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Caring in action: Midwives’ approaches to supporting perinatal mental health in Aotearoa New Zealand

By Roia, T., Barber, C. C.
on Thursday, 21 Aug 2025 in New Zealand College of Midwives Journal - Volume: 61

Background: Pregnancy and the postnatal period are particularly vulnerable times for mothers’ mental health, with an increased risk of women experiencing depression and anxiety. In Aotearoa New Zealand, midwives are uniquely positioned to provide support to women during this critical time, often filling gaps in mental health services. Aim: The qualitative study, based on a select sample of midwives, aimed to explore the tools and resources that these lead maternity care (LMC) midwives find most helpful in supporting women experiencing mental distress during the perinatal period. Method: Using a strengths-based approach, the study recruited seven Aotearoa midwives with a particular interest in mental health. These midwives participated in semi-structured online interviews to share their experiences and insights regarding the practices they find most helpful and the barriers they encounter. Data were analysed using inductive thematic analysis. Findings: Five key themes emerged from the analysis: (1) Screening: “Sometimes we have to sit and unpack it”; (2) Being with: “A listening ear” and beyond; (3) Connecting: “A wraparound type of approach”; (4) Up-skilling: “It should be there for all of us”; and (5) Barriers: “You have to be at the bottom of the scale”. The midwives’ stories revealed their deep empathy and care, as well as the complexity of referrals and challenges in accessing mental health services, which were central to the midwives’ frustration around their ability to fully support mothers. Conclusion: The study highlights midwives’ relational continuity of care as a key strength for supporting perinatal mental health. Their deep empathy and trust built with women underpin their role in mental health screening, advocacy and referral. Enhancing midwives’ capacity, through targeted education, culturally appropriate resources and greater access to mental health services and resources, will help address existing gaps and build on these strengths.

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Exploring the midwifery workplace environment in Aotearoa New Zealand over the three years 2019-2021

By Dixon, L., Clemons, J. H., Mharapara, T.
on Tuesday, 01 Jul 2025 in New Zealand College of Midwives Journal - Volume: 61

Background: A global and national shortage of midwives has made retaining the current workforce in Aotearoa New Zealand increasingly important. Understanding the contemporary workplace environment is essential for retention. Aim: To explore midwives' work environment in Aotearoa New Zealand over three consecutive years (2019-2021). Method: A cross-sectional study was undertaken using an online survey in three consecutive years (2019-2021). The survey gathered demographic data, paid and unpaid work data, work settings and working hours. The survey tools used to describe midwives’ workplace conditions were: Quantitative Workload Inventory, Job Satisfaction Scale, Pay Satisfaction Scale and Work-Life Balance Scale. Findings: The 1766 total participant responses, distributed sequentially across the three years as n = 758, 506 and 502, represented 18% of all registered midwives. Overall, the midwives reported high levels of job satisfaction but low levels of pay satisfaction. Assuming significance is p < .05, variance analyses identified that job satisfaction (Mean [M = 4.31; Standard Deviation [SD] 0.94), pay satisfaction (M = 2.53; SD 1.1), and work-life balance (M = 3.21; SD 1.10) were significantly higher and workload lower (M = 4.31; SD 1.12) for 2020 when compared to 2019 and 2021. Job satisfaction levels for caseloading midwives (M = 4.22; SD 0.9) and those in other mixed roles (M = 4.17; SD 1.01) were significantly higher than for midwives working in secondary (M = 3.81; SD 0.98) and tertiary (M = 3.77; SD 1.01) units. Quantitative Workload Inventory reported significantly higher mean scores for midwives working in tertiary (M = 5.35; SD 0.88) and secondary (M = 4.84; SD 1.03) settings when compared to those working in caseloading (M = 4.09; SD 1.05), primary unit (M = 4.19; SD 1.3) and other mixed role (M = 4.32; SD 1.24) settings. Conclusion: Overall, midwives reported high job satisfaction, but this was alongside high workloads and low pay satisfaction. When work settings were compared, midwives working in secondary and tertiary hospitals reported higher workloads and fewer working hours than those working in primary and other mixed role settings. High workloads and low job satisfaction are risks to workforce sustainability.

