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Uncertainty and flexibility: Midwifery students’ experience during the COVID-19 pandemic in Aotearoa New Zealand

By Jackson, T., Gilkison, A., McAra-Couper, J., Miller, S., Dixon, L., Tamati-Elliffe, J., Griffiths, C.
on Friday, 14 Apr 2023 in New Zealand College of Midwives Journal - Volume: 59

Introduction: The initial COVID-19 lockdown in Aotearoa New Zealand (Aotearoa NZ) in 2020, likely resulted in significant disruption to maternity care and midwifery education. Therefore, we asked the question, “What was the experience of student midwives studying and providing maternity care during the COVID-19 pandemic in Aotearoa NZ?” Aim: Our aim was to explore the impact of the 2020 lockdown phase of the COVID-19 pandemic for student midwives in Aotearoa NZ. Method: This qualitative descriptive study used semi-structured interviews to explore the impact of alert levels 3 and 4 COVID-19 lockdowns in 2020. Inductive thematic analysis was used to identify codes and generate themes and sub-themes from the interview transcripts. Findings: Seven midwifery students described their experiences from which two overall themes were identified. The first of these was Uncertainty in which participants described insecurity, loss of control, isolation and constant worry. On the positive side they described Flexibility and Resilience – the ability to be flexible as they moved to more frequent use of online platforms, which provided connection with their peers; and resilience where the pandemic was considered beneficial by some for the future as it built their ability to face unanticipated challenges in their midwifery practice. Conclusion: During a pandemic, anxiety, isolation and insecurity are common and our participants felt additional institutional support for student midwives was required. We concluded that it is essential to acknowledge the anxiety and individual needs of all students and check in with them regarding their physical and mental wellbeing. Setting up online platforms and facilitating connections between tutors and peers may provide more structural support.

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Women's knowledge, attitudes and access to vaccines in pregnancy: A South Auckland study

By Priday, A., Clemons, J., Krishnan, T., Gillard-Tito, S., Fielder, A., McAra-Couper, J.
on Friday, 24 Mar 2023 in New Zealand College of Midwives Journal - Volume: 59

Background: In Aotearoa New Zealand pertussis and influenza vaccinations are available free-of-charge during pregnancy, although uptake varies between District Health Board areas. Aims: This study was designed to assess the knowledge of, attitudes towards, and infrastructural access to, these vaccines for birthing people in an area of Auckland (Counties Manukau) where uptake has been low. Methods: A mixed methods research design was used involving interviews (n = 7), two focus groups (n = 9) and a paper-based survey (n = 121). Interviews and focus groups were semi-structured and analysed using thematic analysis. The survey comprised of a 20-item Likert scale. Findings: Participants displayed support for maternal vaccinations. Concerns remain regarding potential adverse effects. Awareness of the existence of vaccines in pregnancy is not universal, and 36% of survey participants were unaware that the vaccines are free-of-charge. Appreciation was expressed for trusted healthcare relationships within which people feel supported to make decisions about maternal vaccination, and for immunisation services that are easily accessible. Conclusion: The research contributes to growing evidence on the significance of health professionals providing information about immunisation in pregnancy. Also highlighted is the importance of: culturally safe knowledge sharing; information being tailored to meet individual needs; and continuity of health and maternity care to facilitate that.

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Birth under restrictions: Exploring women’s experiences of maternity care in Aotearoa New Zealand during the COVID-19 lockdown of 2020

By Dixon, L., Jackson, T., Tamati-Elliffe, J., McAra-Couper, J., Griffiths, C., Miller, S., Gilkison, A.
on Tuesday, 07 Mar 2023 in New Zealand College of Midwives - Volume: 59

