduating from nursing school. When she worked at a health center with mothers and newborn babies, it aroused her interest to learn more about the process of pregnancy and birth. Two years after she graduated as a nurse, she went to the midwifery school and started her practice as a midwife ever since.
Bjork started dreaming of becoming a midwife at the age of 17, when she herself was pregnant. One day, her aunt, who was then a midwifery student, was preparing for an exam. Curious, Bjork peeped over her aunt’s shoulder to take a look at what she was reading. This was her first introduction to midwifery. The moment she started her journey into midwifery after completing her nursing education, she has never looked back. Bjork completed her nursing study in Norway where she lived with her little family for many years.
One day, while Esther was thinking of what she wanted to pursue for a job, one of her friends told her that she was going to Belgium to study midwifery. That very moment, Esther thought that this might be a call for her. She joined her friend to study midwifery in Belgium after she finished nursery school. She started her midwifery career at the primary care unit. After she had two sons, Esther worked as a manager for 5 years, and it is during this time that she realised she was meant to be a midwife, not anything else. So she started working as a midwife again. She says, “Supporting women and taking care of them during their delivery is something that I love to do.”
Carola took her decision to pursue midwifery as her career when she visited a midwife for the first time with a colleague who was pregnant. After completing her midwifery education, Carola became a midwife in 1992, and began her practice at a little village in the South of the Netherlands. She says,
"It’s an honour to be part of such a special moment in somebody’s life."
Later, Carola became the Head of Midwives in the clinic. As being a midwife is a huge job, Carola wanted to ensure that midwives have a good position and work in good conditions. In this way, the work of midwives will be the best for women and babies. So she soon switched her career to Policy Management for Midwives. She says, “Decisions about midwives should be taken by midwives.”
Bjork, Sigrun, Carola and Esther are not two sets of twins, but one team of quadruplets. Esther says, “Bjork and I make a very well matched pair, but with the four of us, we are complete.” Carola says, “We are paired two and two, but most of the times the four of us were together during the project and the trips.” The advantage for them was that Sigrun and Bjork lived close, so the four of them could stay together most of the time in Iceland. For them, it is not just a project, but a relationship they have built and they hope to see each other in the future.
Bjork was very impressed with the way she was matched perfectly with Esther. She often wondered whether the project team somehow knew Esther and Bjork beforehand, and thought they would perfectly get along with each other. “We have families, we are married, we have worked in midwifery for a long time, we have a lot of common things. We are taking care of pregnant women in a similar environment, and we have a lot of things to talk about,” says Bjork. When Bjork visited Esther’s house for the first time, they were together in her backyard and drinking wine in front of a campfire. Esther says, “At that moment, she felt like a sister.” Both Esther and Bjork love being in nature, and have the same sense of humour.
Bjork’s favourite moment of this project was in Rotterdam when they spent their day on a boat. Esther’s favourite moments were in Iceland where she saw amazing things in nature.
Sigrun admits that she was a bit worried at the beginning about staying connected with each other over such a long period of time, and staying at each other’s houses. As soon as she met Carola and her group, her experience was rather ‘easy and very nice.’ Sigrun and Carola have met two times more than the other twins of this project, when Carola went to Iceland with her daughter, and when Sigrun went to the Netherlands with her husband for travelling.
Sigrun’s favourite moment was when she came to the little town where Carola lives, it was so cozy, lovely and welcoming. She felt awesome to have a nice walk and a bike ride there. For Carola, the memories of Icelandic nature were her favorite- the waterfalls, hot springs and steam coming out of the ground.
The team has created an infographic titled ‘Strong Midwives Make Strong Mothers’. During pregnancy, many women ask for birth with the help of pain relief and Caesarian section. The team believes that midwives have a huge role to play in influencing pregnant women to make an informed choice on what to do with their bodies for birth. Through this project, the team have studied and analysed the thinking of midwives, and tried to find how they think they play a role in the lives of pregnant women.
In Iceland, it was easy for Bjork and Sigrun to find the right midwives they wanted to interview, and organise a focus group discussion with them. In the Netherlands, it was difficult to organise a focus group discussion, so midwives were consulted via personal interviews.
One of the major challenges that was faced by the team was their language. Sometimes, they were unable to deliver their thoughts in a fluid manner because English was not their first language. However, the team was quick and smart to work on their barriers. Bjork and Sigrun communicated in Icelandic with each other, while Esther and Carola communicated in Dutch. This is how they made sure that the project kept progressing despite their differences.