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Comparing perinatal outcomes for healthy pregnant women presenting at primary and tertiary settings in South Auckland: A retrospective cohort study

By Farry, A., McAra-Couper, J., Weldon, M. C., Clemons, J.
on Monday, 31 Mar 2025 in New Zealand College of Midwives Journal - Volume: 55

Background: Strong evidence supports the premise that many low-risk women and babies experience perinatal outcomes, in a free-standing, midwifery-led, primary level maternity unit (PMU) similar to, or better than, those of an obstetric-led tertiary level maternity hospital (TMH). Aim: The aim of this study was to identify whether place of birth affected measurable maternal and neonatal outcomes in a low-risk cohort within one New Zealand District Health Board. Method: We gathered the birth records of a retrospective cohort of low-risk women (n=4,207), who had birthed within two distinct environments, including one TMH and three PMUs. Comparison was made of three maternal outcomes: emergency caesarean section, acute postpartum admission to theatre/high dependency unit/intensive care unit (<12hr post birth) and postpartum haemorrhage (PPH; >500ml). Neonatal outcomes analysed were 5-min Apgar score <7 and acute neonatal admission to neonatal intensive care unit (NICU; <12hr post birth). Findings: Logistic regression of data revealed statistically significant associations between place of birth and the five perinatal outcomes. Low-risk women giving birth in one of the three PMUs had fewer emergency caesarean sections (OR 0.25, 95% CI, 0.157-0.339), PPHs (OR 0.692, 95% CI, 0.534-0.898), and acute postpartum admissions to theatre (OR 0.201, 95% CI, 0.102-0.398) than women giving birth in the TMH. Babies born to women at a PMU were less likely to experience a 5-min Apgar <7 (OR 0.313, 95% CI, 0.124-0.791) or acute neonatal admission to NICU (OR 0.492, 95% CI, 0.324-0.747) compared to babies of women of similar risk status, born in the TMH. Conclusion: Low-risk women birthing in PMUs in South Auckland, New Zealand, experienced a significant reduction in morbidity for themselves and their babies.

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Erratum to “Comparing perinatal outcomes for healthy pregnant women presenting at primary and tertiary settings in South Auckland: A retrospective cohort study” [New Zealand College of Midwives 55 (2019) 5-13]

By Farry, A., McAra-Couper, J., Weldon, M., Clemons, J.
on Monday, 31 Mar 2025 in New Zealand College of Midwives Journal - Volume: 61

The Publisher regrets that an error appeared in Table 5 of this article. The numbers and percentages for acute postpartum admission to HDU/ICU/theatre “Yes” occurrence were incorrectly stated as PMU n = 85 (7.8%), TMH n = 371 (13.0%). They have been corrected to PMU n = 9 (0.8%), TMH n = 126 (4.1%).

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Understanding midwives’ perspectives about trans inclusion in perinatal care in Aotearoa New Zealand: A national survey

By Miller, S., Parker, G., Ker, A., Kerekere, E., Veale, J., Baddock, S.
on Tuesday, 18 Mar 2025 in New Zealand College of Midwives Journal - Volume: 61

Background: As awareness of the possibilities for trans people to attain parenthood grows, trans, non-binary and other people with diverse genders are increasingly accessing perinatal care as part of their family-building journeys. International literature confirms that midwives can feel clinically challenged by, and poorly prepared for, working with pregnant trans people, but also that they are motivated to provide high quality care and desire professional support to do so. This two-phase study included interviews with trans people who were or had been pregnant, and/or whose partners were or had been pregnant, which informed the development of a nationwide perinatal care workforce survey. Aim: Phase Two aimed to identify current practice relating to inclusion, and the knowledge, beliefs and education needs of the perinatal care workforce in relation to working with pregnant trans people. Method: An online nationwide survey of perinatal care providers was undertaken in 2022. Data were collected through single- and multi-response questions, Likert scales and open-ended text boxes. Analyses included descriptive statistics and content analysis of open-text responses. Results: Of 476 respondents, this paper reports only the midwives’ responses (67%; n = 317). Fewer than 25% of midwives recalled receiving any specific education about providing culturally safe care for trans people, but most (78%) identified interest in accessing education if it were made available. Midwives are knowledgeable regarding some clinical aspects of gender affirming care, e.g., the effects of hormone therapy on fertility, but we identified some knowledge gaps. Most articulated positive attitudes towards caring for pregnant trans, takatāpui and intersex people but a minority raised concerns about what they perceived as the ‘erasure of women’ within wider efforts to be inclusive. Many noted workforce pressure as a barrier to progressing change. Conclusion: Some midwives are already implementing inclusive practices, primarily led by Lead Maternity Carers (LMCs) who champion affirming and inclusive community-based care. Ensuring that trans people and whānau can anticipate consistently affirming care when they engage in services beyond their LMC, particularly during hospital-based care, needs prioritisation as a workforce development strategy. To date, midwives have not been well prepared to provide inclusive care to this community, but they are willing to engage in education to support affirming and inclusive practice.