Introduction: In Aotearoa New Zealand the COVID-19 pandemic in 2020 resulted in a four-week lockdown in March and April of 2020 with ongoing restrictions for several weeks. Aim: To explore the experiences of women who were pregnant, giving birth and/or managing the early weeks of motherhood during the 2020 COVID-19 alert levels 3 and 4 in Aotearoa New Zealand. Method: This qualitative study used semi-structured interviews to explore childbirth experiences during the COVID-19 alert level restrictions. Reflexive, inductive, thematic analysis was used to identify codes, subthemes and themes. Findings: Seventeen women participated in the study. Analysis of the qualitative interviews revealed four themes. The first of these was: Relationship with my midwife, in which participants described the importance of the midwifery continuity of care relationship, with midwives often going above and beyond usual care and filling the gaps in service provision. In the Disruption to care theme the participants described feeling anxious and uncertain, with concerns about the hospital restrictions and changing rules. The participants also described their Isolation during postnatal care in a maternity facility due to separation from their partners/whānau; they describe receiving the bare necessities of care, feeling they were on their own, and working towards their release home; all of which took an emotional and mental toll. The final theme, Undisturbed space, describes the positive aspects of the lockdown of being undisturbed by visitors, being better able to bond with the baby and being able to breastfeed in peace. Conclusion: Midwifery continuity of care appears to have supported these women and their families/whānau during the service restrictions caused by the COVID-19 lockdown. The partner, or other primary support person, and whānau should be considered essential support and should not be excluded from early postpartum hospital care.

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Editorial: "Turn left at the large flax." How times have changed

By Patterson, J.
on Thursday, 01 Dec 2022 in New Zealand College of Midwives Journal - Volume: 58

This year major health reforms have commenced which will change the structure and delivery of health services throughout Aotearoa New Zealand. It is unclear at present what these will mean for midwives but there is no doubt that there will be some impact on how midwives work. Communication technology has already changed the way in which we work.

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Timing of cord clamping: An observational study of cord clamping practice in a maternity hospital in Aotearoa New Zealand

By Hewitt, T., Baddock, S., Patterson, J.
on Thursday, 01 Dec 2022 in New Zealand College of Midwives Journal - Volume: 58

Background: When the umbilical cord is left unclamped after birth, a significant proportion of the blood from the placenta flows into the newborn, increasing the baby's blood volume by approximately 30%. Routine intervention of immediate cord clamping is harmful as it deprives the newborn access to their own blood, resulting in impaired physiological transition at birth and lower iron stores in early infancy. Iron deficiency in early life, even without anaemia, is linked with impaired neurodevelopment. Aim: The aim of this study was to accurately record birth to cord clamping interval at term vaginal births in a tertiary hospital in Aotearoa New Zealand and concurrently to examine some of the circumstances that may influence the timing of when the cord is cut. Method: This observational study was undertaken from August 2017 to April 2018. Participants were pregnant women having a vaginal birth at ≥37 weeks gestation. Data collected included birth to cord clamping interval, mode of birth (spontaneous or instrumental), maternal position for birth and practitioners involved in the birth. Descriptive statistics were used to summarise the data. Results: Participants were 55 women with term vaginal births. The median interval between birth and cord clamping was 3.5 minutes (IQR 2.18 - 5.68 mins). There was a longer median cord clamping time in the group who had a spontaneous birth (median 3.71; IQR 2.67 - 6.23) vs instrumental birth (2.08; IQR 0.55 - 2.30); with maternal side-lying position (6.37; IQR 4.15 - 9.48) vs lithotomy position (2.24; IQR 1.87 - 3.50); with midwife-facilitated birth (4.06; IQR 2.68 - 6.65) vs obstetric-facilitated birth (2.13; IQR 1.48 - 3.28); and when the neonatal team was not called to attend (4.73; IQR3.32 - 8.26) vs when they were called to attend (2.13; IQR 1.28 - 3.27). Discussion: The median cord clamping time of 3.5 minutes aligns with current local, national and international guidelines, although clamping times as short as 0.23 minutes were observed. The study provides a snapshot of practice at one tertiary hospital, examining data on a range of vaginal births, from uncomplicated midwifery-led births to complicated obstetric-led births requiring neonatal team attendance. By identifying some of the circumstances where cords are clamped early, we may be able to modify the associated factors for these births, thereby improving newborn health outcomes in the future.

