The core of the core: What is at the heart of hospital core midwifery practice in New Zealand?

Gilkison, Andrea; McAra‐Couper, Judith; Fielder, Anna; Hunter, Marion; Austin, Diana

doi:10.12784/nzcomjnl53.2017.4.30-37

Cited by 10 publications

(29 citation statements)

References 20 publications

(40 reference statements)

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“…Other literature also shows that midwives who are not able to work in a way or in a capacity that enables them to combine their personal philosophies and working life, may eventually leave the profession (Cox & Smythe, 2011;Gilkison, McAra-Cooper, Fielder, Hunter & Austin, 2017;Sandall, 1997;Jarosova et al, 2015;Pugh et al, 2013;Curtis, Ball & Kirkham, 2006).…”

Section: 24mentioning

confidence: 99%

The Good, the Bad and the Ugly. The experiences of midwives who transition work settings: A qualitative descriptive study

Welfare¹

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This research explores the experiences of midwives as they transition work settings. It has been found that these experiences are both positive and negative. Midwives relish working with women in a capacity that brings them joy and sustains them within the profession. They achieve this with the valued support of their families, practice partners and colleagues. However, there are numerous stressors on midwives including financial, emotional, physical, family commitments, bullying and work demands, which impact on the ability of the midwife to fulfil these obligations. This dissonance leads to increased levels of stress and fatigue and in order to manage this, the midwives who participated in this research appear to transition work settings. By analysing the lived experiences of nine midwives in Aotearoa/New Zealand who have transitioned work settings between core and LMC (or vice versa) in the previous two years, I have explored the research question ‘What are the experiences of midwives who transition work settings?’ using a qualitative descriptive research framework. Face to face interviews were conducted with midwives around the South Island of Aotearoa/New Zealand using semi-structures interview questions, followed by transcription and thematic analysis. Four main themes emerged, ideal midwife, movement happens, support and obstruction and things have changed. The themes and subthemes are discussed in depth through this work and literature used to support the discourse. The main finding was that transitioning work-settings is a way of remaining professionally and personally sustained in the current system of maternity care in Aotearoa/New Zealand. Other findings were that support from family, colleagues and managers, as well as the relationships with the women, are imperative for midwives in either work setting to remain sustainable. That the lack of support, bullying, harassment, poor remuneration and family commitments, are stressors that impact on the working lives of midwives and contribute to their decisions to transition work settings. There are implications from this research for midwives, DHB, workforce planning, educators and the wider profession.

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Section: 24mentioning

confidence: 99%

The Good, the Bad and the Ugly. The experiences of midwives who transition work settings: A qualitative descriptive study

Welfare¹

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“…The clinical skills and attitudes required to protect and promote physiological birth and those required to manage the high technology care which some women require are different skill sets (Milosevic et al, 2020). New Zealand research has identified that core midwives have multiple skills at caring for women with complex health needs, managing emergencies, building relationships and being flexible and adaptable in working with a diverse range of demands (Gilkison et al, 2017).…”

Section: How Core Midwives Are Influenced By Institutional Views Of B...mentioning

confidence: 99%

Seeking safe harbour: Water immersion for women with complex pregnancy

Kara¹

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Background: Water immersion is used by women, particularly within midwifery-led settings, as a strategy to manage the sensations of labour. Low-risk women who have used water immersion in labour express feelings of increased relaxation, support and control in their labour and birth experience. Being labelled ‘high risk’ can significantly impact both a woman’s experience of her pregnancy and her opportunity for experiencing a physiological birth. Women with complex pregnancies have reported an increase in anxiety and a feeling that their normal childbearing journey has been interrupted and subsumed by medical monitoring and risk management. Midwifery frameworks in Aotearoa New Zealand protect and promote the woman’s role as a decision maker within her experience and her right to make informed decisions about her care. Aims: The aim of this research was to develop an understanding of the influences, facilitators and barriers for women who chose to use water immersion for labour and birth, in a hospital setting, when they were labelled/identified as being clinically complex, as well as to explore their experience of using water immersion in labour. Methods: A qualitative descriptive inquiry, using semi-structured interviews was undertaken to explore seven women's experiences of using water immersion during their labour and/or birth after having a complex pregnancy. Inductive thematic analysis was used to analyse participant data. Findings: Thematic analysis identified four themes within the women’s experiences. Women use water immersion to resist the medicalisation of their birthing experience and protect themselves from the iatrogenic risks of birthing within a hospital setting. The desire to use water immersion is often driven by dissatisfaction with previous medicalised experiences of birth and the women’s desire to avoid repeating these experiences. Water provides a safe and protected space to labour which supports a sense of control and privacy. The LMC midwife is a vital ally and advocate in negotiating to use water immersion within the hospital setting. In this environment, staff can either facilitate or be barriers to using water immersion in labour with a complex pregnancy. Conclusions: Women use water immersion in labour to optimise their opportunity for physiological birthing, often in response to previous medicalised births. Water immersion is experienced positively as a strategy to manage labour. Individualised holistic midwifery care from a Lead Maternity Care midwife was valued by the women and viewed as a key support in negotiating for the choice of water immersion. Women needed to purposefully seek a midwife who was willing to support them in their choice to use water immersion.

