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Midwives’ experiences of caring for women with antenatal anxiety and depression: A qualitative study with midwifery acupuncturists

By Lowe, L.-A., Betts, D.
on Wednesday, 07 Jul 2021 in New Zealand College of Midwives Journal - Volume: 57

Background: Pregnant women seek help for a range of physical and emotional pregnancy symptoms from traditional acupuncturists. Whether midwifery acupuncturists in Aotearoa New Zealand (Aotearoa NZ) provide acupuncture for antenatal anxiety and depression (AAD) in practice is currently unknown. Aim: This qualitative arm of a mixed-methods study aimed to explore midwifery acupuncturist experiences of caring for pregnant women with AAD in Aotearoa NZ. The aim of the research was to examine the factors that influence midwifery acupuncturists' perceptions of acupuncture use for AAD. Method: This was a mixed-methods study involving an online survey and in-depth interviews from a convenience sample of Aotearoa NZ midwifery acupuncturists who had completed a Certificate of Midwifery Acupuncture. This paper describes the thematic analysis of the semi-structured interviews. Findings: The eight interviewees were mostly NZ European (n=6) and Lead Maternity Carers (LMCs; n=6) caring for pregnant women in rural and urban locations throughout Aotearoa NZ. The interviews revealed an overarching theme, “helping midwives to navigate the ocean of AAD”, which identified the lack of support participants experienced from current maternity health services for AAD in Aotearoa NZ. Subthemes “Missing the boat during pregnancy” expressed how participants felt no options were available for AAD prevention, while “keeping women afloat with no ship in sight” represented how interviewees tried to keep women in their care stable even though access to maternal mental health services was difficult. Participants felt acupuncture was a useful nonpharmaceutical tool that works; however, they had reservations about “adding acupuncture to the midwifery toolbox”. Conclusion: Aotearoa NZ midwifery acupuncturists were concerned about AAD and the limited conventional options available for women in their care. Acupuncture was viewed as a promising adjunct to usual treatment for AAD. Reservations included adding acupuncture to an already heavy midwifery workload, the cost of acupuncture, and the appropriateness of the treatment.

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A weighty issue: The implications of an ultrasound prediction of a large baby in pregnancy

By Baddington, C., Parker, G.
on Tuesday, 11 May 2021 in New Zealand College of Midwives Journal - Volume: 57

Introduction: The assessment of fetal growth in Aotearoa New Zealand is governed by a largely medical model of care which highly values the purported objectivity of sonographic assessment. Ultrasound scans are an increasingly normalised part of pregnancy care, and expectant parents may advocate strongly for access to them. It could be questioned whether the increasing number of scans is aligned with clinical need. This paper presents a literature review that explores the implications of an ultrasound diagnosis of a large baby during pregnancy. Method: Databases searched were CINAHL, PubMed, Proquest, and Google Scholar. Search terms used were “macrosomia”, “large for dates” and “large for gestational age”. This search was first undertaken in May 2019, and then repeated in November 2020. Findings: Sonographic assessment of fetal size can be inaccurate and the existence of a predicted fetal weight on scan increases the likelihood of birth interventions, regardless of the baby’s actual size. While there are potentially negative outcomes associated with a larger baby, it is unclear whether birth interventions will significantly reduce the occurrence of these outcomes. There is limited research that focuses on the parents’ experience of having a predicted large baby, offering contradictory insights, which suggests the influence of conflicting meanings applied to large babies and ignoring the experiences of women whose babies were predicted to be large but were born “normal” sized. Discussion: Midwives are encouraged to openly discuss with women the limitations in available evidence in this area. Midwives can consider the context of the woman and whānau (wider family), and how they may assess risk uniquely. Finally, midwives can honour the woman and whānau as the decision-makers in their own experience. There are further opportunities for research to provide a counter-narrative to medicalising discourses about large babies, grounded in a midwifery belief in normal birth. Conclusion: Midwives and women are drawn into a risk-centric paradigm that pathologises large babies for questionable benefit. To support informed decision-making within the midwifery partnership, midwives need to critically evaluate existing research and communicate its limitations and risk-centric orientation.

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The role of Aotearoa New Zealand midwives as positive influencers on food literacy with Samoan families: Report on a small Auckland-based study

By Wong Soon, H. N., Crezee, I., Rush, E.
on Friday, 05 Mar 2021 in New Zealand College of Midwives Journal - Volume: 57

Background: Healthy eating is crucial for optimal development during all stages of life and most particularly during pregnancy. According to Stats NZ, Pasefika people make up 8.1% of the total Aotearoa New Zealand population. Information from the Ministry of Health suggests that Pasefika people have the highest level of food insecurity and the highest level of obesity. Women are more likely than men to be involved with food preparation; therefore, it is important to know to what extent women are aware of what healthy eating means for themselves and their families. Aim: This study aimed to explore an understanding of the levels of food literacy among representatives of three generations of women in five Samoan families; how each of the three generations ensured that their dietary intake contributed to their quality of health; and whether the extent of food literacy was influenced both within and between/across generations. Method: The study used a combined Delphi-Talanoa approach to interview 15 Samoan women about the levels of their understanding of food literacy. Findings: Midwives played an important role in helping pregnant Samoan women understand about healthy eating during pregnancy. Women shared with other female relatives what they had learned about healthy eating from their midwives. Learnings taken from midwives included the importance of choosing healthy foods, portion control and physical activity. Conclusion: All study participants who had received antenatal care in Aotearoa New Zealand mentioned the important role of midwives in increasing their understanding of healthy lifestyle choices. What the women learned from their midwives also informed their wider family or aiga.