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Exploring the ways communication technology is used by midwives and pregnant women/people: An integrative review

By Wakelin, K., McAra-Couper, J., Fleming, T., Erlam, G.
on Tuesday, 23 Aug 2022 in New Zealand College of Midwives Journal - Volume: 58

Background: Pregnant women/people globally are increasingly using digital technology such as texting, emailing, instant messaging, pregnancy applications, social media and the internet to access information about their pregnancy. There is little information, however, on how the technology is used to enable midwives and pregnant women/people to communicate with each other and what effect this may have on the quality of maternal and newborn health within Aotearoa New Zealand. Aim: To explore the literature on how communication technology has been used to enable midwives and pregnant women/people to connect with each another. Method: An integrative literature review of peer reviewed studies between 2010 and 2021 was undertaken to explore how communication technology was used to enable midwives and pregnant women/people to connect with each another. The initial search elicited 450 articles, of which five met the inclusion criteria. These were then assessed using the Critical Appraisals Skills Programme checklist. Results: The five relevant studies were summarised using an evidence table to enable comparison of themes or relationships between the studies. Four main themes were identified: (1) connecting, (2) access to healthcare, (3) privacy and confidentiality, and (4) lack of skills and knowledge. Using communication technology appeared to provide a safe space for information sharing within which pregnant women/people and midwives could connect. A feeling of connection was important, in supporting the pregnant woman/person in their access to maternity services. This emotional connection was enabled regardless of whether the pregnant person and midwife were known to each other. However, concerns were identified relating to issues of privacy, and the skills pregnant women/people and midwives needed to access and use the technology. Conclusion: Gaps in the published literature were highlighted through undertaking this integrative literature review. The first was in the understanding of how midwives and pregnant women/people use communication technology when communicating with one another, and the second was in how communication technology is used within a midwifery continuity of care model.

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Midwives’ perspectives on the benefits for women and babies following completion of midwifery postgraduate complex care education

By Maude, R., Douché, J., Holloway, K.
on Friday, 29 Apr 2022 in New Zealand College of Midwives Journal - Volume: 58

Background: Midwives require an expanded level of knowledge and skill to meet the complex care needs of childbearing clients and babies, along with their whānau (extended family and community) throughout their childbearing experience. Complexity in childbirth summons midwives to apply research in practice to support clinical decisions they make. Postgraduate education is key to preparing midwives with a level of expertise in the provision of evidence-based practice, with the view to improving outcomes for women and babies when care becomes complex. Aim: To explore the perceived benefits of midwifery postgraduate education for midwives, women, pregnant people, babies and maternity services, following midwives’ completion of a Postgraduate Certificate in Midwifery (Complex Care) offered at an Aotearoa New Zealand university. Method: A purposive sample of 90 midwives who completed the qualification between 2009 and 2017 were sent a link to an online, mixed method, self-report questionnaire. Twenty-seven surveys were returned and entered in Qualtrics for analysis. The qualitative component of the questionnaire is addressed in Question 13 and reported in this article. Findings: A thematic analysis found benefits of postgraduate complex care education included improved quality of care, enhanced knowledge, increased awareness of research, heightened critical thinking capabilities juxtaposed with improved professional development and enhanced communication. Conclusion: The study corroborated the premise that postgraduate midwifery complex care education is key to improving outcomes for childbearing women and babies in settings requiring complex care. Recognition of the benefits of the Postgraduate Certificate in Midwifery (Complex Care) for the provision of evidence-based practice is central to improving health outcomes when pregnancy and childbirth become complex.

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Promoting positive interactions between midwives and obstetricians at the primary/secondary interface

By Cassie, R., Griffiths, C., Parker, G.
on Friday, 29 Oct 2021 in New Zealand College of Midwives Journal - Volume: 57

Background: Interprofessional communication is a critical component of safe maternity care. The literature reports circumstances in Aotearoa New Zealand and overseas when interprofessional collaboration works well between midwives and obstetricians, as well as descriptions of unsatisfactory communication between the two professions. Aim: To explore and define effective collaboration between midwives and obstetricians at the primary/secondary interface in maternity care, in order to generate suggestions to foster positive collaboration. Method: Eight primary care midwives, three obstetricians and two obstetric registrars from a single District Health Board in Aotearoa New Zealand were interviewed about their interactions at the primary/secondary interface and their understanding, and use, of the Referral Guidelines. The theoretical perspective was Appreciative Inquiry. Data were analysed using thematic analysis. Findings: Results indicate usually positive interprofessional interactions. Dominant emergent themes are the need to negotiate differing philosophies, to clarify blurred boundaries that sometimes lead to lack of clear lines of responsibility, and the importance of three-way conversations. Of the three themes, this article focuses on three-way communication between midwife, obstetrician/registrar and woman. Participants reported that, when effective three-way communication between woman, midwife and obstetrician occurred, philosophical difference could be negotiated, blurred boundaries clarified and understanding of the respective roles of the LMC midwife and the obstetric team promoted. Participants value the Referral Guidelines but report some limitations to their applicability. Conclusion: Effective three-way communication promotes good maternity care. This study has identified ways to support optimal communication.

