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Partnership and reciprocity with women sustain Lead Maternity Carer midwives in practice

By McAra-Couper, J, Gilkison, A, Crowther, S, Hunter, M, Hotchin, C, Gunn, J
on Sunday, 01 Jun 2014 in New Zealand College of Midwives Journal - Volume: 49

New Zealand has a unique maternity service model, whereby women at low risk of complications receive their maternity care from a community based Lead Maternity Carer (LMC) who is usually a midwife, but could be a general practitioner or an obstetrician. Over 80% of women in New Zealand choose to have a midwife as their LMC (Grigg & Tracy, 2013; Guilliland & Pairman, 2010). LMC midwives practise under contract to the Ministry of Health, taking a caseload and providing continuity of care (which requires being on call) for the women booked with them. This qualitative descriptive research set out to understand what sustains on call case- loading LMC midwives who have practised as LMCs for at least eight years. Eleven midwives with 8 to 20 years in practise were recruited and interviewed. Thematic and content analysis was carried out on the data. This article presents an overview of the findings from this study and extracts of selected data. Themes emerged from the findings which described how midwives were sustained in on call, caseloading practice. Themes identified include: the joy of midwifery practice; working in partnership; supportive family relationships; supportive midwifery relationships; generosity of spirit; like-minded midwifery partners, practice arrangements; managing the unpredictability of being on-call; realising one is not indispensable; learning to say “no”; negotiating and keeping boundaries; and passing on the passion for midwifery. This paper is the first in a series. It explores the themes of partnership, and how working in partnership sustains the joy of practice and provides context to the study. Future papers from the study will report on other themes from the study. The significance of this research is that it informs present and future maternity service provision and education.

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Smoking prevalence trends: An analysis of smoking at pregnancy registration and at discharge from a midwife Lead Maternity Carer, 2008 to 2010

By Andrews, A, Dixon, L, Eddy, A, Guilliland, K, Fletcher L, Houston, J
on Sunday, 01 Jun 2014 in New Zealand College of Midwives Journal - Volume: 49

Background: Smoking during pregnancy has a detrimental effect on both maternal and neonatal health. The government has agreed a long term goal for New Zealand (NZ) to become a smoke-free nation by 2025, with smoking cessation during pregnancy a government priority. Contemporary information, reviewing the prevalence and demographics of women who smoke during pregnancy, is important so that change can be monitored and cessation support appropriately targeted. Aim: To examine the prevalence of smoking for 81,821 pregnant women who registered with a midwife Lead Maternity Carer (LMC) between the years 2008 to 2010. Methods: A retrospective observational design using aggregated clinical data from the New Zealand College of Midwives clinical outcomes research database (COMCORD) for the years 2008 to 2010. Women’s self- reported smoking or smoke-free status was recorded at registration with, and at discharge from, a midwife LMC. Findings: A trend of reduced smoking prevalence at registration was found for this NEW ZEALAND RESEARCH cohort (reduced from 19.5% in 2008 to 18.4% in 2010). Women who identified as Maori had the highest rates of smoking (42.9%) followed by Pasifika (15%) and NZ European ethnicity (13.4%). Women in the 16 to 19 years age group had the highest rate of smoking (39.4%) followed by the under 16 years age group (35.7%). Increasing parity was also associated with an increased likelihood of smoking at registration. By discharge from midwifery care there were reduced rates of smoking across all groups. Conclusion: Overall smoking during pregnancy prevalence rates are trending down with reduced rates of smoking across all groups by discharge from a midwife. Cessation messages and support need to be targeted to young women (under 25years), multiparous women and women of Maori ethnicity.

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Pethidine: to prescribe or not to prescribe? A discussion surrounding pethidine's place in midwifery practice and New Zealand prescribing legislation

By Goodson, C, Martis, R
on Sunday, 01 Jun 2014 in New Zealand College of Midwives Journal - Volume: 49

Changes to the New Zealand Misuse of Drugs Act (1975) regarding the prescription of opioids by midwives are currently under discussion. At this time, pethidine is the only controlled drug able to be prescribed by New Zealand midwives. Pethidine is a synthetic opioid which affects the transmission of pain signals to the central nervous system and induces a state of euphoria and sleepiness. It was first used in midwifery in the United Kingdom to sedate anxious women and was never intended to be prescribed for pain relief. Despite the widespread belief that pethidine is effective at reducing pain and shortening women’s labours, the available evidence does not support this. Significant side effects for both the woman and the baby raise further questions about the suitability and safety of pethidine use in New Zealand maternity care. Relevant New Zealand legislation is currently under review with the potential for changes enabling midwives to offer a wider range of opioids. This article represents sections of a case study submitted as part of the requirements for the third year of study towards a Bachelor of Midwifery at Christchurch Polytechnic Institute of Technology (CPIT). It investigates the use of pethidine as a pharmaceutical method of pain relief in the New Zealand context, and the effects of its administration on the length of a woman’s labour and on neonatal outcomes. Considerations for, and potential changes within, midwifery prescribing practices are then discussed.

