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Neurodivergence among healthcare professionals and implications for midwifery: A literature review

By Taylor, A. R., Miller, S., Davies, L.
on Friday, 16 Aug 2024 in New Zealand College of Midwives Journal - Volume: 60

Background: Societal awareness of neurodivergence is increasing and diagnostic pathways are becoming more accurate; more people are therefore pursuing assessments, often later in life. Health professionals, including midwives, may also be traversing this journey of selfdiscovery. Overseas estimates suggest that neurominorities may account for as much as 20% of the general population; this is a significant minority group. The healthcare professions require empathy and social skills, and neurodivergent (ND) people may be seen as unsuitable due to deficits in diagnostic, cognitive and communication skills. Research bias in favour of white males, alongside pervasive stereotypes, has contributed to the underdiagnosis of ND women and gender-diverse people. As a predominately female workforce, including ND colleagues will inevitably become more relevant to the midwifery workforce in the future. Aim: This integrative literature review asks: what is known about the workplace experiences of ND healthcare professionals? The intention is to reflect on the possible ramifications for midwives in Aotearoa New Zealand, and to establish a rationale for future research. Method: Google Scholar, PubMed, CINAHL and ProQuest databases were searched using combinations of key terms. Following the Critical Appraisals Skills Programme (CASP) evaluation, only ethics-approved, peer-reviewed papers in English were included. Findings: Nine studies investigating the workplace experiences of ND healthcare professionals were evaluated. The findings coalesced around two main concepts: (1) The internal experience, with sub-topics Diagnosis and disclosure, Strengths associated with neurodivergence, Sensory processing and Executive functioning; and (2) Navigating a neurotypical world, with sub-topics Social dynamics, Self-management strategies and Workplace accommodations. Conclusion: Ableist barriers to equitable employment experiences were pervasive throughout healthcare workplace settings. All nine studies highlighted workplace challenges for ND healthcare professionals, relating to social, sensory and executive function differences. The absence of literature specific to the unique contextual experiences of ND midwives in Aotearoa New Zealand signifies the scope for future research.

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Letter to the Editor for “The lactation and chestfeeding/breastfeeding information, care and support needs of trans and non-binary parents: An integrative literature review”

By Gribble, K.
on Friday, 19 Jul 2024 in New Zealand College of Midwives Journal - Volume: 60

Dear Editors, Gargiulo-Welch et al. (2023) aimed to identify the lactation and “chestfeeding/ breastfeeding” needs of transgender and nonbinary people to inform midwifery care. Their paper implies that individuals who have had chest masculinisation surgery are quite likely to be able to breastfeed. Unfortunately, this is not the case and midwives who read this article may be misled.

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Letter to the Editor for “The lactation and chestfeeding/breastfeeding information, care and support needs of trans and non-binary parents: An integrative literature review”

By Jones, R.
on Friday, 19 Jul 2024 in New Zealand College of Midwives Journal - Volume: 60

Dear Editors, This article includes several unqualified statements, e.g.: “Not all people who breastfeed/chestfeed are women” and “Unchallenged trans-exclusionary services can foster the assumption that all people who come to PHCPs [Perinatal Healthcare Providers] will be female”.

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Te Kukunetanga: Vegetable and fruit intake during pregnancy

By Wyatt, H. E., Huang, W., Rush, E., Hume, P. A., Waller, N.
on Thursday, 27 Jun 2024 in New Zealand College of Midwives Journal - Volume: 60

