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Midwifery decision making and management of the third stage of labour

By Barlow, K, Hardie, A, Holland, D, Hunter, M, McAra-Couper, J, Berman, S
on Tuesday, 01 Oct 2002 in New Zealand College of Midwives Journal - Volume: 27

This paper reports the key findings of a survey undertaken at the New Zealand College of Midwives Conference in Cambridge, 2000, that examined the views of 121 New Zealand midwives about midwifery decision making and management of third stage of labour.

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Primary maternity care outcomes in New Zealand: a comparison of midwife and medical practitioner care

By Sutton, F, McLauchlan, M, Virtue, C
on Monday, 01 Apr 2002 in New Zealand College of Midwives Journal - Volume: 26

Objectives: To compare the outcomes of primary maternity care delivered by two types of provider: independent midwife and general practitioner. Design: A retrospective cohort study. A regression analysis of two groups of providers on eight indicators of obstetric intervention and adverse outcome using routinely collected data. Setting and participants: Wellington, New Zealand. Primary maternity practitioners and women giving birth between 1 January 1993 and 31 December 1997. Measurements and findings: The eight indicators used were induction, epidural analgesia, instrumental birth, caesarean section, postpartum blood loss, low apgar at 5 minutes, admissions to neonatal intensive care unit, and stillborn. Logistic regression was used to estimate the odds ratios of outcomes, controlling for risk. The study showed that rates of maternal interventions tend to be lower or the same for midwife-led maternity care compared with general practitioner-led care. Conclusions and implications for practice: This study supports midwife-led care as a valid choice for women.

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Equal rights in the birth chamber: the need for a midwife-based system of maternity care in Europe

By O'Connor, M
on Monday, 01 Apr 2002 in New Zealand College of Midwives Journal - Volume: 26

This article provides an overview of the current state of maternity care in Europe and Ireland in particular. It has been reprinted with persmission from MIDIRS Midwifery Digest 2001; 11 (1); 129-132

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Caseload management and midwifery lecturers: recommendations for practice using a modified Delphi technique

By Noseworthy, A
on Monday, 01 Apr 2002 in New Zealand College of Midwives Journal - Volume: 26

Clinical practice is becoming a reality for lecturers in midwifery in New Zealand. The future introduction of legislation that requires proof of competency will make the requirement more pressing. This paper presents the findings of a research project aimed at developing a set of guidelines for midwifery lecturers who take on a continuity caseload as a way of maintaining practice. The purpose of these guidelines is to help managers and lecturers combine practice and academic duties in order to benefit from the practice and avoid the pitfalls. A modified Delphi technique involving midwifery lecturers and school managers in New Zealand was used. The end result was a set of guidelines that contained 25 suggested recommendations.

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Post-traumatic stress disorder and childbirth

By Crompton, J
on Monday, 01 Apr 2002 in New Zealand College of Midwives Journal - Volume: 26

Litigation is an ever present fact of life for those working in the area of women’s obstetric and gynaecological health. Since 1980, when the American Psychiatric Association first described post-traumatic Stress disorder (PTSD), it has been a compensatable diagnosis in litigation. As midwives, we have a duty of care to our clients and, as the causes and symptoms of PTSD have been in the public domain for twenty years, it may be that ‘lack of knowledge’ will be considered an inadequate response in the face of potential litigation. The issue of ‘forseeability of harm’ is now examined by the courts (Jenkins, 1995). Medico-legal considerations have demanded a new precision in thinking, assisted by the new biological dimensions of the disorder, which are currently being explored. This paper highlights some of the issues around trauma and childbirth and seeks to indicate experiences of both clients and midwives that can lead to psychopathology. It begins with the case history of Emma.

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Lead Maternity Carer Response to Intra-Cardiac Echogenic Foci

By Pearse, J
on Monday, 01 Apr 2002 in New Zealand College of Midwives Journal - Volume: 26

Legal comment: I am occasionally rung by Lead Maternity Carers (LMC) for advice when confronted with the presence of intra-cardiac echogenic foci on routine 18-week ultrasound scan reports. It is heartening to hear that midwives are recognising that this finding can represent a dilemma and that they want to know how they should respond to this ‘soft sign’. This type of reflective practice, and the accompanying desire to think through the issues it raises is very healthy.

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Meeting the needs of Maori women: The challenge for midwifery education

By Tupara, H
on Monday, 01 Oct 2001 in New Zealand College of Midwives Journal - Volume: 25

Introduction: During the period that I was educated as a midwife in 1993/4 I began to notice discrepancies between what I was being taught about Māori women as part of my midwifery education and the reality of my personal experience of being Māori. My own pregnancy and birth did not seem to fit the description of Māori women’s experiences being given by teachers or in New Zealand literature about childbirth. I began to question the accuracy of the information and the potential for that information to influence how midwives care for Māori women. These discrepancies were further reinforced when I began to practice [sic] as a registered midwife and was exposed to the many different realities of Māori women in the community.

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Riding the waves of change: The development of modern midwifery within the New Zealand health sector

By Hendry, C
on Monday, 01 Oct 2001 in New Zealand College of Midwives Journal - Volume: 25

Midwives do not work in social isolation. Most would probably agree that they work within a politically labile environment. This paper presents the case of New Zealand midwives’ transition to autonomous practice as an example of opportunistic positioning by the profession, enabling midwives to ride the waves of change in the last decade of the twentieth century. The socio-political environment that existed within New Zealand in the late 1980s fostered the passage of legislation in 1990 that enabled New Zealand midwives to practice [sic] independently from nurses and doctors. An historical review of the impact of key socio-political events and legislative changes on New Zealand midwifery will be presented, to illustrate that the profession in this country was well positioned by the late 1980s to take advantage of a rising consumer movement, the questioning of medical dominance and a government sympathetic to women’s health issues. While achieving the milestone of legal autonomy in 1990, the challenges involved in developing the midwifery profession were complicated a few years later by complex market driven health reforms. Yet the midwives appeared to position themselves well to meet the challenge of this changed political environment. What can we learn from this experience?

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Where do all the midwives go?

By Pairman, S
on Monday, 01 Oct 2001 in New Zealand College of Midwives Journal - Volume: 25

Direct entry midwifery education has been available in New Zealand since 1992 when it was re-introduced as an ‘experimental’ programme following the 1990 Nurses Amendment Act. Five schools of midwifery (Auckland University of Technology, Waikato Polytechnic, Massey University in Wellington and Palmerston North, Christchurch Polytechnic Institute of Technology and Otago Polytechnic in Dunedin) now offer pre-registration midwifery programmes for both direct-entry and registered nurse students. All programmes are required to produce midwives who are capable of independent (autonomous) midwifery practice and able to take on the role of Lead Maternity Carer (LMC) within the New Zealand maternity services (Nursing Council of New Zealand, 1996). Despite the evaluation and monitoring of these programmes that has occurred, graduates have not been followed up to discover whether they do in fact work independently after graduation.

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Midwifery Standards Review: a strategy for credentialling

By Pairman, S, Guilliland, K
on Monday, 01 Oct 2001 in New Zealand College of Midwives Journal - Volume: 25

This paper outlines the New Zealand College of Midwives’ (NZCOM) perspective on credentialling and demonstrates how existing mechanisms can be utilised as a credentialling strategy for midwives. The paper was written in November 2000 and updated in September 2001 in response to the College’s concerns that Ministry of Health work with doctors over credentialling could be inappropriately applied to other health professional groups, including midwives.

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