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Midwifery practice in New Zealand: a student perspective

13 June, 2008

Midwifery practice in New Zealand: a student perspective

The option period of the midwifery course offers students the opportunity to travel and see how maternity services operate in other countries and cultures. Winners of the RCM student travel award in 2003, Lesley Bellis and Wendy Lee describe the time they spent in New Zealand.
The option period of the midwifery course offers students the opportunity to travel and see how maternity services operate in other countries and cultures. Winners of the RCM student travel award in 2003, Lesley Bellis and Wendy Lee describe the time they spent in New Zealand.

Midwives magazine: May 2005




On entering the third year of our direct-entry midwifery course, the realisation of just how fast our training was going hit us. So we began to give our option period, set for the end of the year, some serious thought.We knew we wanted to go abroad as we felt this would provide us with the best opportunity of a culturally different experience of midwifery. While researching our options we were offered a placement in New Zealand. This came from a midwife, Wendy Kitson, who had emigrated there two years before, who we had met in practice during our first year of training. She was prepared to accommodate us in her family home in Auckland and to arrange a structured programme of placements.


Midwifery in New Zealand


On researching midwifery services in New Zealand, we discovered that it was based on the Dutch system: ‘New Zealand lays claim to a maternity service in which midwives are autonomous, and women have the choice of total midwifery care and continuity of care’ (Stewart, 2001). However, this has not always been the case.


During the 1970s, midwifery became medicalised, much as it did in the UK. The setting up of The Home Birth Association in 1978 and the forming of the Save the Midwives Association in 1983, saw midwives and consumers working together to lobby parliament, demanding consumer choice and raising the midwifery profile. In 1990, the Nurses Amendment Act was passed, restoring autonomy to the midwifery profession and allowing midwives to provide total maternity care from conception to six weeks postpartum (Stewart, 2001). On 18 September 2004, the legislation governing the Nursing Council changed to the Health Practitioners Competence Assurance Act 2003 (Nursing Council of New Zealand, 2004).


New Zealand: a profile


The approximate population of New Zealand is 4.8million with one million living in Auckland. Of these, 80% are of European descent, 14.7% are Maori, 6.5% are Pacific Islanders, 2.9% are Chinese and 1.7% are Indian. The official languages are both English and Maori (Statistics New Zealand, 2004). According to tradition, the Polynesian Maori people were the first to inhabit New Zealand. The Maori people feel unjustly treated in what they see as their own country. In recent years, the government has sought to address longstanding Maori grievances spanning back to the signing of the Treaty of Waitangi on 6 February 1840 (The Treaty of Waitangi, 2004).We felt New Zealand with its diverse cultures and midwifery services would have a lot to offer us in broadening our experiences.With the destination decided and the arrangements in place, we applied to the RCM for a student travel award.


Maternity care and placement setting


Our placement base was Waitakere Hospital that catered for low-risk women. There were two maternity wardsboth of which provided antenatal, intranatal and postnatal care. Each of these had four delivery rooms (two with birthing pools), two three-bedded rooms and eight single rooms. Cardiotocograph and neonatal resuscitation equipment was stored out of sight. The wards are staffed with between three and five core midwives. Discussion with staff revealed that each midwife commonly looks after two women, antenatal or postnatal, or one woman if she is in labour. The average stay for postnatal women is three to four days, with 70% exclusively breastfeeding on discharge. Women who chose to formula feed their babies were expected to bring in the milk with them. Sterilising equipment was provided and this was stored in the milk kitchen. We felt this to be a fair option for the women and a realistic one, as it recognises that some women will want or need to use formula milk, but does not actively encourage its use by making it freely available.


Maybe women would give breastfeeding a second thought initially if it were the easier and cheaper option. This also makes the unit more homely. Services available for women in the unit are the ‘know your midwife’ (KYM) midwives, core midwives, Maori midwives, maternal mental health, women’s health social workers and a lactation consultant. Independent midwives also have an arrangement with the hospital to use their facilities. It appears most women give birth in hospital with home birth rates similar to those in the UK (Stewart, 2001; Home Birth Reference Site, 2003). All maternity services are free.


Lead maternity carer


Under the new maternity arrangements, women choose a lead maternity carer (LMC). This can be a midwife, a GP or an obstetrician. The LMC is responsible for providing the greater part of care, including labour and birth. They coordinate any other health professionals’ involvement in the woman’s care. The Ministry of Health publish the Maternity services information kit (Stewart, 2001), aimed at helping women choose an LMC. For 70% of women, a midwife is their LMC.


The role of the midwife


Midwives can either be independent or employed by district health boards. Independent midwives are self-employed and paid directly from the government. Employed midwives either work rostered shifts in a maternity facility or as a KYM midwife. Both independent and KYM midwives work in the same way, providing continuity of care as LMCs. This gives women a great deal of choice in who provides their care – if they are unhappy with their midwife, they simply choose another one. We spent a great deal of time with KYM midwives, something we found fascinating and different to anything we have experienced in the UK. They work in pairs, with one or the other being on-call at all times, providing a 24-hour, seven days a week service.


There are five pairs of KYM midwives attached to Waitakere Hospital, booking 11 women a month between them. They hold antenatal clinics together in the hospital, thus ensuring all women meet them both. Waitakere Hospital caters for the Maori population by providing Maori midwives. They work in a team of three, offering care in exactly the same way as KYM midwives. When a woman goes into labour, she calls her midwife who meets her at the hospital. Once delivered, the core staff care for her under the instruction of the LMC. During their stay, the women are visited every day by their midwife and once discharged, they receive home visits in the usual way, with the support of the lactation consultant remaining accessible.


