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Midwifery Autonomy in New Zealand: How has it influenced the birth outcomes of New Zealand women

Abstract:

Until recently New Zealand and Australian midwifery has had little access to comprehensive national birth outcome statistics. A recent Australian study in the British Medical Journal (Roberts, Tracy & Peat, 2000) has given us a valuable bench mark. It analysed 171,000 women having a live baby during 1996 and 1997 in New South Wales, Australia. The strength of this study is in its size and the validity of the population database it studied. The results are a salutary cause for serious reflection on how environment and choice of care provider can influence birth outcomes even in healthy “low risk” women. The study shows the often-talked about cascade effect of obstetric interventions when applied to low risk primaparous women. The more birth was managed, the more the interventions accumulated (epidural, induction, or augmentation). Among low risk nulliparous women in private hospitals only 18 per 100 achieved a vaginal birth without any intervention, compared with 28 per 100 private patients in public hospitals and 39 per 100 public patients. A similar pattern was shown for low risk multiparous women (39 per 100 private hospitals, 51 per private in public hospital and 67 per 100 in public hospitals).

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autonomy, birth outcomes, cascade effect, intervention