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“It’s a given now, that’s just how we communicate”: Pregnant people’s experiences with using communication technology when connecting with their midwife

By Wakelin, K., McAra-Couper, J., Fleming, T.
on Wednesday, 05 Feb 2025 in New Zealand College of Midwives - Volume: 61

Introduction: Effective communication between pregnant women/people and midwives is important in establishing trusting and respectful relationships. Texting and email have been shown to be convenient ways for people to connect and share information. Aim: This paper reports on findings from interviews with pregnant and recently pregnant women/people on what is important for them when using communication technology to connect with their midwife. Method: Semi-structured interviews were conducted using an online platform. Two participants had previously completed an online survey in phase 1B of the multi-phase study and had expressed interest in participating further. Three other participants were recruited via a closed Pregnancy Facebook group and midwives. All participants were emailed an invitation to participate. Thematic analysis was used to analyse the interview data. Findings: Three themes emerged from the findings, highlighting what was important for participants when using communication technology with their midwife during their pregnancy: being known, access and connectedness, and the midwife recognised as a professional. Discussion: Being known was important when using communication technology, as it enabled respectful and trusting relationships to develop. These relationships were further enhanced through the functionality of communication technology which provided space for participants to compose messages and respond to their midwife, and through the convenience and flexibility with being able to communicate in a non-intrusive manner. The professionalism of the midwife was recognised with ensuring privacy of information, despite participants being unconcerned about privacy themselves. Conclusion: The knowingness that comes from a continuity of care relationship contributed towards a relationship of trust. This was reflected in the respectful choices made by the participants when using communication technology to connect with their midwife.

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Editorial: Evolution of the Journal in the last decade

By Davies, L.
on Wednesday, 18 Dec 2024 in New Zealand College of Midwives Journal - Volume: 60

In late 2014, I was invited to join the Editorial Board of the New Zealand College of Midwives Journal. I was honoured to accept this role, recognising the Journal as a cornerstone for advancing midwifery research and practice in Aotearoa New Zealand. During my tenure as sub-editor, the Journal has adapted to the evolving demands of academic, political and healthcare landscapes, while maintaining its commitment to being a high-quality publication. This editorial serves as an opportunity for me to reflect on the Journal's progress during the decade of my involvement, highlighting its successes, challenges and future directions.

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Women’s experiences of accessing maternal mental health support services: A scoping review

By Taynton, S., Waller, N., Crowther, S.
on Wednesday, 18 Dec 2024 in New Zealand College of Midwives Journal - Volume: 60

Background: Maternal mental health (MMH) conditions affect up to one in five women globally during pregnancy and the year following birth. Many of these women need to access MMH services. However, there is a paucity of research focused on the experiences of women accessing MMH services, in a global context. Aim: The aim of this scoping review was to explore studies that report on women’s experiences of accessing mental health support services within a global context. Method: Six databases were searched in July and August 2022 and May 2023. Only studies focused on the experiences of women with perinatal mental health conditions were included. Key information and findings from published studies were extracted and meta-synthesis was performed using thematic analysis. Findings: Sixteen studies were included, and three themes emerged: Barriers to accessing care, such as fear, stigma and logistical difficulties; Facilitators to accessing care, such as trusting relationships, social support and education; and System-related barriers to accessing support services, such as difficulty getting referrals, accessibility to services and long waiting times. Conclusion: The evidence suggests women’s experiences of accessing MMH support services are variable and influenced by cultural, psychosocial and system factors. Trusting healthcare provider relationships and continuity of care support women to disclose MMH concerns. Midwives are well placed to screen and refer women for MMH conditions; however, further post-registration education is needed. Further multi-agency and multi-professional research in New Zealand and globally would be beneficial in informing education, policy and practice recommendations, with the aim of specifically addressing the barriers to accessing MMH identified in this review.