Maori culture


Maori midwives are sensitive to their culture. They acknowledge and respect the importance of ‘Tinana’ (body of Christ), ‘Hinegaro’ (mind), ‘Wairua’ (soul) and ‘Whanau’ (family). Other cultural traditions can include large numbers of family members being present at the delivery and a care plan for the placenta. Fathers are often encouraged to participate in the delivery by placing their hands on the baby’s head with the midwife’s guidance. This is believed to help with the bonding process. If a delivery is deemed to be slow or a problem arises, it is not unusual for Maori people to sing a prayer over the woman, asking for the safe delivery of the baby. Although we were on-call for a Maori delivery, unfortunately we were not lucky enough to attend one.


We undertook a long drive to visit Rotorua and en route were able to take in some of the breathtaking scenery that New Zealand has to offer. Rotorua is home to traditional Maori villages, and although aimed at tourists, they offer an insight into the history and culture of the Maori people. Here we participated in Hongi (the traditional nose-rubbing greeting) and a Hungi (a typical Maori meal, steam-cooked in the ground) and learnt about their traditions. We were pleased to see some of these customs still being practised in our placements, for example, removing shoes before entering a woman’s home was expected. Most of the Maori population were of a lower socio-economical status, so it was not unusual for Maori midwives to take packs of nappies and food to the woman’s home. They justified these gifts as the women tend not to stay in hospital long enough to make use of its provisions. The Maori midwives often search flea markets for second-hand prams, clothes and other items for their women – the true meaning of ‘being with woman’ we wondered! One of the highlights for us was receiving an invitation to attend a Maori health professional’s forum. This took place in a Marae (meeting place) in the hospital grounds.We stood outside the Marae gates waiting for our welcome call. After much singing and chanting between a nurse and a member of the Marae, we were invited in. We then removed our shoes and did Hongi with the members of the Marae (about 15 men and women in all, a lot of noserubbing!).


We heard speeches made by the men in Maori – they sat in the front rows, as this is traditionally believed to protect their women. After each speech, men and women would join in singing – this is a tradition thought to strengthen their speech and allow the listeners to absorb it.While singing we noticed one member of the Marae was breastfeeding her toddler, a wonderful sight, but sadly an uncommon one in England. We had no idea what was being said or sung, there were no hymn books, but the Maori voices were hauntingly beautiful and the smiles on people’s faces as they sang made it very clear they enjoyed singing.We both felt overwhelmed with emotion. It was a real privilege to see midwives and nurses work together this way, and an experience we will never forget. Even though the Maori population is small in New Zealand, they still have a strong presence there and make every effort to keep tradition as it was. We could see Maori tradition is very much acknowledged and respected in New Zealand.


This also applies to other ethnic groups including Pacific Islanders.While in the hospital staff room, we noticed posters on the boards advertising cultural workshops and all leaflets and information for women and their families were available in many different languages.




We found this experience to be thoroughly enlightening. What we gained is a broader cultural awareness and we believe these differences should be acknowledged. Maybe by setting up cultural workshops in our own practice settings, we could raise awareness of individual needs, especially as we live in a multicultural environment. Having midwives as LMCs is proving to be safe, with perinatal and maternal mortality rates said to be dropping. From our observations and discussions, the KYM system appears to be a very fulfilling way to work, albeit demanding. The women we met spoke highly of the service, which almost guarantees they will deliver their child with a midwife they know. On the downside, we found that the core midwives working in hospitals felt unsupported by the profession and complained of feeling devalued.


Although midwifery practice is similar to that in the UK, the way in which the service is offered differs. It seems the smaller teams in New Zealand are offering more choice and continuity for women, and in return greater satisfaction to the midwives providing that service.We believe the New Zealand midwives have come a long way since the Nurses Amendment Act 14 years ago.


RCM award


It was with much joy that we received the news from the RCM that following our presentation, we had been short-listed for an award and were invited to a prestigious lunch. The RCM patron The Princess Royal was going to be there and naturally we were very disappointed when we realised we would have to miss it as we would be in New Zealand at the time. However, we felt this was too good to miss out on completely so we gained approval for our husbands to go on our behalf. They had a fantastic time and were thrilled to meet The Princess Royal and some of the well-known figures from the RCM. It was the early hours of the morning for us in New Zealand (13hours ahead) when we heard the fantastic news that we were the winners of the student travel award category. You may have seen the photographs of our husbands collecting our award in the January 2004 issue of RCM Midwives Journal – they were thrilled about those too.We never imagined when we embarked on midwifery training that they would get in on the act in such a big way!




We would like to thank the RCM for the student travel award,Wendy Kitson and her family for welcoming us into their home and making so many arrangements on our behalf. Also thanks to our husbands Shaun Bellis and Reuben Lee for their support during the undertaking of this trip.




Stewart S. (2001) Midwifery in New Zealand. MIDIRS Midwifery Digest 11(3): 319-24. New Zealand Ministry of Health. (2003) Health Practitioners Competence Assurance Act. See: www.nursingcouncil.org.nz (accessed March 2005). Statistics New Zealand. (2004) Quick facts – people. See: www.stats.govt.nz/quick-facts/ people/default.htm (accessed November 2004). Treaty of Waitangi. (2004) The story of the Treaty. See: www.treatyofwaitangi.govt.nz/story/ index.php (accessed November 2004). Home Birth Reference Site. (2003) Statistics. See: www.homebirth.org.nz (accessed October 2003).

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