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ABC by LMC midwives: an innovative intervention to support women to become smoke-free in pregnancy

By Eddy, A, Prileszky, G, Nicoll, K, Barker, R, Anisy, J
on Tuesday, 01 Dec 2015 in New Zealand College of Midwives Journal - Volume: 51

Background: Smoking in pregnancy is associated with significant adverse outcomes for women and their babies. Certain population groups contribute disproportionately to smoking prevalence in New Zealand such as younger women and Maori women. It is however a modifiable risk factor and midwives have a role to play in supporting women to achieve smoke-free pregnancies. Objective: This was a demonstration project designed to assess whether frequency of midwives’ smoking cessation advice within the home environment had an impact on smoking rates for the women and their wider household contacts over a 15 month period. Method: A prospective observational study audited the results of smoking cessation intervention practices provided by six Lead Maternity Carer (LMC) midwives using the ABC framework. Demographic and smoking data were collected by the midwives, on each woman who smoked, during a 15 month period. This included women who were already being cared for at the time when data collection commenced as well as women who registered for care subsequently. Data were also collected on the smoking status of partners and other household members, and on the frequency with which the midwives had discussions with the women and others about smoking. Findings: Young and Maori women within this project were more likely to become smoke-free than others. A significant number of the women lived in households with other smokers, which may have made it more difficult for them to become smoke-free. The midwives provided smoking cessation interventions using the ABC to the women with varying frequency; however, the frequency of these interventions did not appear to be related to the likelihood of the women becoming smoke-free. The midwives did not provide ABC at every single visit for every woman; however, for some women it was provided more often than for others. Conclusion: Although midwifery care is provided within, and acknowledges the woman’s context, the majority of women in this project faced considerable day-to-day challenges to becoming smokefree, as they lived in households with others who also smoked. Broad strategies are needed to reduce smoking, that reach beyond the realm of midwifery practice and the health care sector, such as wider tobacco control policies, public health campaigns and smoke-free environments.

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Clinically overweight and obese mothers and low rates of breastfeeding: Exploring women's perspectives

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

Background: It is universally recognised that breastmilk is the best food for babies and that breastfeeding provides significant health benefits for both mothers and babies. Women who are overweight or obese have lower rates of initiation and duration of breastfeeding. There is a need to understand the woman’s perspective, and any additional factors that may contribute to breastfeeding difficulties for overweight or obese women. Objective: The aims of this research were to explore the breastfeeding experiences and perspectives of a specifically recruited group of clinically overweight and obese women and to gain an understanding of what influenced their infant feeding decisions. Method: This study used a qualitative methodology. In-depth interviews were conducted with six mothers who were overweight or obese and initiated breastfeeding, but then did not continue to exclusively or fully breastfeed their babies. Using a thematic analysis the researcher identified seven themes which captured the breastfeeding experiences of these women. Findings: The women believed in the importance of breastfeeding for their babies’ health, but experienced challenges with latching and perceived their breast milk supply to be insufficient. The physical challenges of large breasts and body image issues when feeding in public also contributed to early cessation of exclusive breastfeeding. This study adds to the body of knowledge on this subject and to our understanding of the association between maternal overweight and obesity and early cessation of breastfeeding. Conclusion: It is important to recognise the unique needs of overweight and obese women and provide support antenatally and postnatally. This support is crucial if we are to achieve the public health aim of reaching World Health Organization (WHO) and national targets for exclusive and full breastfeeding.

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New Zealand LMC midwives' approaches to discussing nutrition, activity and weight gain during pregnancy

By Pan, S, Dixon, L, Paterson, H, Campbell, N
on Monday, 01 Dec 2014 in New Zealand College of Midwives Journal - Volume: 50

