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ERRATUM: “I’m ready for you, baby, why won’t you come?” How long is a pregnancy and how long is too long?

By Davies, R
on Monday, 31 Jul 2017 in New Zealand College of Midwives Journal - Volume: 28

ERRATUM: An error was made in the article ‘“I’m ready for you, baby, why won’t you come?” How long is a pregnancy and how long is too long?’ which appeared in Journal 28, April 2003, pp.8-10. We apologise to cited author D.J.R. Hutchon, whose name was spelt incorrectly in the References and in the text. On page 9, it was also stated “There is now a computer software program being used in some maternity units, e.g. Darlington, USA”, when the program was actually being used in Darlington, England.

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A midwifery critical analysis of: A retrospective cohort study of the association between midwifery experience and perinatal mortality (Lawton et al., 2015). ERRATUM

By Guilliland, K, Dixon, L, MacDonald, C
on Thursday, 01 Dec 2016 in New Zealand College of Midwives Journal - Volume: 52

Erratum: An error was made in our original article where the P value of 0.329 was attributed to the single category of midwives with < 1 year of experience, suggesting that no association was found. Instead, this P value related to the global test of differences by category, and was not statistically significant. The hypothesis test for trend according to years of experience resulted in a P value of P=0.031, a statistically significant finding of an association. This infers a need for more exploration. Future research is warranted and must address issues of bias, confounding and be relevant to the current context in order to gain a clearer understanding of the issue in question. The importance of involving New Zealand research midwives during this process cannot be overstated. Original article: http://dx.doi.org/10.12784/nzcomjnl51.2015.9.59-62, https://www.midwife.org.nz/wp-content/uploads/2018/09/Jnl-51-article-9.pdf

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Women's experiences of changes in eating during pregnancy: A qualitative study in Dunedin, New Zealand

By Paterson, H, Hay-Smith, E, Treharne, G
on Thursday, 01 Dec 2016 in New Zealand College of Midwives Journal - Volume: 52

Background: The goal of optimal nutrition in pregnancy is to improve health outcomes for both mother and child. Healthy weight gain in pregnancy has therefore become recognised as an important aspect of perinatal care. Intuitive Eating and related ‘mindful eating’ have been associated with lower gestational weight gain and improved glucose control in pregnancy. Healthy weight gain in pregnancy is a current public health promotion message in New Zealand. Objective: To explore women’s experiences of eating in pregnancy, in the context of intuitive eating. Method: This was a qualitative interview-based study of 12 purposively sampled pregnant women referred by their Lead Maternity Carer, in New Zealand. We investigated these women’s perceived experiences of how their eating changed in pregnancy, specifically in the context of the phenomenon of intuitive eating. Participants were interviewed incorporating a cognitive ‘think-aloud’ process, whilst completing the Intuitive Eating Scale Questionnaire, followed by a semi-structured interview to discuss their experiences of eating. Themes were derived using a general inductive approach. Findings: Four themes regarding eating during pregnancy were identified: Theme one - How women feel; Theme two - External influences; Theme three - Changed eating by choice; and Theme four - Motivation to change. Changes in eating were driven by a variety of reasons which differed between women and between pregnancies. Participants described pregnancy as a time of change with regard to their experiences of eating. Conclusion: The findings of this study support Phelan’s model of pregnancy as a teachable moment for eating behaviours, which provides a potential opportunity to inform women about healthy eating.

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Using a breath CO analyser to improve rate of referrals for smoking cessation during pregnancy: An exploratory single-case evaluation

By Mentor, M, Pihema, N, Kira, A
on Thursday, 01 Dec 2016 in New Zealand College of Midwives Journal - Volume: 52

