Rural midwifery practice in Aotearoa/New Zealand: Strengths, vulnerabilities, opportunities and challenges

Abstract

Background: The sustainability of rural maternity services is threatened by underfunding, insufficient resourcing and challenges with recruitment and retention of midwives. Aims: The broader aim of this study was to gain knowledge to inform the optimisation of equitable and sustainable maternity care for rural communities within New Zealand and Scotland, through eliciting the views of rural midwives about their working conditions and practice. This article focuses on the New Zealand midwives’ responses. Method: Invitations to participate in an online questionnaire were sent out to midwives working in rural areas. Subsequently, themes from the survey results were followed up for more in-depth discussion in confidential, online group forums. 145 New Zealand midwives responded to the survey and 12 took part in the forums. Findings: The New Zealand rural midwives who participated in this study outlined that they are attracted to, and sustained in, rural practice by their sense of connectedness to the countryside and rural communities, and that they need to be uniquely skilled for rural practice. Rural midwives, and the women they provide care to, frequently experience long travel times and distances which are economically costly. Adverse weather conditions, occasional lack of cell phone coverage and variable access to emergency transport are other factors that need to be taken into account in rural midwifery practice. Additionally, many participants noted challenges at the rural/urban interface in relation to referral or transfer of care of a woman and/or a baby. Strategies identified that support rural midwives in New Zealand include: locum and mentoring services, networking with other health professionals, support from social services and community service providers, developing supportive relationships with other rural midwives and providing rural placements for student midwives. Conclusion: Midwives face economic, topographic, meteorological and workforce challenges in providing a service for rural women. However, midwives draw strength through their respect of the women, and the support of their midwifery colleagues and other health professionals in their community.

Midwifery mentorship in Aotearoa New Zealand: The mentors’ perspective

“…A notable exception to this in our findings was the rural midwifery context, in which rural midwives tend to mentor and be mentored by other rural midwives, and conflict at the rural/urban interface remains a key issue despite the support provided by the rural midwife mentors around this. This is supported by the Aotearoa-based literature, which describes rural midwives' experiences of negative judgement and unfair treatment at the urban/rural interface due to a lack of understanding of the realities of rural practice, which can be disempowering and impact on job satisfaction (Crowther, 2016;Crowther et al, 2018;Daellenbach et al, 2020). Daellenbach et al (2020) found that rural midwives identified mentoring as a strategy for supporting them with interface challenges.…”

“…This programme provides peer mentoring support to rural and remote rural midwives facing the unique professional and personal demands of providing LMC midwifery care in isolated and sparsely populated areas (Crowther, 2016). Having a rural mentor has been identified by rural midwives as a key strategy for sustaining them in rural practice (Daellenbach et al, 2020).…”

‘There is no other option’: Exploring health care providers' experiences implementing regional multisite midwifery model of care in South Australia

“…In this study, midwives identified the allocated caseload of 38 women, in addition to providing postnatal home care to women returning after birthing in metropolitan services to be a significant challenge. Concern around regional/rural caseload is not new, with studies asserting that the caseload contract system has been designed for urban‐based midwives and that it does not work as well for rural maternity services 23,24 . In a study which explored midwives working in a caseload model in rural Victoria, 22 the on‐call element of caseload interrupted midwives' personal lives and was one of the most difficult factors.…”

“…Concern around regional/rural caseload is not new, with studies asserting that the caseload contract system has been designed for urban-based midwives and that it does not work as well for rural maternity services. 23,24 In a study which explored midwives working in a caseload model in rural Victoria, 22 the on-call element of caseload interrupted midwives' personal lives and was one of the most difficult factors. Similar to this study, being called in for a birth would necessitate reorganisation of other appointments, impacting not only the women but other care providers as well.…”

Recruitment and retention of the rural podiatry workforce in Aotearoa New Zealand: a qualitative descriptive study of podiatrist perceptions

“…2021 NZ podiatry workforce data indicates approximately 70% of podiatrists work in major or large urban centres as classified by Statistics New Zealand functional rural-urban classification (Urban Rural Experimental Profile 2004; UREP) [2]. However, defining the NZ rural/urban population attributes for research purposes is difficult as there is no consistent agreed definition of rurality [3]. The current UREP classification of urban/rural attributes based upon population size has been criticised as the population defined as "rural" differs from that which actually receives rural health care [4].…”