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Generosity of spirit sustains caseloading Lead Maternity Carer midwives in New Zealand

By Hunter, M, Crowther, S, McAra-Couper, J, Gilkison, A, MacGregor, D, Gunn, J
on Thursday, 01 Dec 2016 in New Zealand College of Midwives Journal - Volume: 52

Background: This article is the third in a series reporting on original research exploring the sustainability of Lead Maternity Carer (LMC) midwifery. Previous publications have described sustainable practice arrangements and the way that partnership and reciprocity with women sustain LMC midwives. Research about sustainable caseload practice is important because lessons can be learnt that ensure this model of care, with its excellent outcomes and high levels of maternal satisfaction, continues. Aim: The aim of this paper is to provide stand-alone data in relation to what sustains LMC midwives in midwifery practice over time. The final theme to emerge from our original research arose from data which support the strong relationship between the midwives’ generosity of spirit alongside professional boundaries that is critical to sustaining caseloading practice. Method: A qualitative descriptive study was conducted in New Zealand. Eleven LMC midwives with between 8-20 years of practice experience were interviewed. Interviews were transcribed and the data thematically analysed. The researchers within the group undertook the analysis together in a reciprocal fashion between the individual interviews and all the data as a whole. Themes were clustered into groups and excerpts from the data used to illustrate the agreed themes. Ethics approval was obtained from Auckland University of Technology Ethics Committee. Conclusion: This paper draws attention to the significance of generosity of spirit in LMC practice and how this acts synergistically with personal and professional boundaries. Reciprocity and partnership work well when generosity of spirt is enabled to flourish, and this, in turn, supports joy of practice. This paper provides further insight into how LMC practice is sustained over time and provides direction for midwives in LMC practice, and those planning to enter LMC practice, in New Zealand and elsewhere.

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The use of maternity acupuncture within a New Zealand public hospital: Integration within an outpatient clinic

By Betts, D, McMullan, J, Walker, L
on Thursday, 01 Dec 2016 in New Zealand College of Midwives Journal - Volume: 52

Background: In June 2008, a maternity acupuncture service began operating within a Hutt Valley Hospital outpatient department, offering access to free acupuncture care for pregnancy and postnatal related conditions. This was the first and, to date, the only clinic of this type within a New Zealand hospital. Objective: To retrospectively describe and analyse routinely collected data from 2013 and 2014, on treatment delivered in this clinic. Specifically we report on the number of women treated, their presenting condition, referral patterns and patient centred outcomes for those women presenting with back or pelvic/hip pain. Methods: Data on the primary reason for seeking acupuncture and referral pathway were collected on a woman’s initial visit. For those women presenting with back or pelvic/hip pain, a Measure Yourself Medical Outcome Profile (MYMOP) form was also completed, with a follow-up form completed on each subsequent visit until discharge. Findings: Two hundred and sixty-one women received treatment. The majority were referred through Lead Maternity Carer (LMC) midwives and were requesting acupuncture treatment for labour preparation, back or pelvic/hip pain. MYMOP reporting demonstrated a high level of patient satisfaction, with 80% of women reporting a change in their pain that was clinically significant. Conclusion: Data from this clinic illustrate a successful partnership between mainstream and complementary medicine, offering integrated healthcare to women in a public health system. Acupuncture offered a non-pharmaceutical treatment option and for those with back or pelvic/hip pain delivered high levels of patient satisfaction. It is hoped that this article will stimulate further interest in the under-researched area of maternity acupuncture.

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Experience of the New Zealand maternity system by a group of Japanese women in one centre

By Doering, K, Patterson, J, Griffiths, C
on Tuesday, 01 Dec 2015 in New Zealand College of Midwives Journal - Volume: 51

Objective: Birth is a social and cultural event, and giving birth in another country is a challenge for immigrant women. This article explores how some Japanese women experienced pregnancy, labour and birth care in New Zealand. Methods: Thirteen Japanese women who had given birth in New Zealand participated in this study. Nine women were interviewed individually, and four women participated in a subsequent focus group. The conversations were analysed using thematic analysis. Findings: The women had a range of experiences including some dilemmas and conflicts during their pregnancy, birth and postnatal care. This care differed from what they would expect had they given birth in Japan where care is shaped by the distinctly Japanese birth knowledge and culture. The women also experienced language and communication barriers even though they did not have problems with speaking English in their daily lives. Discussion: The Japanese women’s understanding of care in the New Zealand maternity system was influenced by the generally more relaxed image of New Zealand society, and issues emerged as a result of communication difficulties between the women and the care providers. This lack of communication was related to Japanese women’s generally passive attitude, where conflict is avoided in the desire to maintain harmony and not cause offence. Conclusion: When sharing information with Japanese women, care providers need to recognise that immigrant women hold knowledge from a different cultural history and maternity care system. Knowledge of these different cultural approaches to birth will enable better communication and help immigrant women make better informed decisions and receive more appropriate care throughout their childbearing experience in New Zealand.