Background: Smoking in pregnancy negatively impacts pregnancy outcomes and wellbeing in infancy and childhood. While midwives are increasingly offering brief advice, cessation support and referral for smoking cessation, the data collected from a significant number of midwifery practices suggests that an estimated 79% of women decline referral. Aim: The aim of this single-case evaluation was to assess if voluntary use of an exhaled carbon monoxide (CO) test would increase referral rates to smoking cessation services. Because of the high rates of smoking during pregnancy by women who identify as Maori (43%), the focus was the practice of a midwife who works with pregnant Maori women. Method: This was an exploratory single-case evaluation including all women who reported that they smoked when they registered with the midwife. The midwife introduced the breath CO analyser (CO test machine) as a way of measuring mother’s and baby’s levels of CO and use was voluntary. Data gathered included: use of the breath CO analyser and number of referrals to cessation services. Additionally, an interview was conducted with the midwife on how the breath CO analyser was used. Simple descriptive statistics were produced and proportions reported. The interview was analysed deductively. Findings: Thirteen pregnant women participated in this study. Seven consented to use the analyser and six declined. Of the 13 women who were offered the analyser, 9 (69%) accepted and 4 (31%) declined referral to a smoking cessation service. The midwife perceived that the analyser made it easier for her to discuss smoking with her clients. Conclusion: The breath CO analyser may be a useful tool for supporting midwives, who care for a high number of women who smoke, to initiate discussions about smoking cessation while pregnant, and to increase acceptance of referral to cessation services. Further research is needed to determine the effectiveness of a breath CO analyser as a tool for midwives nationwide, as well as to determine extra time and resources that may be required.

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Pregnancy gone wrong: Women's experiences of care in relation to coping with a medical complication in pregnancy

By Currie, J, Cornsweet Barber, C
on Thursday, 01 Dec 2016 in New Zealand College of Midwives Journal - Volume: 52

Objective: To understand the experiences of twelve New Zealand women with medical complications in pregnancy. Method: Inductive, semantic, qualitative analysis was employed to obtain an in-depth insight into the experience of having a medical complication during pregnancy. Semi-structured interviews were conducted face-to-face with twelve women. Six had been hospitalised during their pregnancy, while a further six were recruited from outpatient settings. Findings: Five themes were identified: pregnancy distressing and overshadowed by complications; unpredictability and the need for control; importance of the relationship with midwives; disempowerment in hospital; and lessons learnt on the importance of support. Key conclusions: Medical complications during pregnancy can be extremely stressful and women feel particularly vulnerable during this time. Midwives play a key role in supporting women through the process of coping with a pregnancy marked by illness and uncertainty. Implications for practice: Midwives can play a unique role in translating medical jargon and providing emotional guidance and support. A midwife who is engaged and responsive to a woman’s needs has the ability to lower distress at this critical juncture in the development of a woman and her family.

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New Zealand's midwifery profession: Embracing graduate midwives' transition to practice

By Kensington, M, Campbell, N, Gray, E, Dixon, L, Tumilty, E, Pairman, S, Calvert, S, Lennox, S
on Thursday, 01 Dec 2016 in New Zealand College of Midwives Journal - Volume: 52

Background: The first year following registration is considered a stressful time for new health professionals as they transition from student to health practitioner, acclimatise to a new job and work environment, and become confident in their clinical skills. The Midwifery First Year of Practice (MFYP) programme was designed to provide support to graduate midwives during this transition. Aim: This research explored the midwifery graduate’s perspective of the MFYP programme to identify which elements were important and supported them in their transition to confident practitioner. Method: Survey methodology was used to explore the views of the MFYP programme participants for the years 2007 to 2010. This paper provides the qualitative analysis of the open text responses in the survey and explores the support needs of graduate midwives during their first year of practice. Findings: A total of 180 midwives responded to the survey, with the majority also providing text responses to enable more in-depth understanding of their views. Graduate midwife participants were supported to consolidate practice skills and decision making, and to develop networks within the midwifery and wider health communities. An unexpected finding was that this support was provided by the whole midwifery community for all graduates, whether they were employed or self-employed. The mentoring relationship was also considered an important source of support. Conclusion: Graduate midwives are gaining wrap-around support from the whole midwifery community. This research, unlike any previous international or national research, demonstrates that midwives in New Zealand have taken on collective responsibility for supporting graduates. This suggests that this national programme has successfully fostered a culture of nurturing midwife graduates into their professional role.

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The Midwifery First Year of Practice programme: Supporting New Zealand midwifery graduates in their transition to practice

By Pairman, S, Dixon, L, Tumilty, E, Gray, E, Campbell, N, Calvert, S, Lennox, S, Kensington, M
on Thursday, 01 Dec 2016 in New Zealand College of Midwives Journal - Volume: 52