The infographic has been created for midwives in the Netherlands and Iceland, but Sigrun, Bjork, Esther and Carola hope to reach midwives and mothers across different countries. The team wants midwives everywhere to be aware of their role as a midwife, and to know that they have the power to influence women to have trust in their bodies and choose a normal birth.
Enhancing leadership in midwifery curriculum on promoting normal birth
Leonie has worked as a midwife for 25 years in Arnhem, the East of the Netherlands. She later worked as a teacher for 15 years at The Midwifery Academy in Rotterdam. When Leonie was young, studying German was her first choice and midwifery, second, but as she started studying midwifery, it turned out the other way around. While she was studying midwifery, she fell in love with the work and the fact that midwifery involves working with strong and healthy women.
Berglind works at the University of Iceland. She studied philosophy when she was young, and sometimes felt it dissolved her picture of the world. At the age of 23, she saw she had to pursue a profession that would rather make her happy and help make sense of the complexity of life. All of a sudden, she had the idea to become a midwife. When she started diving into midwifery, it became a political and ethical passion for her. She says,
"Midwifery is a profession that matters to the foundation of society, so it became a different type of passion not just to make myself happy, but also to make a difference in the world."
Olof Asta has been working at the University of Iceland since 1995. She started studying midwifery when she was twenty years old. When Olof Asta was 12, she knew a midwife who just became a grandmother. When Olof was passing the hospital, the midwife who attended the birth called to Olof, “Come and meet this baby.” Little Olof Asta was not clean as she had been busy haying at the sheep shed, yet she was given the baby in her arms. This little moment stirred a chord in her heart, and must have inspired her to study midwifery. Olof now teaches midwifery and is happy to lead her students in their birth of becoming a midwife.
Elke has worked as a midwife for more than 20 years, and has been working as a midwifery teacher for the last 12 years. Her passion for midwifery began at a very young age of 6, when she accompanied her pregnant aunt to visit her midwife. She says, “All my life was about being a midwife. After becoming a midwife, I focussed on doing research, and after that, in being a politician. A lot changed, but being a midwife was something that never changed in my life.”
Elke and Berglind are very structured and organised with their profession. When they first met, they were very ambitious and goal driven. When Berglind met Elke, the first thing she saw was her kindness. She says, “Elke is such a wonderful person to be around.” After spending much time with each other, Elke says that from Berglind, she learnt how to be positive even during hard times, and how to make the best out of bad experiences. During their journey, the twins had a realisation about the staple food of their own countries. Due to their history, Iceland relies on animal based food like meat and dairy products. While in the Netherlands, their staple food is based on agriculture.
Elke’s favourite moment with Berglind was the simplest moment of sitting with her and watching television together, and talking to each other about their lives and their profession. Berglind’s favourite moment was similar; sitting in a little cottage outside Amsterdam and having a deep conversation about their families.
Leonie and Olof Asta first met at Schiphol Airport in Amsterdam. They have a lot in common, the most prominent one being the fact that both Leonie and Olof Asta have had hip replacements. Olof says, “I had this notion that we had met before. It was easy to connect on the spot.” One of the dearest memories Olof Asta narrates is when Leonie helped her to get dressed in her Icelandic costume for the Icelandic Conference. Instead of calling her sister, she had Leonie.
A major difference that Leonie noticed was the way in which the Dutch and Icelandics consume their energy and resources. “In the Netherlands we really try to keep the warmth inside in winter, because energy is very expensive. But then in Iceland, and it is normal for them to keep the window and doors open even when it snows.” says Leonie.
Leonie and Olof Asta connected with each other’s families in a deep way. Leonie had a wonderful moment watching ‘Frozen’ with Olof Asta’s little grandson, who even taught her a little Icelandic. Similarly, Olof Asta felt at home when she went to Leonie’s house and in the evening they watched the news together with her husband Frank.
The current curriculum for midwifery contains all the elements needed to enable someone to have knowledge on midwifery, but one thing that can be enhanced is- leadership skills. A new education module can be the first step in a domino effect that will increase the midwives‘ leadership skills and influence. It will empower women and their families, and promote normality in childbirth.