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“I’ve done a test, what now?” A focus group study exploring eHealth access for women

By McAra-Couper, J., Gilkison, A., Clemons, J., Payne, D., Dann, L., Benn, C.
on Tuesday, 01 Dec 2020 in New Zealand College of Midwives Journal - Volume: 56

Background: Following the receipt of a pregnancy test result, a woman's access to timely and appropriate information is essential for enabling her to make informed decisions. Individually tailored information can be hard to find, which can constrain decision-making, leading to delayed engagement with maternity services. Carefully designed eHealth interventions could speedily deliver targeted information but women at most risk of adverse birth outcomes may experience significant barriers to accessing digitally delivered information. Aim: To investigate how women find information about what to do next when they have a positive or negative pregnancy test. Method: Professional networks were used to recruit women from ethnic and socio-demographic groups associated with delayed engagement in antenatal care. Informed by participatory design, we sought to understand how these women access reproductive health information following a pregnancy test; and then we explored their perspectives about which eHealth tool they would find most helpful. We collected qualitative and quantitative data from three focus groups and two individual interviews. Qualitative data were analysed interpretively using thematic analysis, and quantitative data were analysed descriptively. Findings: Women accessed reproductive information following pregnancy from doctors, school nurses, midwives, the internet and, for some, family and friends. Barriers to access included financial challenges, degree of information literacy and the feeling of being judged by others. Participants expressed a clear preference for reproductive information which was free, instant, private and personalised to them. The most preferred eHealth tool was a free 0800 number and the least popular were the QR code and free text options. Conclusions: Despite the rapid uptake of eHealth health tools to access health information in general, following a pregnancy test, study participants indicated they valued free, confidential and personal interactions with a health professional to supplement any electronic information they used or accessed. These methods did not eclipse the importance to many participants of embodied, face-to-face contact with a desired health professional, specifically a midwife.

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Writing a journal article from your thesis or research project

By Patterson, J., Gilkison, A.
on Tuesday, 01 Dec 2020 in New Zealand College of Midwives Journal - Volume: 56

Background: Many midwives who have completed their thesis or dissertation have not subsequently published their findings in a peer reviewed journal. This means that the potential contribution of their research findings to midwifery knowledge does not reach a wider audience. Aim: The aim of this paper is to alert prospective midwife authors to useful tips and writing strategies and encourage them to write and submit an article to a peer reviewed journal. Discussion: Adapting a large manuscript to the size and shape required by a journal can be a daunting task, requiring trimming and rewriting. Some authors may also experience writer anxiety and a lack of practical support. These issues are addressed, and readers are alerted to steps and strategies for writing well and establishing a simple clear argument. We discuss the practical challenges and offer advice on making time to write, choosing a journal, enlisting the help of a co-author, preparing for submission, and responding to editor or reviewer comments. Conclusion: It is our intention to assist midwives to publish their research, while acknowledging that this work needs to fit around already busy lives. In this article we address the personal and practical issues which may inhibit some midwives from writing, plus discuss tips and strategies to manage the writing tasks.

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Maternal socio-economic disadvantage in Aotearoa New Zealand and the impact on midwifery care

By Dixon, L., Neely, E., Eddy, A., Raven, B., Bartle, C.
on Sunday, 12 Apr 2020 in New Zealand College of Midwives Journal - Volume: 56

Background: Maternal socio-economic disadvantage affects the short- and long-term health of women and their babies, with pregnancy being a particularly vulnerable time. Aim: The aim of this study was to identify the key factors that relate to poverty for women during pregnancy and childbirth (as identified by midwives), the effects on women during maternity care and the subsequent impact on the midwives providing that care. Method: Survey methodology was used to identify Aotearoa New Zealand midwives’ experiences of working with women living with socio-economic disadvantage. Findings: A total of 436 midwives (16.3%) who were members of the New Zealand College of Midwives responded to the survey, with 55% working in the community as Lead Maternity Care midwives, or caseloading midwives, and the remainder mostly working in maternity facilities. The survey results found that 70% of the cohort of midwives had worked with women living with whānau (family) /friends; 69% with women who had moved house during pregnancy due to the unaffordability of housing; 66% with women who lived in overcrowded homes; and 56.6% with women who lived in emergency housing, in garages (31.6%), in cars (16.5%) or on the streets (11%). The cohort of midwives identified that women’s non-attendance of appointments was due to lack of transport and lack of money for phones, resulting in a limited ability to communicate. In these circumstances these midwives reported going to women’s homes to provide midwifery care to optimise the chances of making contact. The midwives reported needing to spend more time than usual referring and liaising with other services and agencies, to ensure that the woman and her baby/family had the necessities of life and health. This cohort of midwives identified that women’s insufficient income meant that midwives needed to find ways to support them to access prescriptions and transport for hospital appointments. The midwives also indicated there was a range of social issues, such as family violence, drugs, alcohol, and care and protection concerns, that directly affected their work. Conclusion: Recognising the impact of socio-economic disadvantage on maternal health and wellbeing is important to improving both maternal and child health. This cohort of midwives identified that they are frequently working with women living with disadvantage; they see the reality of women’s lives and the difficulties and issues they may face in relation to accessing physical and social support during childbirth.