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Birth in the time of COVID-19: Midwives’ experiences of providing care during the 2020 COVID-19 pandemic in Aotearoa New Zealand

By Miller, S., Griffiths, C., Dixon, L., Tamati-Elliffe, J., McAra-Couper, J., Gilkison, A., Jackson, T.
on Friday, 11 Oct 2024 in New Zealand College of Midwives Journal - Volume: 60

Introduction: During the COVID-19 pandemic lockdowns in 2020, midwives in Aotearoa New Zealand were classified as essential workers and continued providing maternity services in hospitals, birth centres and the community. Midwives adapted their practice, using virtual care and navigating the restrictions imposed on birthing women/people and their whānau. This paper reports on midwives’ experiences of providing care during the pandemic. Aim: To identify the impacts of the pandemic on midwives providing antenatal, labour and birth, and postnatal care to birthing women/people and their whānau during the 2020 Level 4 and Level 3 restrictions. Method: In-depth exploratory interviews and Braun and Clarke’s (2019) process of reflexive thematic analysis were used to explore impacts on the practice and personal lives of midwives. Findings: Fifteen midwives described their work-related challenges: significantly increased workloads, inconsistent messaging regarding practice guidance between health authorities and others, and limited access to personal protective equipment. Reflections about wider professional interests included these midwives’ immense pride in their profession and their increased agility in the use of new technologies. But these positive elements were juxtaposed against a perceived lack of recognition and financial support for their increased workloads, leaving midwives feeling marginalised and invisible. Midwives’ personal lives were significantly challenged by the stress and fear of facing COVID-19 itself, the juggle of managing their work and whānau lives, and their sense of conflict from feeling unable to practise in ways that aligned with their philosophies of inclusion and family-centredness. Conclusion: Despite challenges, these midwives were committed to whānau in their care and demonstrated resilience, adaptability and resourcefulness in meeting their needs. Health planners should recognise that, as a primary health service, a significant amount of midwifery care is provided in the community setting and future pandemic planning should ensure smooth provision of resources to community-based midwives. Streamlining of information from trusted sources, together with consistency across the country, will assist midwives to respond to health directives confidently.

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The shared journey of induced lactation: A case study

By Cleaver, D.
on Thursday, 19 Sep 2024 in New Zealand College of Midwives Journal - Volume: 60

Background: Induced lactation or adoptive breastfeeding is a little-spoken-of event and can be life-changing for participants. While not common, it is nonetheless within our realm of practice as midwives and, therefore, important that we understand how our role can support whānau who make this choice. Aim: The aim of this case study is to share a narrative of induced lactation and adoptive breastfeeding from the midwifery and whānau perspectives. The multilayers of midwifery care evident in this case study and breastfeeding success will be discussed, with the hope that this can also support midwives who are caring for LGBTQIA+ whānau who are inducing lactation. Method: This is an anonymised, “instrumental” case study that offers a first-person practitioner narrative and reflection of a single case, representative of a phenomenon that most midwifery tauira (see glossary) and early-career midwives may not readily observe first-hand. Discussion: Three important outcomes are noted. First, the intrapersonal and psychosocial factors that are part of the narrative were incorporated in a care plan providing holistic assessment and clinical decisions, acknowledging the gift of breastfeeding that carried a much larger significance than purely a nutritional choice. Second, collegial relationships support an inclusive experience for all involved. Third, re-telling, reflecting on and analysing the various elements in Anna’s story offer an educational example for in-depth learning and understanding. Conclusion: The professional responsibility of the midwife was a part of the process, and integral to Anna’s positive experience of induced lactation.

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