Background: The Midwifery First Year of Practice programme (MFYP) is a fully government- funded programme aimed at supporting newly qualified midwives in their first year of practice. This formalised programme provides mentor support, professional continuing education and quality assessment and reflection. Aim: This research was designed to assess and explore the MFYP programme and identify which components New Zealand midwifery graduates considered important and supported them to develop confidence as a midwifery practitioner in their first year of practice. Method: A survey of graduate midwives who participated in the MFYP programme from 2007 to 2010 was undertaken. A survey tool was developed which was designed to explore each element of the programme. Likert scales were provided for the majority of questions with comment boxes also provided so that answers could be contextualised. Quantitative data were analysed using SPSS 21 with descriptive statistics provided to demonstrate responses. Findings: Between the years 2007 and 2010, there were 415 new graduate midwives who participated in the MFYP programme, of which 180 responded to the survey (43.4% response rate). The demographics of the respondents were reflective of the total cohort of MFYP programme participants. In their first year of practice, respondents were almost evenly split between self-employed midwives in case loading practice (47.5%) and midwives employed by a maternity facility (45.5%). Support from the mentor and the financial support for education were considered important contributors to developing professional confidence for these new graduates. The majority of respondents reported feeling supported when attending women during labour and birth (92.2%), and at other times during clinical practice (93.9%). Main sources of support were midwives employed within the facility, midwifery practice partners, and midwife mentors from the MFYP programme. Conclusion: Each element of the programme was considered important by new graduates and this was regardless of their practice setting. The MFYP programme is flexible, meets the needs of New Zealand graduates and helps them to increase confidence in their first year of practice as a registered midwife.

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Providing rural and remote rural midwifery care: an 'expensive hobby'

By Crowther, S
on Thursday, 01 Dec 2016 in New Zealand College of Midwives Journal - Volume: 52

Background: Providing midwifery care in rural and remote rural regions can be challenging in many ways. This includes financial arrangements for midwives in New Zealand. This paper draws from a larger study exploring the lived experience of rural and remote rural families, midwives, general practitioners (GPs) and ambulance crews. Aim: The focus of this paper is on the financial lived experiences of the rural midwife participants in this study. Method: A qualitative study using hermeneutic phenomenology was used to explore the experiences of six rural midwives. Participants were from two regions in the South Island and two regions in the North Island and interviewed following ethical approval. Interviews were interpretively analysed. Findings: Several tensions surfaced in the study. Across these tensions it was evident that the current funding for rural and remote rural midwifery is not working well. The participants revealed the challenges and financial hardships which they as rural midwives experience in maintaining a local midwifery service and how these challenges adversely affect their wellbeing and safety. The themes, ‘cost of distance’, ‘spirit of generosity exploited’, ‘being treated unfairly’ and ‘working rurally can be an expensive hobby’, are uncovered through stories of rural and remote rural midwives. Conclusion: The current financial system does not serve these midwifery practitioners working in rural and remote areas. Without more financial support reflecting local needs, midwifery services in some of these rural regions are not sustainable and recruitment and retention will continue to be a challenge. There are Lead Maternity Carer (LMC) midwives working in rural, and in particular, remote rural regions who are concerned about the inequality and unfairness of remuneration. This may result in increasing the vulnerability of the maternity service for these regions. Rural and remote rural midwives’ need for improved financial support is urgent and requires immediate attention at national level.

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Editorial: Working together to bring you a world class journal

By Davies, L
on Thursday, 01 Dec 2016 in New Zealand College of Midwives Journal - Volume: 52

"... a piece that honours the work that the editors, sub-editors and support crew carry out behind the scenes of the Journal."

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The high price of being labelled "high risk": Social context as a health determinant for sudden unexpected infant death in Māori communities

By Houkamau, C, Tipene-Leach, D, Clarke, K
on Thursday, 01 Dec 2016 in New Zealand College of Midwives Journal - Volume: 52

Background: For over 25 years, nationwide efforts to address sudden infant death in New Zealand have focused on advising parents to avoid four risk factors labelled as modifiable. But Māori infants still have sudden unexpected death in infancy (SUDI) at five times the rate of non-Māori. Aim: This paper expands the conceptualisation of SUDI risk factors and suggests a reconsideration of the use of risk factor terminology. Discussion: Working from the assumption that health outcomes are influenced by social determinants, we put forward two key propositions. Firstly, we argue (using maternal smoking as a case in point) that greater attention must be paid to the role of social and socio-economic factors in the prevention of SUDI in Māori communities. Secondly, we propose that the language of risk reduction impedes Māori engagement with health services because the discourse associated with being "at risk" and "vulnerable" casts Māori in a deficit framework affecting how Māori are perceived by health professionals and, more importantly perhaps, how Māori see themselves.

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