Background: Carotenoids, found in vegetables and fruits, act as antioxidants and are a source of vitamin A. Carotenoids may play an important role in maternal and fetal health (e.g., eye health and brain development) and the prevention of pre-eclampsia, preterm birth, small for gestational age babies and/or intrauterine growth restriction. No studies have examined relationships among carotenoid concentrations, intake of vegetables and fruit, and weeks of gestation. Understanding of the stability of carotenoid concentrations across gestation, despite increasing demands placed on the body (e.g., increase in metabolic demands, body mass and volume), may help inform specific guidelines for vegetable and fruit intake during pregnancy. Aim: This study aimed to investigate the relationships of vegetable and fruit intake, body mass, volume, density and gestation with the carotenoid reflection score. Method: Carotenoid concentration in the fat of women throughout their pregnancy was assessed using a non-invasive Veggie Meter™ device which measures carotenoid reflection spectroscopy from the fingertip. Gestation and vegetable and fruit intake were self-reported. Body mass and body volume were measured via a 3D body scanner and force plate. Correlations between baseline visit measures, differences between visit I and II and repeated measures correlations (up to four visits) were analysed for all measures. Findings: Only nine of the 35 women (25.7%) in this study met the guideline of 7+ a day for vegetable and fruit intake. Carotenoid reflective scores tended to be lower for those with greater body mass (r = -0.48, 95% CI = -0.70, -0.18; p < 0.001) and volume (r = -0.50, 95% CI = -0.71, -0.20; p < 0.001). Although women increased their vegetable and fruit intake with increased gestation (rrm = 0.60, 95% CI = 0.2, 0.83; p = 0.01), their carotenoid reflective score did not increase (rrm = -0.29, 95% CI = -0.66, 0.19; p = 0.22). Conclusion: Supporting previous recommendations for the general population that vegetable and fruit intake should increase relative to body size, the current study findings suggest it may be advisable for women to progressively consume more vegetables and fruit to align with increases in body mass throughout pregnancy.

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Midwifery mentorship in Aotearoa New Zealand: The mentors' perspective

By Daellenbach, S., Dixon, L., Kensington, M., Griffiths, C., Pihema, N., Te Huia, J., Otukolo, D., Gray, E.
on Friday, 14 Jun 2024 in New Zealand College of Midwives Journal - Volume: 60

Background: In Aotearoa New Zealand, midwifery mentoring aims to develop professional confidence and is formalised in a number of programmes to support sustainable midwifery practice in different settings. Mentoring is shown to be beneficial for mentee midwives, but little is known about the impact on the person who is doing the mentoring. Aim: To explore the key attributes that underpin midwifery mentoring in Aotearoa New Zealand from the mentors’ perspective; how these are applied by mentors within the mentoring relationship; and what impact this has on them professionally. Method: This qualitative research used focus groups with mentor midwives identified from the Find Your Mentor database. A semistructured topic guide used seven simple open-ended questions to stimulate discussion. Discussions were transcribed and analysed using the 6 steps of Braun and Clarke’s (2006) inductive thematic analysis. Findings: Four main themes were identified. The mentors described Creating an empowered, safe space in which power was balanced with trust and respect, and confidentiality built so that experiences could be shared and reflections supported. The second theme identified the mentors’ role in Building a support infrastructure which focused firstly on the mentees’ development, ensuring professional knowledge and professional responsibilities were met, and secondly on building a network of professional relationships to enable safe practice. The third theme Supporting professional cohesion described how the mentors and the profession benefit from the understanding and acceptance of different ways of practising midwifery and different midwifery roles as seen through the mentees’ lens. The final theme Sustaining midwifery practice described how mentoring keeps mentors up to date and that, by supporting the work-life balance of the mentees, they also reflect on their own work-life balance and holistic wellbeing. The enthusiasm of the mentored midwives affirmed and fed the mentors’ own passion for their roles as both a midwife and a mentor, and reflected positively for the health of the profession. Conclusion: Midwifery mentoring relationships benefit both mentees and mentors, and support cohesion and sustainability within the profession.

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Partnership in a hospital setting: Consumer perspectives of hospital midwifery care in Aotearoa New Zealand

By Daellenbach, S., Dixon, L., Anderson, J., Nisa-Waller, A., Lockwood, S., Neely, E.
on Tuesday, 23 Apr 2024 in New Zealand College of Midwives Journal - Volume: 60

