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Otaki Birthing Centre - He Whare Kohanga Ora

By Stojanovic, J
on Tuesday, 01 Apr 2003 in New Zealand College of Midwives Journal - Volume: 28

The Otaki Birthing Centre is a very small, midwife owned and operated public primary birthing facility in a small rural town. It is probably the smallest of the three midwife owned and managed birthing facilities in New Zealand. Funded for between 20 – 30 births annually, it provides a facility for labour, birth, assessment of women, antenatal education and midwife ‘gatherings’. Birthing families go home when ready after the birth, commonly 2 to 4 hours postpartum. The centre is not funded to provide midwifery care – the contract is purely for the provision and management of the facility. The woman’s lead maternity carer (LMC) provides the midwifery care within the facility and the follow-up at home. As LMCs we also have our own clients who elect to birth in other facilities or at home. In keeping with the principles of informed choice we try very hard not to influence women’s decisions regarding birth–place. We acknowledge that there is difficulty in presenting unbiased information when one is committed and enthusiastic about a particular course of action.

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The organisation of maternity services by midwives in rural localities within the South Island of New Zealand

By Hendry, C
on Tuesday, 01 Apr 2003 in New Zealand College of Midwives Journal - Volume: 28

At the time of this study (September 2001) there were twenty-one rural maternity facilities (meaning hospitals or birthing units) in the South Island of New Zealand, located within rural towns. None of these facilities provide for caesarean sections. Sixteen of the facilities were located more than 60 minutes from a secondary or tertiary maternity facility (HFA, 2000). The nine rural facilities scanned for this study accounted for about a third of the primary facility births and 66.9% of rural facility births in the South Island. See Table One for the types of maternity facilities, excluding homebirth, in New Zealand in 1999. The scan was carried out as part of a midwifery doctoral study into the organisation of maternity services in rural localities by midwives.

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The midwife in the 'risk' society

By Skinner, J
on Tuesday, 01 Apr 2003 in New Zealand College of Midwives Journal - Volume: 28

Midwifery practice in the current New Zealand context is beset with both challenges and possibilities. As midwives we have achieved our aim of autonomous practice. The new challenges that are faced relate now to managing care in an environment which, to a large extent, remains dominated by a techno-rational model of birth. The vision of providing care which would enhance and protect the normal process has been constrained by societal attitudes still dominated by the notions of modernity: control, technology and individual choice (Beck, 1999). The key concept which reflects this state of being, certainly in the Western world, is that of ‘risk’. Risk plays a dominant role in Western society and impacts on the lives of midwives both in the assessment of risk in the women we care for, and in the management of our own risk within the current medico-legal context. This risk paradigm directly challenges the model of birth as a normal part of human existence and presents challenges for midwives as we attempt to enact in practice this model of normality. Midwives are faced with a significant paradox in attempting to work a ‘birth is normal’ paradigm within a ‘birth is risky’ context. I propose that risk and how it is currently constructed contribute significantly to increasing intervention and escalating medico-legal action. It is a core issue for maternity care in general and midwifery in particular.

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Towards a sustainable model of midwifery practice in a continuity of carer setting: The experience of New Zealand midwives

By Engel, C
on Tuesday, 01 Apr 2003 in New Zealand College of Midwives Journal - Volume: 28

It is important to understand the influence that legislation and funding structures has had on the way midwives in New Zealand practice and how these changes have impacted on the continuity of care and carer models of midwifery. The 1990 Amendments to the relevant Acts that impacted on midwifery practice in effect gave the midwife the same legal rights as medical practitioners to provide a comprehensive maternity care service for New Zealand women. The legislation changes created a precedent for midwives making them eligible to provide a full range of maternity care services. Previous legislation and funding stipulated medical involvement in the provision of maternity care (New Zealand Statute, 1904, 1925, 1945, 1971, 1977). At the time that this research was carried out, 60% of low risk New Zealand women chose a midwife as their Lead Maternity Carer (Health Benefits Ltd., 1999).

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Boundaries: work and home

By McLardy, E
on Tuesday, 01 Oct 2002 in New Zealand College of Midwives Journal - Volume: 27

It is time for midwives to debate how they make choices concerning competing demands between home and work. As the resources, both personal and institutional, available for maternity care have become constrained, some midwives have been slow at adapting their professional outlook to cope with these changes. As a result, a number have become burnt out and not been in the work force for some time. Others have become disillusioned and left midwifery altogether. In this context of health service reform and change, debate will open fundamental questions about how midwives set boundaries between their home and work lives.

