Members

Search the New Zealand College of Midwives Journal

Welcome to the Journal search facility.

Please enter an author, keyword or topic in the search facility below to find relevant articles that have been published in the Journal.

To make a wider search of New Zealand midwifery research, including relevant articles from the New Zealand College of Midwives Journal, articles in other Journals, research theses, books and book chapters, please search the New Zealand Midwifery Research Database.

Editorial: Twenty years on: where to from here?

By Skinner, J
on Thursday, 01 Oct 2009 in New Zealand College of Midwives Journal - Volume: 41

We have already achieved, and in many cases have surpassed the goals set out in the WHO strategic direction for nurse and midwives. The question might be: where to from here and where are the priority areas for action?

View Article

Editorial: Support for midwifery practice

By Skinner, J
on Thursday, 01 Oct 2009 in New Zealand College of Midwives Journal - Volume: 39

I have been struck more and more recently about how important it is for midwives to have good solid support for their practice. This is not only because of the challenges that we, as a profession and as individuals, face as we endeavour to function in a ‘risk society’; nor is it only to improve the sustainability of practice. Support in practice is, I would contend, fundamentally about maintaining and/or improving the quality of the care that we can and should provide for women and their families, as they prepare for and make the transition to being a new family. Sustainable practice and confident, focused practitioners are the means to the end, not the end itself.

View Article

Report on mapping the rural midwifery workforce in New Zealand for 2008

By Hendry, C
on Thursday, 01 Oct 2009 in New Zealand College of Midwives Journal - Volume: 41

In December 2008, the Midwifery and Maternity Providers Organisation commissioned by the Ministry of Health completed the ‘mapping’ of the rural midwifery workforce in New Zealand. It covered the localities of all 52 rural primary maternity hospitals that were spread throughout the country. Findings indicated that just under a quarter of all birthing women and a quarter of LMC midwives lived closer to a rural primary maternity facility than a base obstetric hospital. With only two facilities having LMC medical practitioners and only 13 having 24/7 medical cover, rural maternity facilities in this country were reliant predominantly on local midwives to maintain their local maternity services. The mapping also highlighted features that appeared to sustain a local midwifery workforce in rural localities as well as identifying some common features of rural localities struggling to retain their midwifery and consequently their maternity workforce.

View Article

To suture or not to suture second degree perineal lacerations: What informs this decision?

By Cronin, R, Maude, R
on Thursday, 01 Oct 2009 in New Zealand College of Midwives Journal - Volume: 41

This literature review examines the body of knowledge of perineal care that influences midwives’ decision making. Women’s informed choice depends on the midwife’s assessment of her perineum. The critical skill is accurate assessment of the tear to determine need for suturing. Midwives must justify and document their decision making clearly.

View Article

Midwives care during the Third Stage of Labour: An analysis of the New Zealand College of Midwives Midwifery Database 2004-2008

By Dixon, L, Fletcher, L, Tracy, S, Guilliland, K, Pairman, S, Hendry, C
on Thursday, 01 Oct 2009 in New Zealand College of Midwives Journal - Volume: 41

Background and purpose: The third stage of labour is the period of time following the birth of the baby when the placenta separates and is expelled from the uterus. There are two options or care pathways that can be provided. The first is a physiological pathway for the third stage (also called expectant management). The second is an actively managed third stage pathway. Midwives in New Zealand provide both types of care for women during the third stage of labour. The purpose of this research was to describe, analyse, and compare the outcomes of the two different management pathways for the third stage of labour following a normal physiological birth. Methods: Aggregated data from a sample of 33,752 women over a period of five years were used to identify the type of third stage provided. Selection criteria were applied so that only normal labour and births were included. Comparisons were made between women who received physiological care in third stage and those who received active management of the third stage of labour. Results: There were 16,238 (48.1%) women who received physiological management and 17,514 (51.9%) who received active management. Women who gave birth at home or in a primary birthing unit were more likely to have a physiological third stage than those who gave birth in a secondary or tertiary unit. Overall, the majority of women had a blood loss of less than 500 mls following birth. For those women who lost less than 500ml of blood, more women received physiological management (96.3%) than active management (93.1%), Z=12.7, p< 0.05). A physiological third stage took longer than an actively managed third stage with a length of more than 40 minutes for 11.3% of the physiological managed group compared to 5.4% of the actively managed group. For women in the active management group a longer time to the delivery of the placenta was associated with an increased blood loss (x2 = 221, df=2. p,0.001). Conclusions: The data demonstrates that following a physiological labour and birth, physiological care for the third stage results in less blood loss than active management and a lower incidence of post partum haemorrhage of between 500mls and 1000mls (3.1% compared to 5.3%) and more than 1000mls (0.5% compared to 1.5%).

