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Handing over the reins - an evolving Editorial Board

By Gilkison, A, Dixon, L
on Saturday, 01 Oct 2011 in New Zealand College of Midwives Journal - Volume: 45

New Zealand College of Midwives Editorial Board

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Being with women with risk: The referral and consultation practices and attitudes of New Zealand midwives

By Skinner, J
on Saturday, 01 Oct 2011 in New Zealand College of Midwives Journal - Volume: 45

Managing risk is an important part of a midwife’s work and the decision to refer for an obstetric consultation is one way that this is expressed in practice. The research that this paper presents took a mixed method approach and describes the referral for obstetric consultation practices and attitudes of New Zealand midwives. It found that the consultation referral rate was 35%, that there were a large number of reasons for referral, and that midwives usually continued to provide some midwifery care even when risk had been identified. Midwives spoke of the centrality of the woman despite her level of risk.

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First-time New Zealand mothers' experience of birth: importance of relationship and support

By Howarth, A, Swain, N, Treharne, G
on Saturday, 01 Oct 2011 in New Zealand College of Midwives Journal - Volume: 45

Background: Becoming a mother is a major developmental life event. The new mother may need to reorganize her priorities, behaviours, and goals to meet this new challenge while at the same time sustaining her sense of self. Support from others contextualises these adjustments, but little is known about mothers’ experience of support received from the range of people they interact with, in the build up to and during birthing. Method: A qualitative methodology was employed to obtain an in-depth insight into the birth experience of first-time New Zealand mothers. Ten participants aged 24 to 38 years (median 31.5 years) were interviewed face-to-face within 11 days to 16 weeks of giving birth (median 13.5 weeks). The semistructured interviews were audio-recorded, transcribed verbatim and analysed using a phenomenological form of thematic analysis. Results: A core theme identified as common across transcripts was relationship issues. Four subthemes were differentiated: midwife relationships; partner involvement; family and friend support; and continuous support. The midwife relationship was notably important to all participants. Partners were considered the primary providers of continuous support, along with family, friends and midwives. Participants wanted their partners fully involved for the support partners gave and as an acknowledgement of the changes occurring in their relationships, from couple-hood to family. Conclusions: The present findings reflect the importance new mothers in New Zealand attribute to relationships. Acknowledging the importance of relationships and encouraging relationship development are likely to enhance the sense of birth satisfaction felt by New Zealand first-time mothers.

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The effects of childhood sexual abuse on labour and birthing: An exploration to assist midwives

By Clark, E, Smythe, L
on Saturday, 01 Oct 2011 in New Zealand College of Midwives Journal - Volume: 45

The subject of childhood sexual abuse has found considerable attention in the popular press in recent times. While the common focus appears to be on the perpetrator of the abuse, less attention has been devoted to the effects of this abuse on the survivor, particularly on the effects for a childbearing woman. This article draws on the relevant professional literature and close observation using the heuristic of experiential anecdote to provide a practice context for midwives.

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Do low risk women actually birth in their planned place of birth and does ethnicity influence women's choices of birthplace?

By Hunter, M, Pairman, S, Benn, C, Baddock, S, Davis, D, Herbison, P, Dixon, L, Wilson, D, Anderson, J
on Sunday, 01 May 2011 in New Zealand College of Midwives Journal - Volume: 44

Purpose: Midwives practising as lead maternity caregivers in New Zealand (NZ) provide continuity of care to women who choose to give birth in a variety of settings including home, primary maternity units, secondary and tertiary level hospitals. The purpose of this study was to compare how frequently the planned place of birth matched the actual place of birth for a cohort of low risk women in the care of midwives and to identify whether ethnicity influences women’s choices in relation to planned place of birth. Method: The Midwifery and Maternity Provider Organisation (MMPO) database was accessed with agreement from the NZ College of Midwives (NZCOM). Ethical approval was gained from the NZ Multi-region Ethics Committee. Data were obtained from the MMPO database from 2006-2007 for a total of 39,667 births. Data were reduced through exclusion criteria to establish the cohort of 16,453 low risk women (41.47% of total sample) according to planned birthplace. The Stata statistical package was used to analyse data for this cohort of low risk women. Results: Within the total cohort (n=16,453), 9.36% of women had a homebirth, 16.25% of women birthed in a primary maternity unit and 74.36% of women birthed in a secondary/ tertiary hospital. Five women (0.03%) birthed in an atypical small maternity unit with access to epidural analgesia. This facility was categorised as a ‘primary plus’ facility and is different from primary units and secondary/ tertiary hospitals. Of the women planning a homebirth, 82.68% (n =1,513) gave birth at home. Just over ninety percent (n= 2,594) of women planning to birth in a primary maternity unit gave birth in this setting and over 99% of women planning birth in secondary/tertiary hospitals (n = 12,066) gave birth there. Only 3.95% of multiparous women did not give birth in their planned birthplace as compared with 6.02% of primiparous women.

