Midwives in the Americas Region achieve communication, collaboration and celebration: the ICM Americas Regional Conference, Port of Spain, Trinidad, April 23-24, 2004, broke new ground in bringing together 450 midwives from across two continents.

'Midwifery in the Americas: yesterday, today and tomorrow'--this was the theme of the conference: exceptionally well-chosen to encourage a wide range of excellent papers to be presented, and at the same time offering an over-arching concept that most fittingly symbolised the bringing together of disparate ideas, cultures and geographical backgrounds, while underlining that these are all part of one broad spectrum. The notion that the skills of midwifery in the past, complemented with the knowledge of the present, can lead to improved wellbeing for mothers and babies in the future, was all-embracing. In nearly every individual presentation, there was an acknowledgement of this truth, as tribute was paid to the value of experience and tradition, while there was no lack of keenness to harness the power of new technologies.

The conference and its associated events provided an action-packed week in all, and this short report aims to describe only some of the many highlights, but future issues of IM will include more details of some of the ICM activities.

Traditional midwifery in the Americas

The vivid presence of a number of traditional midwives at the conference was a reminder of those countries whose existence rarely impacts on inhabitants of the industrialised world, among them El Salvador, Guatemala, Honduras and Nicaragua. The world's media do not report on famines, conflicts and disasters in these countries: their populations are small so numbers of deaths do not grab the headlines. Nevertheless, the maternal mortality ratios are 183, 267, 221 and 246 (for every, 100,000 births) for these countries respectively. They have large families so the risks for women are high. There is no national midwifery service, and doctors are few and far between--effectively unreachable for most families in rural areas. The thinly stretched network of traditional midwives is the only source of care mad support for these women.

Alicia Huete Diaz, known as 'Mama Licha', a traditional midwife in Nicaragua, spoke movingly of the lives of herself and her colleagues. The traditional midwives in general do not receive state funding. They are dependent on what their clients can pay which may be little or literally nothing. Most midwives practise another trade or craft, often pottery or basket-weaving, to help provide an income. This profound poverty shared by cater and families is the root of the prevailing poor health outcomes in childbirth, rather than the...