The first step of this project was conducting a qualitative research in the Netherlands and Iceland to find out what they felt was missing from the midwifery curriculum. Based on the findings of this research, the team developed a new educational midwifery module on enhancing leadership on promoting normal birth. This new education module was tested in both countries on a pilot basis to see how it works. Changes and adjustments were being made in this module continuously for its perfection. Currently, the midwifery schools who were involved are in the process of implementing the whole module or a part of the module where it fits best in their pre-existing curriculum.
The finalised module has been developed to involve issues on empowerment, advocacy, gender and feminism. It includes lectures on social media presence and presentations, keeping in mind the power and influence of technology and screens in the present and future. Using this module, students will be taught the art of persuasion in a rhetorical situation, and engage in role playing exercises. Lastly, it includes an optional assignment where students will work to promote normal birth on social media.
The team believes that: When midwives are empowered, so are the mothers; and promotion of physiological birth can give them healthier and better birth experiences. “Every midwife can become a leader, and it is our responsibility in education to provide our students with the tools to become leaders,” says Berglind.
Contractions: The Politics of Midwifery
Inga graduated from midwifery in 2018. She lives in Reykjavik with her partner and nine month old baby boy. When Inga was 8 years old, her parents had twin babies, but they passed away as soon as they were born. Inga, who was a child herself, was sad about the fact that she couldn’t help her mother. That was the first time she thought of what she wanted to do in her future. Six years later, her baby brother was born. She was happy to be present at the birth. With this experience of seeing her mother give birth to her little brother, she was sure that she wanted to become a midwife when she grew up. Inga now works as a midwife at the National Hospital of Iceland.
Rodante graduated from midwifery in February 2020. She studied philosophy, and is currently pursuing PhD where she is looking at obstetric violence from a philosophical point of view. She is working at an independent home birth clinic in Amsterdam. One day, Rodante was playing Scrabble with her mother, who made the word 'vroedvrouw' on the board, which translates to ‘midwife’ in English. Rodante looked up for more details about the word, and thought that midwifery was a really cool job. She worked as a maternity nurse next to her philosophy studies for a couple of years. In the Netherlands, one can become a maternity nurse quite easily. After finishing her studies in philosophy, she studied to become a midwife.
Rodante and Inga were both shy at their first meeting with each other. They spoke about politics, midwifery and the involvement of men during birth. They discovered that they have similar interests as they both enjoy writing and politics; not just politics related to midwifery, but politics at a broader scale. However, both Inga and Rodante have a difference in opinion about their political views, yet they have the same opinion about midwifery. Rodante says,
"It's interesting how you can be on the opposite sides of the spectrum yet actually agree on midwifery."
Inga and Rodante remember and laugh about the fact that they have had bad luck while visiting places in both the countries. In Iceland, they drove to a museum which they found closed upon arrival. Similarly, when they visited a birth center in the Netherlands, it was closed too. So they ended up taking a nice walk and looking around the beautiful cities.
Both Inga and Rodante are passionate about politics. Together, Inga and Rodante are creating a series of podcasts titled ‘Contractions’, which connect personal stories of midwives to national political issues. With the podcasts, they want to bring out stories of the struggles and frustration of midwives in their day to day life. “This will help midwives realise that they are not alone with their experiences,” says Inga.
In the year 2018, there was a strike in Iceland where midwives protested against the government for not coming to a final decision regarding the contract and salaries of midwives, in spite of having multiple meetings. The protest received huge support from society and families in Iceland. The protest finally ended with the government accepting the demands made by the midwives. Inga and Rodante believe that all over the world, midwives undergo struggles in various forms that are related to their work. In the Netherlands, the midwives work independently, but their job is as precarious. They interviewed the leader of this strike for one of their podcasts with the hope of reaching out to midwives in other countries too, so that they are inspired to put forward their demands in front of their government and hope for a solution.
“Contractions is a podcast about the politics of midwifery wherein midwives labour through political ideas, contract utopian visions into our ears and where every pain brings us closer to better birth. All ‘contractions’ (i.e. episodes) address the analysis and practical change of political issues- such as obstetric violence, workload, sexism and racism. The contractions are performed by midwives. Every contraction is necessary to bring closer a world wherein we can give birth more freely, equally, and emotionally and physically safe.” -Inga and Rodante
Positive Birth Stories
Erna has been a midwife for 31 years. She lives with her husband, and has one son and two daughters. She loves sports and adventure such as skiing, snowboarding, diving, sailing and ice-skating. Erna was inspired to become a midwife from her mother, who had delivered six babies. Her mother used to tell her beautiful stories of strong women delivering babies that sounded almost magical to her. She was curious and fascinated with the biology of a baby developing inside its mother’s womb, and wanted to be part of a process which involved bringing this little human into the world.