Background: Midwives in Aotearoa New Zealand, regardless of the setting, practise within a model of midwifery partnership. Soliciting feedback on practice provides an essential mechanism for midwives to work towards improving their practice. The New Zealand College of Midwives provides such a process for consumers of midwifery services to give feedback on their experiences directly to the midwife, via online consumer feedback forms. Aim: To identify the characteristics of midwifery care that contribute to positive and negative midwifery care relationships within the hospital setting. Methods: A retrospective mixed methods approach was used to analyse the consumer feedback on hospital midwives received between 1 January and 31 December, 2019. Quantitative data from feedback forms were analysed descriptively in combination with an iterative and reflexive thematic approach for the qualitative data. The analysis sought to identify characteristics of care that contributed to a positive or negative midwifery care experience in a hospital setting. Findings: There were 1,284 online feedback forms received for hospital midwives. The majority of respondents who completed feedback questionnaires were satisfied with their care (92%), reporting that hospital midwives provided information/explanations to support informed decision-making (94.0%), that they felt involved in planning/decisions about their care (93.7%) and that they experienced respect for decisions made (93.7%); these characteristics having the highest levels of agreement. Via qualitative analysis, we identified four key themes as contributing to the midwifery care experience in a hospital setting. Positive experience themes included: Building trust quickly, Respecting decision-making and Fostering maternal confidence, resulting in Meaningful partnerships. The negative experience themes were found to be the inverse of a positive midwifery care experience in a hospital setting. Specifically, these were: Not giving time and Judgement and disrespect, resulting in an Unsafe space and an Absence of partnership. Conclusion: The data from consumer feedback forms for 2019 affirm that the quality of the relationship with a hospital midwife is important in shaping the maternity care experience of women and birthing whānau in Aotearoa New Zealand. The characteristics of care that contribute to a positive midwifery care relationship in hospital reflect the principles outlined in the model of midwifery partnership.

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Editorial: A world of fun discoveries

By Dixon, L.
on Tuesday, 16 Jan 2024 in New Zealand College of Midwives Journal - Volume: 59

Many midwives describe midwifery as a calling or a vocation. I never felt “called” to the role but, once I became a midwife 37 years ago, I never wanted to do anything else. Being a midwife has always provided a deeply satisfying and meaningful focus within my life. Similarly, the role of midwifery researcher has provided fulfilment as I explored the world of midwifery and the positive impact that midwives have on the women they care for. For me, research has indeed been a world of fun discoveries. Now, though, it is time for me to refocus my life as I retire from my work as Journal co-editor and midwifery advisor at the College and say, Hello to a new world, one which is free of schedules, time clocks and company rules and where there is time to discover other passions.

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The lactation and chestfeeding/breastfeeding information, care and support needs of trans and non-binary parents: An integrative literature review

By Gargiulo-Welch, S., Parker, G., Miller, S.
on Tuesday, 12 Dec 2023 in New Zealand College of Midwives Journal - Volume: 59

Background: The National Breastfeeding Strategy launched by the Ministry of Health in 2020, commits to the protection, promotion and support for breastfeeding with the aim of increasing exclusive breastfeeding rates in Aotearoa New Zealand. This strategy includes a recommendation that the breastfeeding/chestfeeding information and support needs of trans and non-binary parents and their whānau are identified so that those involved in their care are knowledgeable about these specific needs. Midwives are the primary providers of lactation and breastfeeding/chestfeeding information, care and support for most pregnant people in Aotearoa New Zealand. Aims: An integrative literature review was undertaken: to ascertain the specific lactation and chestfeeding/breastfeeding information and care needs for trans, non-binary, takatāpui and other gender diverse whānau; to consider the implications of this knowledge for contemporary midwifery in Aotearoa New Zealand; and to identify continuing research needs. Method: Literature for this integrative review was primarily sourced through the Ovid Online Database using search terms pertinent to the topic and limited to articles published in peer reviewed journals in English, excluding editorials, commentaries and opinion pieces. Findings: Literature about trans and non-binary parents and chestfeeding/breastfeeding, although increasing since 2010, is limited internationally and absent nationally. From extant literature, connections between healthcare barriers and the negative experiences of trans and non-binary parents are identified and explored in three overarching themes: the foundations of Western perinatal healthcare systems; the invisibility of trans and non-binary people within perinatal healthcare systems; and the lack of perinatal healthcare provider knowledge. Conclusion: Cis-normative, gender binary foundations are omnipresent in perinatal healthcare, rendering trans and non-binary people invisible, and excluded from this space. These factors contribute to the limiting of perinatal healthcare provider knowledge, an overwhelming finding in the literature. The absence of locally produced literature presents scope for research production here in Aotearoa New Zealand, exploring this topic from our unique cultural contexts. Such contributions may help inform whether adaptations and additions to current midwifery education are necessary to support midwives in the provision of equitable, safe, culturally appropriate, gender-inclusive care.