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Editorial: Creating and critiquing knowledge

By Skinner, J
on Sunday, 01 May 2011 in New Zealand College of Midwives Journal - Volume: 44

Interpreting research

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Quantity or quality of postnatal length of stay? A literary review examining the issues and the evidence

By Cuncarr, C, Skinner, J
on Sunday, 01 May 2011 in New Zealand College of Midwives Journal - Volume: 44

In New Zealand as in other Western countries, length of hospital postnatal stay has reduced dramatically over the last few decades. Contrary to this trend, a recent New Zealand Government initiative provided funding to increase the length of postnatal stay. This literature review sought evidence that would inform and support this policy initiative. The literature located suggests that the focus of care should be directed to improving quality and flexibility of postnatal hospital stay rather than offering a longer length of stay per se.

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Comment on the Evers et al., (2010). Perinatal mortality and severe morbidity in low and high risk term pregnancies in the Netherlands

By Gilkison, A, Crowther, S, Hunter, M
on Sunday, 01 May 2011 in New Zealand College of Midwives Journal - Volume: 44

Midwifery practice in the primary setting has once again come under a critical lens. Evers et al. (2010) published the results of a prospective cohort study which investigated the association between perinatal mortality and maternity caregiver in the BMJ last November. The authors (who included four gynaecologists, a neonatologist, a paediatrician, an epidemiologist, a professor of obstetrics and a secondary care midwife) set out to compare the incidence of perinatal mortality and severe perinatal morbidity between low risk women who were cared for by a midwife in a primary setting and high risk women who received secondary care under the care of an obstetrician. Despite having a high standard of maternity care, the Netherlands have a higher than average perinatal mortality rate (11.4:1000 births) compared with the United Kingdom, Australia and New Zealand who have a perinatal mortality rate of approximately 10:1000 births (PMMRC, 2010). The authors of this study wanted to establish whether the two tiered, primary and secondary maternity care system in the Netherlands was a contributing factor to the higher than average perinatal mortality rate. The main conclusion of the study was that the Dutch obstetric system (which is based on risk selection according to an ‘obstetric indication’ list) possibly contributed to a higher perinatal mortality. This conclusion was based on the findings that delivery related perinatal death was significantly higher for babies of women who had been classed as low risk and were cared for by a midwife in a primary setting compared to women who had been classed as high risk and were cared for by an obstetrician in a secondary setting.

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Experiences of midwives' leaving Lead Maternity Care (LMC) practice

By Cox, P, Smythe, L
on Sunday, 01 May 2011 in New Zealand College of Midwives Journal - Volume: 44

Background: The government funded self-employed midwifery model of practice is unique to New Zealand. The nature of such practice requires an on-call lifestyle, a willingness to take responsibility for whatever unexpected situations may occur, while still staying connected with family and friends. Midwives talk of the privilege it is to practice in such a way, yet even then they also decide to leave such practice. This article describes the experiences of three Lead Maternity Carer (LMC) midwives as they made their decision to leave their LMC practice. Method: An interpretive methodology was used to uncover the nature of lived experience. Three midwives who had recently left self-employed practice as Lead Maternity Carers were interviewed. Data were analysed through a process of reading, thinking, writing and re-writing. Findings: The collective story of the three midwives interviewed is one of being passionate and committed to midwifery practice. Paradoxically it is perhaps these characteristics that lead to midwives over-spending themselves and becoming burdened to the point of choosing to leave. Situations that provoke feelings of betrayal, excessive responsibility, and outrage tipped the balance. One situation too many brought awareness that it was time to ‘finish’. Conclusion: The findings illustrate the potential for a high emotional cost of providing continuity of midwifery care which can trigger the need to leave. Midwives might consider the possibility of seeking additional support to identify and deal with the emotional and physical demands of their work. The Midwife First Year of Practice programme and processes of professional support such as professional supervision may go some way in alleviating the isolation that can be part of LMC practice.

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Editorial: If we don't know where we came from we won't know where to go!

By Skinner, J
on Monday, 01 Nov 2010 in New Zealand College of Midwives Journal - Volume: 43

History of midwifery

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