Steina has been a midwife for 18 years. She loves staying outside and hiking up the mountains, and has just begun to learn golf. She has recently become a grandmother to a baby boy, and has a granddaughter who is 6 years old. A fun fact about Steina is that her daughter-in-law is a midwife, and so is her mother-in-law; which means that they are three generations of in-laws who are midwives! Steina became interested in midwifery when she saw the work of her mother-in-law, and took the decision to become a midwife after having her two sons.
“Steina was the first Icelandic midwife to come out of the gate at Schiphol Airport. I was rather emotional because after we have been talking about the project for weeks and weeks, now the moment was there,” says Erna. They both became friends immediately, and throughout the project, have not faced any issues where they did not agree with each other.
Erna remembers the Nordic Conference in Iceland as one of her most favourite moments, as she was excited to see Icelandic midwives in their national costumes. Erna and Steina enjoyed staying at each other’s homes, meeting their families and visiting their workplaces. They work at the same kind of practice with new mothers. Both of them are teachers, researchers, and board members, but what came as a surprise to them was that they both had an equal passion for handicrafts and knitting.
Steina is battling cancer, and has been ill since last year. “Yet,” says Erna,
"She stood strong and confident, and carried out her work with no compromises."
Steina says, “Erna pulled me up and assured me that it was possible to still continue with the plans we had made. She has been an inspiration for me throughout this journey.”
Erna and Steina created two videos to share stories of positive birth experiences. The purpose of these videos are to show that giving birth with a midwife at home, or in a midwife led unit is safe. “So we are ‘advertising’ normal births, because there have been too many medical interventions in the birthing process,” says Erna. Steina adds, “We chose to do interviews with women who have experienced giving birth, because we wanted to listen to the women and we wanted other women and families to hear that giving birth with just midwives in a midwife led unit or at home is safe.” The interviews were taken in Ducth and Icelandic, but the videos contain English subtitles to help people from different parts of the world understand the experiences and get inspired.
Erna and Steina interviewed new parents in their own countries, where they spoke about their experiences with pregnancy, their thoughts and feelings before birth, and after their baby was born. In Holland, it is common for women to give birth at home. The Dutch video shows the new mothers very relaxed about their birth experience. Their calmness could be sensed in the way they narrate their stories. In the Icelandic video, the new parents narrate how they prepared themselves by doing yoga and exercise before they went through the labour process. The videos also emphasise that even when there is a difficult or complicated birth, a woman can still have a positive experience.
An individual’s context and personality are two different things that are often intertwined, yet appear independent from each other. In many ways the process of twinning is like slow cooking. For this reason it needs time. In the case of the Twinning Project, that was three profound years. During the twinning process, twins get to know each other as human beings. For relationships to build trust, a fair amount of friction experienced as a shared problem is necessary to get to know each other and bond. This supports people to learn to trust each other.
‘Twinning’ is not linear. It is a complex process. This complexity is best navigated by understanding the complexity, by paying the needed attention to the different contexts of the twins and accepting that twins are adults who are part of an evolving process. Being prepared for unexpected things to happen and open to change direction when necessary is crucial for twinning to be successful.
This three-year long journey did not just create products, but most of all, it created relationships between people that can last for their lifetime. One of the midwife twins, Esther Nieuwschepen-Ensing says, “Before, Iceland was just another country in the North. But now, I have a twin sister there.”
The Royal Dutch Organisation of Midwives (KNOV)
Icelandic Midwifery Association
Edythe L. Mangindin
Ásta Dan Ingibergsdóttir
Hanna de Klerk
Carola J. M. Groenen
Edda Rún Kjartansdóttir
Hrafnhildur Lóa Guðmundsdóttir
Guðlaug María Sigurðardóttir
Harpa Ósk Valgeirsdóttir
Margretha van Riemsdijk
Inga María Hlíðar Thorsteinson
Rodante van der Waal
Ólöf Ásta Ólafsdóttir
Leonie D. Welling
Steina Þórey Ragnarsdóttir
Moeders voor Moeders
RedOrange Media and Communications
Nujhat Jahan Khan
RedOrange Media and Communications