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A vision of decolonisation: Midwifery mentoring from the perspective of Māori mentors

By Pihema, N., Daellenbach, S., Te Huia, J., Dixon, L., Kensington, M., Griffiths, C., Gray, E., Otukolo, D.
on Thursday, 21 Sep 2023 in New Zealand College of Midwives Journal - Volume: 59

Background: Mentoring is a valued form of professional and cultural support among midwives in Aotearoa (see glossary for te reo Māori translations). Mentoring occurs both informally and via formal programmes, including Māori mentoring initiatives with tauira, new graduate and rural midwives. International studies identify indigenous mentorship as a viable approach to supporting the retention and professional development of indigenous health workers. However, little research exists on the mentoring relationship from the perspective of Māori mentor midwives. Objective: To examine the mentoring relationship from the perspective of Māori mentor midwives. Method: This qualitative research used focus groups of Māori mentors, identified from the Find Your Mentor database, to explore their views of mentoring from a Māori perspective. A semi-structured topic guide used seven simple, open questions to stimulate discussion. Discussions were transcribed and analysed using Braun and Clarke’s (2006) six steps of inductive thematic analysis. Findings: A vision of decolonisation lies at the heart of the mentoring relationship for Māori mentor midwives. Mentors see their role as supporting mentees to navigate the challenges of a Pākehā health system, and to strengthen their midwifery practice through Te Ao Māori. Mentors describe how they are guided by the principles of tika and pono, and work to create a culturally safe space based on mutuality and trust through sharing kai and incorporating their whānau and that of the mentee into the relationship. Being a Māori mentor also fills the kete of the mentors. Māori mentors are sustained through being part of a midwifery hapū and experience joy and hope in sharing ngā taonga tuku iho with the next generation. Conclusion: The decolonising approach to Māori midwifery mentoring has tangible benefits for Māori mentees and Māori midwifery. Māori mentoring activities evoke different experiences for Māori mentees, as evidenced by mentor behaviours that are unique within Te Ao Māori. Being part of Māori mentoring relationships also nurtures the resilience of the mentors.

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Midwives’ perceptions of enablers and barriers to pertussis and influenza vaccination in pregnancy and information sharing

By Young, A., Willing, E., Gauld, N., Dawson, P., Charania, N. A., Norris, P., Turner, N.
on Friday, 25 Aug 2023 in New Zealand College of Midwives Journal - Volume: 59

Background: Vaccination in pregnancy against influenza and pertussis protects the pregnant woman/person and their infant against severe disease. Aotearoa New Zealand has a lower uptake of vaccination in pregnancy than some other countries, despite this immunisation being publicly funded. Coverage is also inequitable, with Māori, Pacific people, and people from high deprivation areas less likely to be vaccinated. Many barriers exist to vaccinations in pregnancy, e.g., access barriers and lack of knowledge about vaccination. Discussions about recommended vaccines with healthcare professionals, particularly midwives, may have a positive impact on vaccine decision-making. Aim: This study aimed to investigate midwives’ perceptions of enablers and barriers with discussions about vaccinations in pregnancy, barriers to vaccination in pregnancy, and influences on vaccine decision-making in pregnancy. The study also aimed to gather midwives’ insights into what might improve vaccination uptake. Method: A structured questionnaire was developed containing a mix of closed and open-ended questions. The questionnaire was sent out to 3002 midwives registered in Aotearoa New Zealand in October 2021, using REDCap electronic data capture tools. Simple descriptive statistics were undertaken on the quantitative data. The answers to the open-ended questions were analysed using a direct, qualitative content analysis approach. Findings: Fifty-one midwives’ responses were included in the analysis (1.8% response rate). Almost all reported sufficient knowledge of vaccinations in pregnancy but had varying levels of confidence when discussing them. The most common enablers to conversations were good relationships, easy communication, and having the time and resources available. Respondents perceived that barriers to conversations were negative preconceptions, communication difficulties and lack of time. Lack of awareness, cost to access services and competing priorities for time were also thought to reduce the likelihood of vaccination in pregnancy. To improve vaccine uptake, respondents identified the need for accessible and suitable vaccination venues, appropriate information and the support of all healthcare professionals involved in maternal healthcare. Conclusion: Midwives surveyed understand the importance of vaccination in pregnancy but there may be lack of confidence, time or resources to effectively engage in discussions. A trusting relationship is important but this can be affected by disengagement or late presentation to healthcare services. Resources to counter pre-existing negative ideas and support communication would help midwives to provide useful information about vaccination. Furthermore, respect and cultural understanding of hapū Māori and their needs will positively support their ability to make informed decisions.

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