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Rural midwifery practice in Aotearoa/New Zealand: Strengths, vulnerabilities, opportunities and challenges

By Daellenbach, R., Davies, L., Kensington, M., Crowther, S., Gilkison, A., Deery, R. , Rankin, J.
on Sunday, 12 Jan 2020 in New Zealand College of Midwives Journal - Volume: 56

Background: The sustainability of rural maternity services is threatened by underfunding, insufficient resourcing and challenges with recruitment and retention of midwives. Aims: The broader aim of this study was to gain knowledge to inform the optimisation of equitable and sustainable maternity care for rural communities within New Zealand and Scotland, through eliciting the views of rural midwives about their working conditions and practice. This article focuses on the New Zealand midwives’ responses. Method: Invitations to participate in an online questionnaire were sent out to midwives working in rural areas. Subsequently, themes from the survey results were followed up for more in-depth discussion in confidential, online group forums. 145 New Zealand midwives responded to the survey and 12 took part in the forums. Findings: The New Zealand rural midwives who participated in this study outlined that they are attracted to, and sustained in, rural practice by their sense of connectedness to the countryside and rural communities, and that they need to be uniquely skilled for rural practice. Rural midwives, and the women they provide care to, frequently experience long travel times and distances which are economically costly. Adverse weather conditions, occasional lack of cell phone coverage and variable access to emergency transport are other factors that need to be taken into account in rural midwifery practice. Additionally, many participants noted challenges at the rural/urban interface in relation to referral or transfer of care of a woman and/or a baby. Strategies identified that support rural midwives in New Zealand include: locum and mentoring services, networking with other health professionals, support from social services and community service providers, developing supportive relationships with other rural midwives and providing rural placements for student midwives. Conclusion: Midwives face economic, topographic, meteorological and workforce challenges in providing a service for rural women. However, midwives draw strength through their respect of the women, and the support of their midwifery colleagues and other health professionals in their community.

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Editorial: A new direction for the College Journal

By Gilkison, A., Dixon, L.
on Sunday, 12 Jan 2020 in New Zealand College of Midwives Journal - Volume: 56

2020: the Year of the Midwife, and the year of Covid-19…what a year it has been for midwives in every role and every part of Aotearoa, and throughout the world. In Aotearoa, midwives have shown incredible dedication, innovation and flexibility to continue providing quality care for women and babies throughout the pandemic. Midwifery educators have continued to teach, midwifery researchers have continued to research – everything has needed to be adapted to virtual consultations, virtual teaching and virtual research.

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Guest editorial: Celebrating 30 years

By Manoharan, H.
on Tuesday, 07 Jan 2020 in New Zealand College of Midwives Journal - Volume: 56

This issue celebrates the 30th birthday of the New Zealand 2 RETURNS College of Midwives Journal and I feel highly privileged to be SHIFT RETURN asked to write this editorial at such a significant time. We celebrate 30 years of providing an accessible source of scholarly articles on clinical midwifery sciences and current practice issues which are all rigorously peer reviewed, edited and printed, all contributing to midwifery knowledge development.

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Midwives’ perspectives of maternal mental health assessment and screening for risk during pregnancy

By Mellor, C, Payne, D, McAra-Couper, J
on Sunday, 01 Dec 2019 in New Zealand College of Midwives Journal - Volume: 55

Background: Increased maternal mental health needs are associated with an increased risk of maternal morbidity and mortality and occur more frequently during pregnancy than during the postnatal period. The implications of this antenatally for the mother, baby and family is increasingly becoming recognised and recommendations are being made for routine antenatal screening. Aim: This qualitative descriptive research study explored midwives’ perceptions of maternal mental health antenatally, including screening. Method: Twenty-seven Lead Maternity Carer (LMC) midwives participated in five focus group interviews. These were analysed using thematic analysis to identify the key ways in which midwives perceived and assessed maternal mental health during the antenatal period. Findings: The study identified that these midwives routinely assessed women’s mental health during antenatal care in informal and not necessarily explicit ways. Caring for women who were highly anxious was not an infrequent experience and led to the midwives feeling responsible for the woman’s mental health needs without a safety-net. Midwives were concerned about the introduction of routine universal antenatal screening without the availability of appropriate maternal mental health services for women who had identified as having mild to moderate mental health issues, such as anxiety. Conclusion: The mental health services that the midwives needed to refer pregnant women experiencing mental health issues to, particularly those women with mild to moderate issues, are lacking. We suggest that the introduction of routine antenatal mental health screening would need to be well supported with accessible and appropriate mental health services to meet the needs of all women, not just those experiencing serious mental ill health.

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