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Editorial: Celebrating and honouring midwifery in New Zealand

By Crowther, S
on Tuesday, 01 Dec 2015 in New Zealand College of Midwives Journal - Volume: 51

New Zealand model of care

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Health guides for unattended births in New Zealand and Australia 1900-1950

By Wood, P, Jones, J
on Tuesday, 01 Dec 2015 in New Zealand College of Midwives Journal - Volume: 51

Background: In the early twentieth century, most women in Australia and New Zealand gave birth at home. As in colonial times, women living in the isolated New Zealand backblocks or Australian bush without access to a midwife, nurse or doctor, or women in towns who could not afford their service, gave birth with only a neighbouring woman, husband or older child to help. Most households had a domestic health guide as a source of health information and support in caring for themselves and others. This guide might therefore be the only assistance available to women and their lay attendants during childbirth. Aim: This research aimed to identify the information domestic health guides provided on childbirth, particularly if addressed to a person assisting the woman in the absence of a midwife, nurse or doctor, and to compare it with information midwives were expected to know. Methods: Using historical methodology, the researchers analysed the childbirth information in a range of domestic health guides available in Australia and New Zealand, 1900-1950. The information was also compared with midwifery textbooks and considered within the context of the increasing professionalisation of midwifery to discover how it reflected boundaries between lay and professional knowledge and practice. Findings: Some domestic health guides provided as detailed information as midwifery texts but without their scientific rationale that was a mark of professional knowledge and practice. Conclusion: By providing clear information, domestic health guides could have been a significant part of the culture of self-reliance and mutual aid, and of the cultures of health in both rural and urban environments in New Zealand and Australia in this time period.

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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)

By Guilliland, K, Dixon, L, MacDonald, C
on Tuesday, 01 Dec 2015 in New Zealand College of Midwives Journal - Volume: 51

Background: New Zealand has a unique model of maternity care, with midwives as the predominant carers. A recently published retrospective cohort study sought to compare the experience levels of Lead Maternity Carer midwives with rates of perinatal mortality. The paper claimed that an association was found between first year of practice midwives and increased perinatal mortality. However, the study design was seriously flawed and the data do not support the conclusions that were drawn. Aim: To systematically critique the study using the principles of epidemiological research. Methods: The study design and methodology were critically analysed in terms of the three potential sources of error that occur in observational studies: bias (measurement error), confounding and chance. The potential impacts on results were considered. Findings: Four areas of misclassification bias were identified, which introduced error to the data from the design stage. Important confounders were not distinguished and therefore neither excluded in the design stage nor adjusted for in the analysis. These flaws invalidate the results. The hypothesis test for the outcome of interest indicated an extremely high likelihood that the apparent association between midwives in their first year of practice and increased perinatal mortality was due to chance. Conclusion: Because of the major methodological flaws in this research, no conclusions can be drawn from the results. This paper highlights the importance of involving members of the profession being studied in the research team to improve quality by providing crucial insight into the sector and identifying potential sources of error.

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The impact on midwives of their first stillbirth

By Jones, K, Smythe, L
on Tuesday, 01 Dec 2015 in New Zealand College of Midwives Journal - Volume: 51

Objective: This study seeks understanding of the midwife’s experiences in relation to the loss of a baby. Current research focuses mainly on the experiences of the families who have gone through stillbirth while studies of the experience of the midwife involved in stillbirth care is lacking. When caring for a woman who is going through a stillbirth, the midwife must navigate her own personal and professional journey. Methods: The midwife’s journey was the focus of this qualitative study which utilised hermeneutic interpretive phenomenology. As part of a master's dissertation, five New Zealand self-employed midwives were interviewed and asked to tell their story of the first time they cared for a woman whose baby had died in utero and the aftermath of their experience. Findings: Two emergent themes were identified: 'A pocketfull of grief' and 'A heavy heart'. This paper focuses on the theme, 'A pocketfull of grief' which is made up of three sub-themes: ‘Shockwave’, ‘Self-protection’ and ‘Blameworthiness’. The death of a baby is a significant event for the midwife providing care. Conclusion: This study has provided a deeper understanding of the emotional impact of still birth on the midwife. Each midwife experienced shock and an intense and personal sense of loss. This created tension as they strived to cope with their own emotions and continued to care for the woman and her family.