Background: Excessive weight gain during pregnancy can lead to increased retention of weight postpartum and the risk of becoming overweight or obese later in life. Obesity is an increasing problem within New Zealand society and being overweight or obese during pregnancy increases risks for both the mother and the baby. In New Zealand, primary maternity care is largely provided by midwives in the role of Lead Maternity Carer (LMC). These midwives provide continuity of maternity care and information to women to support informed decision making and healthy lifestyles choices. Aim: To explore how LMC midwives discuss nutrition, activity and weight gain when providing primary maternity health care to pregnant women in New Zealand. Method: A nationwide survey was undertaken with a cohort of LMC midwives in New Zealand to identify what advice and information were being provided to pregnant women about nutrition, activity and weight gain. An electronically administered survey was distributed to eligible midwives through the New Zealand College of Midwives membership database. Descriptive statistics were used to describe survey responses; the large volume of free text data were analysed using a qualitative inductive approach. Results: A total of 428 LMC midwives responded, giving a response rate of 42.9%. Nearly all these midwives discussed nutrition (97.6%) and activity (94.3%) with women during pregnancy. The majority of midwives (70%) calculated the woman’s body mass index (BMI) at pregnancy registration. Recommendations for weight gain varied dependent on the woman’s BMI; the respondents in this study generally recommended lower weight gain targets than the updated Institute of Medicine (IOM) (2009) published guidelines. Free text data themes identified that midwives customized their care to the individual woman. Midwives discussed weight gain and obesity as a sensitive issue which needed an individualised approach. Obesity was considered to be a wider societal issue that requires a broader national response. Conclusion: Midwives in New Zealand are discussing nutrition, activity and weight gain during pregnancy with women. Changing established lifestyles requires a wider societal approach.

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Place of birth and outcomes for a cohort of low risk women in New Zealand: A comparison with Birthplace England

By Dixon, L, Prileszky, G, Guilliland, K, Miller, S, Anderson, J
on Monday, 01 Dec 2014 in New Zealand College of Midwives Journal - Volume: 50

Background: Choice, safety and availability of different birth settings are important issues for women and midwives in New Zealand (NZ). In England, the Birthplace England Research Study (BPE) has provided detailed information on outcomes for low risk women related to place of birth. These outcomes cannot be generalised to New Zealand owing to differences in context, culture and models of maternity care. Aim: This observational study has used retrospective data to determine demographic differences between planned birth place setting, neonatal outcomes and transfer rates for a cohort of low risk New Zealand women and compared these findings where possible with those of the Birthplace England research. Method: Data from the New Zealand College of Midwives Clinical Outcomes Research (NZCOMCORD) database were analysed for the years 2006 to 2010 inclusive for low risk women. Comparisons have been made between place of birth (home, primary unit) and parity, ethnicity, age, body mass index, transfer rates, and neonatal outcomes (Apgars, NICU admission, perinatal mortality). Results: There were 61,072 women considered low risk, of whom 8% had planned a home birth and 16.6% a primary unit birth. Women who planned to birth at home in New Zealand were older and more likely to be multiparous. These were similar findings to those of the Birthplace England study. The rates of transfer from home (16.9%) or primary unit (12.6%) to hospital were lower than the Birthplace England cohort (21%). There was a higher proportion of nulliparous women (35%) in the planned homebirth group who transferred although this was significantly lower than the Birthplace England cohort (45%) (P<0.002). NZ Maori are the indigenous ethnicity of New Zealand, and a greater proportion of Maori planned birth in a primary unit (27.2%) than a secondary unit (23.2%), home (17.4%) or tertiary hospital (11.1%). The actual number of perinatal mortality outcomes was low across all settings for low risk women in New Zealand and differences in birthplace were not statistically significant (p < 0.14). Conclusion: A greater proportion of indigenous New Zealand women planned to birth at home or in a primary unit. Fewer women were transferred in labour in the NZ study. This research further refines our understanding of who plans to birth where, and reinforces the evidence that, where a low risk woman plans to birth in NZ, does not significantly increase adverse outcomes for her baby.

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Survey results of first and second year New Zealand midwifery students' level of engagement in a flexible delivery programme

By Milne, T, Skinner, J, Baird, K
on Monday, 01 Dec 2014 in New Zealand College of Midwives Journal - Volume: 50

Objective: This paper describes the survey results of first and second year New Zealand (NZ) midwifery students’ level of engagement while being taught in face-to-face, videoconference (VC) and online activities as part of a fully flexible delivery curriculum. Methods: First and second year undergraduate midwifery students (n = 104) from one New Zealand midwifery education provider were invited to participate and complete an online survey. Students were recruited from the main city campus learning hub and three smaller regional learning hubs (RLH). Measurements: The survey asked for: demographic information, skills, experience and confidence with modes of flexible learning, information technology, online student learning platforms, and engagement with learning. Data were analysed using descriptive statistics including minimum and maximum scores, means, ranges and weighted averages. Results: 52 % (n = 54) of students provided feedback. 40 % (n = 21) of respondents considered they had minimal experience with online learning platforms and 48 % (n = 49) indicated a lack of confidence to participate in learning sessions delivered via VC. 66 % (n = 67) of respondents rated their involvement in learning much higher in face-to-face sessions than with VC. Respondents felt more engaged with their peers from their own regional learning hub (RLH) and less with the teaching, clinical and administration teams. Conclusion: Students need to be orientated and educated to use technology adequately for their learning. Although flexible modes of delivery in midwifery education enhance student access, the quality of learning requires reliable technology with good capacity, and pedagogy that fosters a high level of interaction. Rural and remote students rated engagement with face-to-face teaching highly. Support and continuing training and education for both faculty and students need to be offered to maximise the potential of flexible delivery modes. This was a small survey with students from one NZ midwifery education provider. Results need to be interpreted with this in mind.

