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Informed Consent

By Donley, J
on Friday, 01 Apr 1994 in New Zealand College of Midwives Journal - Volume: 10

The Cartwright Inquiry into clinical research brought doctors in New Zealand face-to-face with the concept of informed consent and patients' rights. This stuck at the root of their long tradition of clinical freedom. As Judge Cartwright said: The doctor is no longer autonomous. As a concept, clinical freedom has been proved worthless at National Women's Hospital when patients' safety or the rigorous testing of a new treatment protocol were at stake. The NZ Health Council Working Party came up with protocols which were ridiculed by many doctors. Rather than acknowledge their determination to maintain the clinical freedom on which their doctor-patient relationship is based, they argued that patients in hospital are too dependent on doctors to make their own decisions; the time required to meet ethical requirements would make doctors' lives very difficult and add to the time they took to do their jobs, causing waiting lists to grow.

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Contracting for health services

By Lovell, M
on Friday, 01 Apr 1994 in New Zealand College of Midwives Journal - Volume: 10

In July 1991 the National Government announced its intention to effect reforms in the health services. Improved community health status, universal access to identified core health services and increased cost effectiveness and accountability were the stated aims of the health reforsm. A number of changes to the then current system were to be instrumental in the achievement of these aims. The purchaser or funder/provider split represented the most major change. The intent of this split was to allow the purchaser to select the best services available to meet the needs of its consumers. The purchasers, four (Northern, Midland, Central and Southern) Regional Health Authorities (RHAs) would be funded by government according to their population size and characteristics. Providers such as the Crown Health Enterprises (previously Area Health Boards) and independent health professionals (including midwives) would contract in a competitive market for the provision of subsidised services.

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After birth: A perspective of postnatal care and early discharge

By Wood, M
on Friday, 01 Apr 1994 in New Zealand College of Midwives Journal - Volume: 10

Within the sphere of midwifery practice, postnatal care seems to almost hold an aura of the 'poor relation', when compared with ante or intrapartum care. Yet, when women are asked what the most significant aspect of the whole experience of childbearing has been, the most frequently mentioned time is the postpartum period, with the second most common being the actual birth (Prince and Adams, 1987 p. 104). Within hospitals, these three aspects of midwifery care in general, continue to be fragmented, with continuity of midwifery care being the exception rather than the rule, despite the generally accdepted knowledge this is what women and their families want. It is my intention in this article to reflect on my experiences of postnatal care and of the challenges that couples sometimes face, especially with their first child. I will discuss why I have found early discharge to be beneficial for women and their families, and consider the barriers to planned early discharge.

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Relationships within midwifery

By Woodley, J
on Friday, 01 Apr 1994 in New Zealand College of Midwives Journal - Volume: 10

On 5 August, 1987, several hundred midwives and consumers attended a conference in Auckland where the keynote speaker, Caroline Flint, an English midwife, asked us to participate in a short, guided visualisation of ourselves as women. Caroline asked us to close our eyes and feel how unique we are as individuals, how strong we are as women, and the miracle of the conception, growth and birth of a child through ourselves as women. We were then asked to open our eyes and be together as midwives and women. Since 1987 the politics of control over childbirth have undergone dramatic change. The 1990 Nurses' Amendment Act has liberated midwives from the control of doctors and with this liberation has come uncertainy, stress and conflict. We seem to have closed our eyes and separated into our own isolated areas of work. This division causes severe problems for our profession and the women we are here to serve. The purpose of my writing is to discuss the effect that the recent legislation has had on midwives' relationships with one another and ultimately with the women. I will look at where we are historicdally within this culture of rapid change and suggest ways of altering our behaviour to enable us to truly work to support and sustain one another.

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Letter to the editor re: Placenta...a user's guide

By Wheeler, K
on Friday, 01 Oct 1993 in New Zealand College of Midwives Journal - Volume: 9

I am writing to draw attention to a misprint in the article 'Placenta... A User's Guide' [New Zealand College of Midwives Journal, Issue 8]. In the section about fat transport the text in the journal reads 'liquids', the intent was 'lipids' or those long chain fatty acids that make up cell membranes.

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International Confederation of Midwives: 23rd Triennial Congress

By Guilliland, K, Pairman, S
on Friday, 01 Oct 1993 in New Zealand College of Midwives Journal - Volume: 9

We arrived in Vancouver in the afternoon of the 3rd May, 24 hours after leaving New Zealand... The first week of the conference was the council meeting of the ICM... There were approximately 100 midwife delegates present at this meeting, representing 50 countries...Listening to other countries' problems and the restraints and constraints that they work within made us appreciate New Zealand and its advantages and the progress that we have made.

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Peripartum cardiomyopathy

By Flay, S
on Friday, 01 Oct 1993 in New Zealand College of Midwives Journal - Volume: 9

Peripartum cardiomyopathy is a rare condition occurring in healthy women with no history of cardiac disease. Unfortunately for those affected, there are few warning signs. The etiology remains unknown and reoccurrence in subsequent pregnancies may occur. The clinical manifestations are easily confused with the normal haemodynamic changes of pregnancy, which often leads to misdiagnosis and subsequent delay in appropriate medical therapy. The prognosis appears to depend on the rapidity with which the heart returns to normal size... The midwife plays an important role in providing support and education to both the woman and her family throughout her treatment and recovery.

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Mozambique

By Kearney, A
on Friday, 01 Oct 1993 in New Zealand College of Midwives Journal - Volume: 9

(Angela is in Mozambique working as a nurse manager to develop a health programme for members of the disbanded Renamo Army.) The Ministry of Health in Mozambique encourages and facilitates the training of traditional birth attendants [TBAs]. During 1991 in Zambezia Province, the government midwives were trained in the provincial capital, Quelimane, to train TBAs in courses of three weeks' duration. In Morrumbala district a study was undertaken to examine the Knowledge, Attitudes ad Practices of the TBAs before and then six months after their training courses. This article examines the findings and recommends that TBA training continues as a priority to improve the maternal and child health care to the rural disadvantaged.

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Political comment: Risk lists - who's at risk?

By Donley, J
on Friday, 01 Oct 1993 in New Zealand College of Midwives Journal - Volume: 9

In August, the College received several documents for comment...One of these - from the RNZCOG Council - was 'Guidelines for Consultation with an Obstetric Specialist'... The nine pages of NZCOG risks for referral are predicatably based on the medical model. On the other hand, the combined RHAs joint review of maternity services to assess 'the costly conflict over the control of childbirth services', is addressing 'issues relating to quality, access, information and resource allocation with respect to future contract arrangements'.

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Midwives raise the options for childbirth

By Coco, J
on Friday, 01 Oct 1993 in New Zealand College of Midwives Journal - Volume: 9

The NZCOM Auckland Region notes the comments of Dr. Philip Rushmer and his colleagues as identified by their article in the NZ Herald Monday 19 July 1993. In 1990 the Nurses' Amendment Act again restored independence of practice to midwives. The competitive environment that the change to the Nurses' Act has caused is something that our colleagues in general practice have not been trained to cope with, and, indeed, have not experienced before. No doubt this contributes to their feelings of doubts about their worth and low prestige. Their right to be the primary care givers for well women and babies during pregnancy, birth and the postnatal period had been protected until these changes occurred. The changes to the Nurses' Act allowed a competitor into the area of pregnancy and childbirth and, as with any monopoly, this is a heavy blow. It is feasible to suggest that, with ongoing deregulation of industry including healthe services, further competitors in other areas of health may also appear on the scene.

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