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Keeping birth normal: midwives experiences in a tertiary obstetric setting

By Earl, D, Hunter, M
on Saturday, 01 Apr 2006 in New Zealand College of Midwives Journal - Volume: 34

Th is qualitative interpretive study explored the experience of eight core midwives employed within the labour ward of two tertiary obstetric hospitals in the Auckland region. Th e purpose of this study was to gain a deeper understanding of how midwives’ work within these busy settings in relation to their challenges with respect to ‘keeping birth normal’. Th e key themes from this study include: being a midwife is keeping birth normal; stepping back or stepping in to achieve normal outcomes; and interacting with doctors, which included being caught within doctor’s decisions. In this article, the theme of ‘stepping back or stepping in’ in order to achieve normal birth outcomes will be explored. Th is includes a sub-theme of ‘using minor interventions to prevent major interventions’.

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The sunshine vitamin - is there really a need for dietary vitamin D?

By Elias, S
on Saturday, 01 Apr 2006 in New Zealand College of Midwives Journal - Volume: 34

Vitamin D plays an important role in skeletal development and bone mineralisation during pregnancy and lactation. A defi ciency in vitamin D causes skeletal abnormalities such as rickets in infants and osteomalacia in adults. Th ere are limited food sources of vitamin D in New Zealand and the majority of vitamin D in the body is synthesised in the skin through the action of ultra-violet light. Supplementation of vitamin D during pregnancy and lactation may be benefi - cial for pregnant and lactating women, particularly those with dark skin and those who avoid sunlight exposure.

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Promoting normal birth: a case for birth centres

By Skinner, J, Lennox, S
on Saturday, 01 Apr 2006 in New Zealand College of Midwives Journal - Volume: 34

Interest in birth centres has arisen in response to consumer pressure for a birth centre in Wellington. Recent literature supports claims that birth centres reduce intervention in labour. Th e twentieth century in New Zealand saw women move from home to hospital to give birth. Th is transition for many entailed giving birth in small maternity homes. A strategy is proposed encouraging the use and development of primary units and reversing the recent trend to deliver in secondary and tertiary units. Th ere are three areas requiring attention: working for policy changes, involving the community and supporting midwives to use primary birthing facilities.

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From autonomy and back again: educating midwives across a century - Part 2

By Pairman, S
on Saturday, 01 Apr 2006 in New Zealand College of Midwives Journal - Volume: 34

By the time these women’s groups were advocating for an autonomous midwife, midwifery itself was at its lowest point. By 1971 the word ‘midwife’ had been removed from the title of the legislation altogether. Although the separate register for midwives was retained, midwifery was seen as a specialist postgraduate area of nursing practice rather than a separate profession in its own right. Midwives had lost their relative autonomy and worked instead with delegated authority under the supervision of doctors. The maternity service no longer needed autonomous midwives because the majority of women gave birth in hospitals under medical care. Childbirth was seen as a pathological event requiring hospitalisation and medical intervention in order to achieve a safe outcome. In 1979 the six-month midwifery courses were closed and instead midwifery became an ‘option’ module within the polytechnic-based Advanced Diploma of Nursing (ADN). Interestingly it was this downgrading of midwifery education that provided the catalyst for midwives to become politically active in an eff ort to claim a separate identity to nursing.

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Midwives as mentors

By Gray, E
on Saturday, 01 Apr 2006 in New Zealand College of Midwives Journal - Volume: 34

Currently there is no formally recognised mentorship framework for New Zealand midwives and this has been the subject of discussion in the profession and Ministry of Health (MOH) for some years. Recent research (Kensington, 2005; Stewart, 2005) has highlighted the need for a mentorship framework for New Zealand. Although midwives have been informally acting as mentors there is a range of opinions on the defi nition of mentorship and the roles and responsibilities of the mentor and the mentored midwife in the mentorship relationship. Anecdotal evidence of the need for a supportive mentoring framework is now supported by research identifying that midwifery is an aging workforce and that midwives remain in the profession for less time than previously thought (NZCOM, 2005a). One aspect of creating a supportive professional framework for all midwives is to formalise a model and framework for mentorship. Th e New Zealand College of Midwives’ (NZCOM) Strategic Plan 2004-2006 aims to strengthen the midwifery workforce and one strategy to achieve this is the development of a mentorship framework and the establishment of a culture of mentorship for New Zealand midwives (NZCOM, 2004). Th e importance of mentorship is also recognised by the Midwifery Council of New Zealand (MCNZ) in its identifi cation of mentoring as a professional development activity that attracts points within its Recertifi cation Programme and in which all midwives are required to participate in order to demonstrate their continuing competence to practise (MCNZ, 2005). Th is article introduces a conceptual model and framework for mentorship that refl ects New Zealand midwifery’s founding principle of partnership (NZCOM, 2005b).