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The emotional and hormonal pathways of labour and birth: integrating mind, body and behaviour

By Dixon, L, Skinner, J, Foureur, M
on Sunday, 01 Dec 2013 in New Zealand College of Midwives Journal - Volume: 48

Background: Women have described normal labour and birth in terms of their emotions. Major advances in knowledge have occurred within the sciences resulting in an understanding of emotions as prime directors of human behaviour which is orchestrated by neurohormones. Method: This paper focusses on key aspects of contemporary knowledge of childbirth physiology, neuroscience and behaviour. It integrates this understanding with women’s descriptions of their emotions during labour. Findings: Neurohormones associated with labour and birth are designed to trigger a transformation in the body and behaviour and create an environment which supports both the mother and the baby. Hormones and emotions are intertwined and interconnected. Labour hormones are linked to the woman’s emotions and behaviour during labour and birth as well as the physical signs of labour. An interactive model is presented which explains labour in terms of both the physical effects and the emotional affects that women have described as part of their labour experience. The hypothesis for this model is that the hormones that initiate and sustain labour also cause the instinctual emotions that women feel, and the behaviour they exhibit, during spontaneous labour and birth. Conclusions: Hormonal changes are necessary to support the physical and emotional changes during labour and birth. The neurohormones which operate during pregnancy and during labour and birth also support PRACTICE ISSUE parenting behaviour. This paper integrates the contemporary scientific understanding of the role of neurohormones and their association, with the woman’s behaviour and emotions during labour. It argues for, and provides the foundations of, a new conceptual framework for understanding labour and birth, one which integrates mind, body and behaviour.

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Gastro-esophageal Reflux in Breastfed Babies: What's Missing?

By el Banna, H, Jutel, A
on Sunday, 01 Dec 2013 in New Zealand College of Midwives Journal - Volume: 48

Breast milk is the food of choice for babies under six months. However, babies experiencing gastro-esophageal reflux (GER) are often prematurely weaned from the breast. A discursive literature review method was used to identify how research available to health care professionals considers the place of breast milk and breastfeeding (BF) in the presence of GER. Searching PubMed and CINAHL for the terms “gastroesophageal reflux” OR “gastroesophageal reflux” in healthy babies, and in articles that discuss non-pharmacological management of babies with GER, 54 articles were located and 27 articles related to babies with GER met the inclusion criteria. The articles are divided into three groups: those that make frequent reference to breastfeeding/breast milk, those that mention breastfeeding/breast milk briefly, and those that make no mention at all—resorting to management strategies that focus on the formula-fed baby. This discursive literature review demonstrates that breast milk and breastfeeding are not widely considered in publications about GER. Formula milk would appear to be the default food for babies who have GER. There is a need for more research, new recommendations and support for breastfeeding mothers who have babies experiencing GER.

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A case of anencephaly: integrated palliative care

By Chapman, B
on Sunday, 01 Dec 2013 in New Zealand College of Midwives Journal - Volume: 48

Following a diagnosis of anencephaly at the 24 week anatomy follow-up scan this case study exhibits an approach that integrates the primary, secondary and community services while maintaining the family unit at the centre of care, when an outcome to a pregnancy is not what was originally envisaged. Hope’s journey illustrates how integration of the multidisciplinary hospital team and community care can assist and support the family when planning a way forward, tailored to the family’s personal, physical, emotional and spiritual needs. After her mother’s full term pregnancy and vaginal birth after caesarean section (VBAC), Hope was discharged home seven hours after her birth as her parents wished for palliative care. She lived 14 hours, a life filled with love, dying in her family home as her parents wished. This pregnancy and outcome was a highly emotional journey. The care the family received was compared to that of a perinatal palliative care model and identifies strategies that could be adopted by maternity teams for similar cases in the future.

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The safety-net: what influences New Zealand first-time mothers' perceptions of safety for self and unborn child?

By Howarth, A, Swain, N, Treharne, G
on Sunday, 01 Dec 2013 in New Zealand College of Midwives Journal - Volume: 48

Background: Pregnancy, labour and birth are times when a mother wants to ensure both her, and her developing baby’s, safety. An objective of the present study was to investigate New Zealand (NZ) primiparous mothers’ perceptions of what contributes to a sense of safety for themselves and their unborn babies. Method: A qualitative method was used to obtain an insight into childbearing experience and new mothers’ concept of safety. Ten New Zealand first-time mothers aged 24 to 38 years (median 31.5 years) participated. These women took part in a semi-structured face-to-face interview within 11 days to 16 weeks of giving birth (median 13.5 weeks). The interviews were audio-recorded, transcribed verbatim and then analysed using thematic analysis informed by Interpretive Phenomenological Analysis (IPA). Method: A core theme identified across transcripts was designated ‘safetynet’. This theme incorporated the four subthemes: care of self and unborn child; the importance of midwife skills; the availability of a hospital facility and its resources; and the availability of medical expertise and intervention. Conclusions: The present study highlights what influences first-time mothers’ perceptions of safety for self and unborn baby. Women sought out relevant information and managed important lifestyle changes. They took care over selection of a midwife. Additionally, the availability of a local tertiary care facility with highly skilled obstetricians, obstetric registrars, anaesthetists, paediatricians and hospital support staff increased participants’ perception of safety and gave them the confidence to select birth options suited to their needs.

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Editorial: Nourishing the relationship and encouraging the heart

By Patterson, J
on Sunday, 01 Dec 2013 in New Zealand College of Midwives Journal - Volume: 48

The role of relationships and support in successful birth experiences.

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Reflections on evolution

By Gunn, J
on Saturday, 01 Jun 2013 in New Zealand College of Midwives Journal - Volume: 47

The evolution of the New Zealand College of Midwives Journal.

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The shaping of midwifery education in Aotearoa, New Zealand

By Gilkison, A, Giddings, L, Smythe, L
on Saturday, 01 Jun 2013 in New Zealand College of Midwives Journal - Volume: 47

This paper reviews approaches to midwifery education from the 1900s to 2013. During this time, education has been influenced by various factors such as: midwifery registration, perinatal mortality rates, pain relief and technology for childbirth, educational theory, the consumer movement, midwifery autonomy and economic imperatives. The various factors have not only influenced what has been taught in midwifery education but how it has been taught (the pedagogical approach). Uncovering what has shaped the pedagogy assists in understanding assumptions about the way midwives are educated and opens the potential to consider new pedagogical approaches, such as narrative pedagogy.

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