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Core midwifery: the challenge continues

By Earl, D, Gibson, E, Isa, T, McAra-Couper, J, McGregor, B, Thwaites, I
on Tuesday, 01 Oct 2002 in New Zealand College of Midwives Journal - Volume: 27

To meet the requirements of Section 88 (Ministry of Health, 2002), South Auckland Health, Middlemore is about to significantly change the way it delivers primary care and as a service provider will have to restructure its services. For Middlemore and the midwives it employs, Section 88 will change the way midwives work. It will require fewer core staff and more midwives able, and willing, to work in a model offering continuity of midwifery carer. As a group of midwives who are part of a service provider that before July 1st 2002 provided a large primary care service, we believe our voice in the midwifery profession can only add to the richness of who we are; as New Zealand midwives and as members of the New Zealand College of Midwives.

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How safe is a tired midwife? Strategies to enhance the provision of effective care in situations of sleep deprivation

By Miller, S
on Tuesday, 01 Oct 2002 in New Zealand College of Midwives Journal - Volume: 27

Setting the scene: It’s late. Actually, it’s early… whatever the time is, your time with this woman and this birthing has been long. You’re tired, so is she and so are her companions. The steady ebb and flow of this labour is beginning to unravel, your trust in this woman’s process begins to erode, some new decisions are needing to be made. She and the little one, all of you in fact, are wrapped in the protective cocoon of your relationships with one another but as the hours unfold and a crisis develops, how safe are your decisions? This paper will explore some of the tensions which emerge when midwives attempt to strike the balance between maintaining the continuity we promise (and the woman and her family have come to expect) and providing safe care in a situation where we are sleep deprived. There is much research in the field of how sleep loss affects performance in a variety of ways and I will use this research as a basis to describe some strategies for ensuring that we meet our obligations both to the families we care for, and to ourselves as safe and effective practitioners. I will uncover some of the ethical dimensions involved in this subtle interplay between the discourses of continuity and our need to sometimes acknowledge that enough is enough, and I will explore the impact on partnership inherent in this interplay.

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Guest editorial: New Zealand midwifery and the rising Caesarian [sic] Section Rate (CSR)

By Savage, W
on Tuesday, 01 Oct 2002 in New Zealand College of Midwives Journal - Volume: 27

The rising caesarean rate

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Is routine antenatal screening for Group B Streptococcus appropriate for women in New Zealand? A review of the evidence

By Grigg, C
on Tuesday, 01 Oct 2002 in New Zealand College of Midwives Journal - Volume: 27

The management of Group B beta-hemolytic Streptococcus (GBS) has become a practice issue for New Zealand midwives in recent years, as hospitals have implemented protocols for ‘risk factor’ screening in an attempt to reduce the incidence of Early Onset GBS Infection (EOGBSI). These protocols have been developed in an informal, ad hoc way and vary from hospital to hospital within New Zealand. Consequently, the prospect of routine antenatal screening for GBS colonisation motivated this review of research about GBS carriage patterns, sensitivity, effectiveness and cost of screening. Recommendations for practice and policy are offered which are based on evidence rather than fear, anecdote and a potentially misplaced belief in the efficacy of screening in this context.

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Shoulder Dystocia - a midwifery action wheel

By Soutter, C
on Tuesday, 01 Oct 2002 in New Zealand College of Midwives Journal - Volume: 27

A recent experience with the unthinkable, that a baby could die, and that I might not be able to help the mother birth her baby because its shoulders were stuck, is the subject of this analysis. This has been my most challenging encounter with shoulder dystocia, and its impact has had a significant influence on me, as a midwife and on how I view my midwifery practice. As a corollary of this experience, a thorough investigation into this phenomenon became imperative, so that I could put reality into perspective, and make some sense of the unpredictable nightmare that is shoulder dystocia. I am now able to put the incident into a framework that will not influence my practice in an irrational and paranoid manner, but add to my quest for ongoing growth of practice wisdom. This article describes the midwifery management of shoulder dystocia by the presentation of an action model that I have developed in the form of a wheel. My specific focus is the needs of midwives who are practising in the home or in birthing facilities without access to immediate medical emergency services.

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