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The microbiota of the vulva and vagina: Ways of washing to optimise the protective function of the vulvo-vaginal microbiota during pregnancy

By Banga, L.
on Wednesday, 29 Sep 2021 in New Zealand College of Midwives Journal - Volume: 57

Background: The microbiota of the vulva and vagina has a crucial protective function, which is important for all women and has particular significance in pregnancy. Yet this microbiota is part of a delicately balanced ecosystem, susceptible to extrinsic factors which include the simple matter of how women wash themselves. Clinical observation and anecdotal evidence indicate that women in Aotearoa New Zealand have washing practices that may compromise the naturally acidic vulvo-vaginal environment crucial to optimising the protective function of the microbiota. Aims: The aims of this review are: to determine if there is dissonance between how women are washing their vulva and vagina and recommended washing practices; and to raise awareness of the emerging significance of the vulvo-vaginal microbiota to women’s health, particularly in pregnancy. Method: A literature review was undertaken to discover what is reported (in the published literature) about the ways women wash themselves, products used, and their effect on the vulvo-vaginal microbiota. The evidence behind the “wash with water” recommendation was investigated. Findings: There is a lack of primary research on ways of vaginal washing used by women in Aotearoa New Zealand. Globally, women are routinely using a variety of products that include soap, anti-bacterial wipes, gels and baby wipes, and invasive vaginal washing practices such as douching, flannel scrubs and internal soap cleansing. All washing products, including gentle soap but excluding lactic-acid based gels, alter pH levels when used on either the vulva or the vagina. Washing practices that alter vaginal pH levels can cause a microbial shift into a sub-optimal state that compromises the protective function of the vulvo-vaginal microbiota and is more susceptible to bacterial vaginosis and group B streptococcus vaginal colonisation. The frequency and duration within suboptimal states may be predictors of risk. Conclusion: There is dissonance between the ways women wash their vulva and vagina, and evidence-based advice to just wash with water. The back-to-basics message “just wash with water” promotes a way of washing that optimises the protective function of the vulvo-vaginal microbiota, while also protecting the integrity of vulval skin, and supporting physiological self-cleaning of the vagina.

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A daunting journey: A qualitative comparative study of women’s experiences of accessing midwifery care

By Priday, A., Payne, D., Hunter, M.
on Friday, 13 Aug 2021 in New Zealand College of Midwives Journal - Volume: 57

Background: Early engagement with a maternity carer is recommended as a means of reducing stillbirth and neonatal mortality. This is especially important for women who live in high deprivation areas, as these areas have been associated with late access to maternity/midwifery care and significantly higher rates of stillbirth and neonatal mortality. Co-locating midwives at general practitioner (GP) clinics in such an area was established with the aim of facilitating women’s early access to midwifery care. Aim: To explore the experience of multiparous women who live in socio-economically deprived communities within the Counties Manukau Health region and who accessed the services of midwives at co-located clinics. Method: Interpretive descriptive methodology was used to explore the experiences of each woman before and after using a co-located midwifery clinic. One-to-one, semi-structured interviews were undertaken and data examined using thematic analysis. Findings: The eight women interviewed found accessing Lead Maternity Care (LMC) midwives during early pregnancy a daunting journey before being able to use a co-located clinic in the Counties Manukau Health region. Barriers identified were: a lack of knowledge about how to find a LMC midwife, limited finance and limited time. These impacted on women’s ability and confidence to find a suitable LMC midwife. The women expressed the need for help to circumvent the maternity care maze through receiving a recommendation for a LMC midwife and having access to a midwife co-located at their GP clinic. Conclusions: The participants encountered numerous barriers accessing early LMC midwifery care. Enablers to accessing early LMC midwifery care include receiving recommendations from GP clinic personnel, and midwives being co-located at GP clinics to make maternity care convenient and with a smooth transition from GP to LMC midwife care.

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