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Midwives' wellbeing following adverse events - what does the research indicate?

By Austin, D, Smythe, E, Jull, A
on Monday, 01 Dec 2014 in New Zealand College of Midwives Journal - Volume: 50

This paper explores the current influences and expectations in relation to adverse events in New Zealand’s maternity setting and the affect these have on midwives. Midwives, like other health professionals, have the potential to become the second victim, a term used to encompass the health professional’s feelings of despair following an adverse event. Insights from international research and reports are related back to midwifery and a growing number of New Zealand qualitative studies that identify the effect of adverse effects on midwives are highlighted. The evidence indicates that the current tools or support measures that are implemented at the individual or group level may be limited in their effectiveness. Common principles emerge from the literature that could facilitate a midwife’s safe journey through the emotional distress when there is an adverse event. These are: understanding the nature of midwifery practice, the midwife’s own emotional well-being, providing safe environments, seeking and receiving professional reassurance, and a willingness to learn from the adverse advent. An action research study is planned by the primary author to work with midwives about their experiences of successfully navigating adverse events with the aim of facilitating accessible support to reduce the trauma of adverse events. For midwives to be able to support women and their families they too need to be supported.

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Editorial: Nga Haerenga - the Journeys

By Martis, R
on Monday, 01 Dec 2014 in New Zealand College of Midwives Journal - Volume: 50

Partnership in continuity of care model

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Editorial: Sustainable midwifery practice

By Gilkison, A
on Sunday, 01 Jun 2014 in New Zealand College of Midwives Journal - Volume: 49

It is important to explore sustainable practice so that individual midwives and the profession as a whole can be maintained and supported.

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When the midwife-woman partnership breaks down - principles for ending the relationship

By MacGregor, D, Smythe, L
on Sunday, 01 Jun 2014 in New Zealand College of Midwives Journal - Volume: 49

New Zealand’s unique Lead Maternity Carer (LMC) midwifery model of practice is a privilege for both women and midwives. Underpinning this model of practice is the concept of partnership. The midwife-woman relationship has been identified as the key sustaining element of one-onone midwifery care. However practice experience reveals the potential for this key relationship to break down. This becomes a particularly complex and conflicting challenge when the midwife recognises that for her own professional safety she needs to unilaterally end the midwife-woman relationship. Of paramount importance to a healthy functional partnership is mutual trust, respect and reciprocity. There is a taken for granted assumption that trust can be established and maintained, that there is willingness for sharing on both sides and a reciprocal respect. When trust is eroded or irretrievably breaks down, the health and survival of the relationship are threatened, and the alliance has the potential to become unstable and unsafe. Consequently the midwife may decide to end the relationship. A framework, to help navigate and support the midwife who is experiencing this distressing challenge, does not exist. A case study, explored through descriptive interpretive analysis, is used to present one of the author's experience of a breakdown in the trust relationship. Analysis of the experience reveals the intuitive process this midwife utilised, to ensure she upheld her professional responsibility as well as maintaining her self-worth and integrity. Implications for practice arose from the discussion and principles were distilled. These may provide an appropriate and professional process for midwives on the rare occasion they need to end the partnership.

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Creating a better work-life balance

By Donald, H, Smythe, L, McAra-Couper, J
on Sunday, 01 Jun 2014 in New Zealand College of Midwives Journal - Volume: 49

Co-operative inquiry, an action research approach, was selected to investigate the work-life balance of 16 caseloading midwives living in Auckland. For some of the midwives the tension between their professional and personal commitments was at times hard to control, as they believed they needed always to be there for the women in their care. Thus burnout was a risk from the continuous on call nature of their role. The participants met with the researcher in a series of focus groups for dialogue and inspiration as they evaluated their individual practice assumptions. Thus together they became co-participants and co-researchers in the study. The midwives reflected on and re-evaluated their assumptions about their practice roles and in particular their relationships with women and with colleagues. Resolutions to make and sustain change involved weighing up the options available and stepping out to create new relationships and new ways of working. Further, the findings in the study lead to the development of a work-life balance tool for midwives.

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