View Article

The cost of healthy eating for pregnant and breasfeeding women in Otago

By Boland, R, Gibbons, M
on Thursday, 01 Oct 2009 in New Zealand College of Midwives Journal - Volume: 41

Having access to sufficient, safe and nutritious food is important for all New Zealanders, but it assumes an even greater importance for women when they are pregnant or breastfeeding. There are a number of barriers to accessing a healthy diet; these include cost, availability and affordability within the family budget. The aim of this investigation was to determine whether or not the recommended nutritional guidelines for pregnant and breastfeeding women set out by the New Zealand Ministry of Health (MOH) are realistically affordable for women in today’s economic climate. Using the Ministry of Health guidelines for healthy eating in pregnancy and breastfeeding sample menus (MOH, 2008) a shopping list was developed and priced at three Dunedin Supermarkets and one rural Otago general store. The final costs were compared to the University of Otago (Department of Human Nutrition, 2008) estimated food costs for adult Dunedin women to determine whether the guidelines are realistic and affordable. In addition the number of foods available for purchase in each location provided data on the accessibility of the food. The cost of purchasing the food in all locations was prohibitive when compared to the University of Otago estimated costs and only 65% of the food items were available for purchase in the rural location. The cost was also expensive when compared to household estimated expenditure by Statistics New Zealand (2008). This study provides information for midwives and other health professionals working with women during pregnancy and breastfeeding about the affordability of healthy eating. There is a challenge to consider the food and nutrition guidelines in the relation to the individual circumstances of the woman. Of further concern is the difficulty for woman in rural locations to have access to the foods recommended in the sample menus from the Ministry of Health. Further research is required into the actual barrier to health, particularly during pregnancy and breastfeeding, so that guidelines can be met. From this research it can be recommended that the MOH, dieticians and midwives collaborate to produce a more realistic sample menu.

View Article

Warkworth Birthing Centre: exemplifying the future

By Smythe, L, Payne, D, Wilson, S, Wynyard, S
on Thursday, 01 Oct 2009 in New Zealand College of Midwives Journal - Volume: 41

Purpose: Our research asked ‘what works well at Warkworth Birthing Centre?’ This was a collaborative study between researchers and co-directors of the centre, taking an appreciative inquiry approach. While it is a small study it provides a valuable case study of a primary rural birthing centre highlighting the factors that come together to give a service positive regard. Method: Questions sought to identify strengths, achievements, values, ethos and the positive core. Data was gathered through focus groups of women who had birthed at the Warkworth Birthing Centre, midwives who practice there, and staff of the centre. Individual interviews were conducted with the Co-directors and the Chair of the Trust Board. Transcripts were interpreted thematically. Findings: This paper takes the findings of the study and puts them alongside the Principles of the New Zealand Ministry of Health Maternity Action Plan 2008-2012 (Draft for Consultation). We argue that the women described a way of being cared for that is ‘women-centred’. Care approaches seemed to support positive health outcomes for women and their babies. The comprehensiveness of Warkworth Birthing Centre’s service was impressive, as was the cultural safety. There appeared to be a seamless continuity of care. Discussion: The factors that achieved the kind of maternity service outline in the Maternity Action Plan (Draft) are already being enacted at the Warkworth Birthing Centre. The keys to success lie in committed midwifery leadership, funding decisions kept close to practice, and an ethos of care that permeates all staff.