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Midwifery practice arrangements which sustain caseloading Lead Maternity Carer midwives in New Zealand

By Gilkison, A, McAra-Couper, J, Gunn, J, Crowther, S, Hunter, M, Macgregor, C, Hotchin, D
on Tuesday, 01 Dec 2015 in New Zealand College of Midwives Journal - Volume: 51

Background: The New Zealand Lead Maternity Carer (LMC) midwifery model has benefits for women and babies and is a satisfying way to work for midwives. Due to the need to be on-call for long periods of time, there have been questions raised about the sustainability of the model for midwives and the potential for burnout. Objective: This qualitative descriptive study explored what sustains on-call, caseloading Lead Maternity Carer (LMC) midwives in New Zealand. Methods: Eleven midwives with 12 to 20 years in practice were interviewed and thematic analysis used to identify themes which sustained these LMC midwives in practice. Findings: Overall, the study found that it was the joy of midwifery practice, managing the unpredictability of being on-call, having clear boundaries, having good relationships with colleagues, having supportive families and friends, and workable practice arrangements which sustain them in practice. This paper presents the findings from the theme: workable practice arrangements. The midwives interviewed explained that having regular time off, a manageable caseload size, working together as a practice, the financial arrangements, and the sharing of arrangements with women created a sustainable way to practice. Conclusion: This paper has identified aspects of sustainable practice which are congruent with the international research but also very specific to the New Zealand model of midwifery.

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Evaluation of the learning components of a blended Bachelor of Midwifery programme: student perceptions of how these contributed to their learning and their readiness for practice

By Patterson, J, Baddock, S, Pairman, S, Griffiths, C, Miller, S
on Tuesday, 01 Dec 2015 in New Zealand College of Midwives Journal - Volume: 51

Background: New information technologies for communication and distance learning enable programmes of study to be delivered, wholly or partly, off campus increasing the choice and flexibility for students. In 2007, Otago Polytechnic (OP) and Christchurch Polytechnic Institution of Technology (CPIT) Schools of Midwifery began a collaborative curriculum development for a jointly owned Bachelor of Midwifery, using a blended learning model for students based in seven regional sites throughout the South Island of New Zealand. Aim: The aim of this survey was to evaluate the effectiveness of this new model of curriculum design and students’ perceptions of their readiness for practice. Method: A non-experimental descriptive survey of a purposive sample was developed to capture student demographics, their experiences of the blended learning components, and their perceptions of their readiness for practice. Graduands in 2011, 2012 and 2013 were invited to complete the survey. Ethical approval was obtained from the Otago Polytechnic Ethics Committee following consultation with the Kaitohutohu (Maori Advisor). Findings: A response rate of 93% (14/15) students was achieved in 2011 for a paper survey and 47% (16/34) in 2012 and 50% (20/40) in 2013 with an online survey. Overall, the students agreed or strongly agreed that the weekly face-to-face tutorials, intensive block courses, online learning modules and online tutorials had all contributed positively to their learning, while some disagreed or strongly disagreed that aspects of their akonga (tutorial) group process, the number of peer group presentations in intensives, and the level of oversight for their practice portfolio facilitated their learning. Almost all (12/13 in 2011, 14/14 in 2012; 11/12 in 2013) participants agreed or strongly agreed about the value of clinical placements and perceived themselves well prepared for midwifery practice. Conclusion: This survey was successful in identifying components of the blended delivery programme that students perceived enhanced their learning, and aspects of these that could be improved. Almost all who participated agreed that the programme had prepared them for beginning practice as a midwife.

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Learning by simulation - is it a useful tool for midwifery education?

By Coffey, F
on Tuesday, 01 Dec 2015 in New Zealand College of Midwives Journal - Volume: 51

Background: In both undergraduate teaching and post-registration education, simulation is increasingly being used as a teaching tool within midwifery to teach both emergency situations and practice skills. Yet simulation may not suit the needs of all. It can increase stress, especially if it is related to assessing competency. A literature review was undertaken with the aim of exploring and facilitating a greater understanding of simulation as a learning strategy within midwifery from a pedagogical perspective. Methods: CINAHL Plus and Science Direct databases were searched using the search terms: simulation, drill and midwifery or obstetrics. Inclusion and exclusion criteria were applied, resulting in 15 studies being reviewed. These studies used both qualitative and quantitative methodologies so a thematic analysis was undertaken to identify the consistent themes. Findings: Eight themes were identified demonstrating that simulation is frequently used within midwifery education. Simulation supports feelings of confidence and self-efficacy but in order to be effective needs to include briefing, good communication, observation (witnessing peers/being observers), repetition, reflection/debriefing and evaluation. Lecturer preparation is important as is the realism of the simulation. Conclusion: Although simulation can improve confidence, it is less convincing as a determinant of skill acquisition/clinical ability. Ongoing caution is warranted before considering simulation as a substitute to clinical practice experience without further evidence of its impact on clinical outcomes. As exposure to clinical emergencies can be rare it is important to ensure that substitute education is appropriate. Simulated activities, that allow participants to establish expectations, seek clarification, collaborate, assess against an accepted standard and integrate reflections, can improve learning. Further research is necessary which recognises the "expectant" and "observational" nature of midwifery and how this could be incorporated into simulation activities.

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