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From autonomy and back again: educating midwives across a century - Part 1

By Pairman, S
on Saturday, 01 Oct 2005 in New Zealand College of Midwives Journal - Volume: 33

Midwifery education reflects the role and scope of practice expected of a midwife. In the century since midwives were first registered in New Zealand midwifery education has variously prepared midwives for relative autonomy, dependent practice and now, in 2005, for full professional autonomy. This article traces the evolution of midwifery education in New Zealand across a century and is presented in two parts. The second part will be included in the April 2006 journal. This article provided the basis for the keynote address given by the author at NZCOM Biennial conference, Wellington, 16 – 18 September 2004.

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Dear Sarah

By Falconer McGlashan, M
on Saturday, 01 Oct 2005 in New Zealand College of Midwives Journal - Volume: 33

22 April 2005. Dear Sarah, Congratulations on your 21st birthday. It is a milestone for me too as it is 21 years since my first homebirth. Your Mum a very shy girl of 17 asked me to be her midwife as she wanted to have her baby at home. She had found a doctor that was willing to come out to your country home, but it was too far for one of the few homebirth midwives to come. I scolded her and told her how dangerous it was to have a baby out of hospital. I asked her if this doctor was a hippy or an ex-missionary. She said he did look a bit like Billy Graham. My negativity went on throughout the pregnancy. I decided that I would be the martyr and come along as she wasn’t going to budge midwife or no midwife.

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Building a picture of labour: how midwives use vaginal examination during labour

By Dixon, L
on Saturday, 01 Oct 2005 in New Zealand College of Midwives Journal - Volume: 33

Vaginal examination has been part an important part of midwifery practice for many years. However, the invasiveness of the procedure raises concerns regarding an increased risk of infection and the negative perceptions of women. This research is a small, qualitative, descriptive study exploring midwives’ use of vaginal examination during labour in the New Zealand model of continuity of care. Six midwives working in a Lead Maternity Carer role were interviewed and provided data for thematic analysis. Three themes were identified. These were: the woman’s beliefs and expectations, the midwives’ ability to build a picture of labour, and the influence of the medical culture within the tertiary unit.

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Maternal request for an elective caesarean section

By Arthur, D, Payne, D
on Saturday, 01 Oct 2005 in New Zealand College of Midwives Journal - Volume: 33

The number of women requesting to have their child born by caesarean section when there are no medical indications for them to do so is increasing. This qualitative study identifies the themes that emerged in interviews with five primigravidae who requested that their baby be born by elective caesarean section. The overriding influence identified by the women was the representation of normal vaginal birth as hazardous, both for themselves and for their babies. The women perceived caesarean section as the best means of maintaining control over the birthing process, ensuring the birth of a normal, healthy child and reducing harm to themselves. While some of the women asserted their right to choose to give birth by caesarean section, they felt guilty about their decision.

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"I'm ready for you baby, why won't you come?" Further discussion around the issue of post dates pregnancy and the intervention of induction of labour

By Davies, R
on Saturday, 01 Oct 2005 in New Zealand College of Midwives Journal - Volume: 33

Prolonged pregnancy (PP) continues to avoid consensus of approach amongst midwives, obstetricians and researchers. Establishing solid evidence-based practice is probably ethically beyond our reach. Midwives exist to keep birth normal; to maintain normalcy of other aspects, within any intervention process. The issue of PP is complex and the intervention not without risk. The woman’s feeling about waiting, and about choosing to end the wait, are known to be significant in the success of the management. Critical to her feelings is her understanding. In this second article on prolonged pregnancy the author discusses the associated terminology, the current understanding of the spontaneous, natural end to a pregnancy and reports on sequelae of the choice of induction to end the pregnancy when the only, and dubious, deviation is that the woman is ‘post dates’.

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