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“…In Aotearoa/New Zealand, research tends to focus on community case-loading midwifery, with little insights into hospital midwifery. Two studies focussing on hospital midwives in Aotearoa/New Zealand do not ask the question of why midwives choose to work in institutional maternity units, however give some insight into this indirectly (Gilkison et al, 2017;Wynn-Williams, 2006). Midwives are sustained in their work as a hospital midwife through developing skills valuable to their work and quickly developing rapport with women in a fast paced, ever-changing environment (Gilkison, McAra-Couper, Hunter & Austin 2017).…”

Section: Identifying the Research Problemmentioning

confidence: 99%

“…Two studies focussing on hospital midwives in Aotearoa/New Zealand do not ask the question of why midwives choose to work in institutional maternity units, however give some insight into this indirectly (Gilkison et al, 2017;Wynn-Williams, 2006). Midwives are sustained in their work as a hospital midwife through developing skills valuable to their work and quickly developing rapport with women in a fast paced, ever-changing environment (Gilkison, McAra-Couper, Hunter & Austin 2017). When exploring why midwives transition work settings, which is an option in the Aotearoa/New Zealand maternity system, the researchers found transitioning from hospital to community midwifery and vice-versa is a tool midwives used to remain professionally sustainable, and remain in midwifery as a profession (Welfare, 2018).…”

Section: Identifying the Research Problemmentioning

confidence: 99%

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Valuing Moments of Connection: The experiences of hospital midwives in maternity units in Aotearoa/New Zealand

Smith¹

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This research explored the experiences of employed midwives in maternity facilities in Aotearoa/New Zealand. In Aotearoa/New Zealand, midwives mainly work in the community as a case loading midwife or are employed within an institution. Aotearoa/New Zealand midwifery research has mainly focused on the unique community case loading model, with a lack of research focussing on employed midwifery, especially the strengths of employed midwifery. Due to the shortage and declining workforce of midwives nationally and internationally, there is abundant research exploring the reasons midwives give for leaving practice. Research as to why midwives stay in practice in Aotearoa/New Zealand is not as evident. This study used a qualitative descriptive methodology with an appreciative inquiry lens. Appreciative inquiry (AI) uses a positive framework to interview participants, giving an affirmative lens to the results. This allows the researcher to discover what works well in a system rather than the traditional method of identifying problems. Midwives from different locations in Aotearoa/New Zealand were interviewed face to face or by zoom. The principles of AI were used to develop semi-structured interview questions, which were transcribed and analysed by thematic analysis. Four main findings were identified: Midwife heart and soul, advancing practice roles, work-life balance, and tension in the institution. Employed midwives value the relationships they form with wāhine/women and their whānau/families and being able to provide the care they consider is a high standard. They are also sustained by achieving work-life balance and being able to advance their practice role. However, tension in the institution leads to frustration and limits midwives’ autonomy and growth. There are implications from this research for midwives, maternity facilities, and the wider profession.

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The core of the core: What is at the heart of hospital core midwifery practice in New Zealand?

Cited by 10 publications

References 20 publications

The Good, the Bad and the Ugly. The experiences of midwives who transition work settings: A qualitative descriptive study

The Good, the Bad and the Ugly. The experiences of midwives who transition work settings: A qualitative descriptive study

Seeking safe harbour: Water immersion for women with complex pregnancy

Valuing Moments of Connection: The experiences of hospital midwives in maternity units in Aotearoa/New Zealand

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