A different view

My first impression of New Zealand was just how friendly everybody was. From free cups of tea in the airport, to smiles and conversation wherever we went, we were made to feel welcome by everybody we met. This was especially true at the hospital, where we spent our first two weeks of placement.

Palmerston North is a secondary care hospital and has a labour suite consisting of eight labour rooms, plus one ‘SANDS’ room used for families experiencing IUFD or stillbirth. The region had 2201 births last year. The unit has two or three midwives on duty per shift. This sounded ludicrous to me at first, coming from a busy 16-room unit at home. However, once I began to learn more about the maternity system, I realised that the unit could quite easily run on three midwives.

In 1996, Lead Maternity Carers (LMCs) were introduced in New Zealand, reinforcing the importance of continuity of care. Section 88 of the NZ Health and Disability Act (2000) stated that every woman is entitled to an LMC. This may be a midwife or an obstetrician who is responsible for assessing and caring for a woman’s individual needs throughout pregnancy, birth and postnatal period. If a woman is low-risk and no complications arise, she may not see anyone other than her midwife, with her chosen LMC facilitating a home birth or accompanying her into hospital to conduct the birth, although the LMC can hand care over at any time if complications arise. This explained why so few midwives were on duty, as about 76% of women choose independent midwives as their LMC.

I found that both the LMCs and hospital setting were very proactive in promoting normal birth. Each birthing room had a large bath, giving women the option of using water as pain relief during labour and/or birth, plus new wireless CTG machines, which allowed women to be mobile in labour, and be monitored in all positions, including in water.

Following birth, midwives were proactive in encouraging uninterrupted skin-to-skin contact for as long as possible by both mum and dad. There were also posters all around the hospital, in a variety of styles and languages, promoting the benefits of skin-to-skin and breastfeeding. However, I felt the most valuable resource was the hospital’s lactation consultant, who held a talk on the ward every morning for all new mothers who wanted to breastfeed. Here she discussed positioning and attachment, describing changes in both the breast and the baby’s stomach, which I felt helped the women to understand how breastfeeding patterns change over time. There was also a DVD available at all times for women to access, demonstrating the stages of breastfeeding. I felt the success of these resources is reflected in the high breastfeeding rates, with 76% of women exclusively breastfeeding when they are transferred home.

I found working on the ward quite different to back home. There was one ward consisting of 19 beds, with rooms either single or twin rooms, compared to the four-bed bays at home. Paediatricians do not see babies routinely, with newborn examinations being performed by the midwives, unless a baby has a known problem. Similarly, routine hearing screening is not currently performed on the wards, although hip checks are carried out on all babies by an orthopedic registrar.

I found it interesting to observe that the neonatal screening heel prick test is routinely performed within the first 48 hours. This test is performed for seven conditions, as opposed to our five. All midwives are prescribers and women can self-administer certain medicines themselves, such as paracetamol and diclofenac.

The one main difference that I found between New Zealand and the UK was the high number of independent midwives working as LMCs, and I spent the second two weeks observing their practice and the partnership model of care. The New Zealand College Of Midwives suggests caring for four to five women per month depending on individual choice. However, most LMCs choose between five to seven women a month, to allow for miscarriage and house moves. The LMCs are required by Section 88 to be on call 24 hours a day, seven days a week, for phone calls and urgent attention if required. For this reason, most LMCs work in pairs and are on call for each other, with women meeting these partners at least once in the pregnancy to ensure continuity of care wherever possible.

Women choose their own LMC and are encouraged to speak to several midwives before making a decision. A contract is then signed by both woman and midwife before care begins, stating what is expected from both parties, which again must meet requirements of section 88. A woman may change LMC at any time if she is not happy. Maternity care is provided free to all New Zealand residents, although non-residents pay, often in excess of 5000 dollars.

Any care that an LMC provides is claimed back via the ministry of health to provide a salary. Midwives are responsible for their women for a minimum of six weeks postnatally and must do a minimum of seven visits. I found this period really interesting to observe, as women often had problems with feeding or infections, which I don’t see at home, due to earlier transfer of care from midwife to health visitor. This broadened my knowledge of problems women may face once home with their babies.

The LMCs were extremely proactive in promoting normal birth and were able to spend time with the women in the antenatal period discussing birth plans and what to expect in labour, which I felt helped to prepare them for the journey ahead and gave them the opportunity to ask questions and discuss anything they weren’t sure of. Most of the independent midwives also practised acupuncture and acupressure which was offered routinely throughout pregnancy and labour with amazing results, in particular in aiding the rotation of fetuses that were in occiput posterior positions.

Overall I found this placement to be an amazing experience and one that I will treasure throughout my midwifery career.

References

Department of internal affairs. (2007) Section 88 of the New Zealand Public health and disability Act 2000. Wickliffe LTD.  New Zealand.

Stojonovic, J. Douche, J. (2007). The legal Professional and cultural environment for New Zealand Midwives.  Massey university. Palmerston North.