View Article

New Zealand and Canadian midwives' use of complementary and alternative medicine

By Harding, D, Foureur, M
on Wednesday, 01 Apr 2009 in New Zealand College of Midwives Journal - Volume: 40

Background: Complementary and alternative medicine (CAM) is widely used by women and midwives in maternity care despite the lack of strong evidence for safety or efficacy. The purpose of this research was to investigate how midwives in primary midwifery care practice in two countries use CAM. Methods: A pre-tested survey was administered to all registered midwives (265) in two provinces of Canada (British Columbia and Ontario) and a sample (383) of midwives in primary care practice in New Zealand. The two part survey consisted of 40 items including Likert scale, yes/no and open ended questions. Part one collected midwives’ demographics and information regarding the use of CAM by midwives and women, the types of CAM therapies, referral patterns and midwives’ opinions regarding the role of CAM in midwifery practice. Part two examined the use of evening primrose oil, chosen as an exemplar to explore typical patterns of CAM use by midwives, and is reported elsewhere. Results: A total of 343 midwives responded (53%) with results indicating that CAM is widespread in both countries. The most commonly used therapy was homeopathy, followed by herbs, aromatherapy and acupuncture. CAM was perceived as an essential part of midwifery practice by 71.5% of respondents. A similar number agreed that CAM enhances midwifery care and supports normal birth. However, 74.4% of respondents perceived CAM use as an intervention. Although 77.4% concurred that CAM is a traditional part of midwifery practice, 63.3% felt that the long history of CAM use is not evidence for safety in practice. There was strong support (81.4%) by midwives for the statement that CAM is used to avoid medical interventions. Midwives who may not discuss CAM with every client indicated they would discuss CAM options in circumstances such as breech presentation or postdates pregnancy. A qualitative analysis interpreted four main reasons for the use of CAM, identified in this study as ‘Resistance’ to the dominant medical paradigm, ‘Efficacy’ since CAM is perceived to make a difference, supporting ‘Women’s Choice’ and as a way of ‘Keeping Birth Normal’. Conclusions: This study demonstrates that midwives regard CAM as an essential and traditional part of midwifery practice, supporting normal birth. However, midwives also regard the traditional and empirical basis of CAM as problematic since contemporary midwifery care requires midwives to base their practice on robust evidence of efficacy.

View Article

Smoke-free outcomes with Midwife Lead Maternity Carers: An analysis of smoking during pregnancy from the New Zealand College of Midwives Midwifery Database 2004-2007

By Dixon, L, Aimer, P, Fletcher, L, Guilliland, K, Hendry, C
on Wednesday, 01 Apr 2009 in New Zealand College of Midwives Journal - Volume: 40

Tobacco smoking during pregnancy has adverse health implications for both the mother and the baby. The New Zealand College of Midwives MMPO midwifery database was used to examine the smoking or smoke free status of women who had a midwife as their Lead Maternity Carer between the years 2004 to 2007. The database contained data for more than 61,000 women over a period of four years. Smoking and smoke free status during pregnancy and the postpartum period are provided for each year along with the age and ethnicity of the women. Analysis of the data showed a small reduction in the incidence of smoking at pregnancy registration over the four years. This research was able to link the data from the antenatal to the post natal period so that changes in smoking behaviour could be identified. This revealed a much larger reduction in smoking during the post partum period. The groups with the highest reductions are women who are under twenty or of Maori ethnicity. Continuity of midwifery care over the pregnancy, birth and postnatal periods may contribute to these outcomes. This research has provided a unique and contemporary picture of the smoke free and smoking behaviour of women during pregnancy and following birth in New Zealand.

View Article

Intrapartum fetal heart rate monitoring: using audit methodology to identify areas for research and practice improvement

By Maude, R, Foureur, M
on Wednesday, 01 Apr 2009 in New Zealand College of Midwives Journal - Volume: 40

The purpose of the study was to explore the fetal heart rate monitoring practices of midwives and doctors to determine compliance with an evidence-based guideline for fetal heart rate monitoring endorsed by one New Zealand (NZ) District Health Board (DHB). A retrospective audit of 193 randomly selected medical records was undertaken over six months (July-December 2006). The audit revealed deficiencies in choice of fetal heart rate monitoring modality, monitoring technique, documentation, communication and use of a standardised approach and language for interpreting cardiotocograph (CTG) traces especially the description and categorisation of the four main fetal heart rate features. Multidisciplinary education and a standardised template for reporting CTG’s were key recommendations.

View Article

Phone

+64 03 377 2732

Fax

+64 03 377 5662

Delivery

376 Manchester Street
St Albans
Christchurch 8014
New Zealand

Post

PO Box 21-106
Christchurch 8140
New Zealand

Shielded Site