Midwifery Council Forum Dunedin

Having just completed the first audit of my practice by Midwifery Council I have decided there is some value in continuing to reflect in my blog, making it easier to pull some reflection together for standards review and audit. I will not reflect in my blog about actual midwifery practice and will save that for a closed activity as I am acutely aware of the issues of confidentiality. If a woman particularly told me she was happy for me to write in my blog I would do so and would also make it clear that I had permission to post on my blog from the woman and her family.





Image from Luxmart's photos on Flickr.com

The purpose of this post is to reflect on the Midwifery Council forum in Dunedin, which I attended today.

It was great to get together with many friends and colleagues, some of whom I had not seen for a long time. It was also nice to meet midwives I had not met before, for example Andrea Vincent, who is a new member of midwifery council. I was sad to learn that Sue Bree's term of office on midwifery council has ended. Sue is a wonderful and inspiring woman and I have enormous admiration for her.

It was also good to meet up with Ruth Martis, my colleague from Christchurch Polytechnic and arrange to meet up with her in October for a day brainstorming the Midwifery Practice Skills course for 2011.

During the forum we had a brainstorming session establishing what midwives wanted for the next three year cycle of Technical Skills workshops. Everyone was adamant the day on complex skills should remain. There were quite few other topics that the room came up with for the other Technical Skills workshop day. Amongst the topics discussed were Pharmacology and Prescribing and Newborn assessment. Courses on these topics are available as part of the overseas midwives competency programme and are available too for New Zealand midwives who wish to do them. Antenatal screening was another topic, there is a course available through the National Screening unit for midwives to complete at no cost. Other topics discussed were postdates care, keeping birth normal, postnatal care, preventing burnout and complex care. This was a useful session and it will be for Midwifery Council to decide what the components of the next technical skills workshop will be.If you are a midwife do you have any ideas about topics that should be in the Technical skills workshops of available as continuing education for midwives. The advantage of having a topic in the technical skills workshops is that all midwives must do it, however if it is just available as a course only those who choose to will do it.

In the forum we looked at the proposed new code of conduct for midwives and also the new cultural competence guidelines for midwives. We were able to feedback some thoughts on these proposed requirements for midwifery practice. These will provide good guidance to midwives but we need to be careful what we regulate. For example there is a clause in the proposed code of conduct which states that midwives should not have an emotional or sexual relationship with clients. Many at the forum saw this as a problem as many midwives provide care to family members and also there is an emotional connection with families when you have been the midwife with that family for several births. What do you think? Should midwives be able to care for family members, or should they only be able to be a support person in this situation?

Council also explained there move into and electronic format for the midwifery recertification and payment and issuing practicing certificates.

At the end we had an open session where issues such as the timing of midwifery standards review were discussed, some were interested in moving this to a three yearly component but the consensus and midwifery council position was to leave this as a biennial requirement. Do you think that biennial standards review is a good time spacing or should it be annual or three yearly?

It was quite a long day and I picked up some fried chicken on the way home on request of my husband. Not my favourite meal but saves coming home to cook.

Lovely harp and violin

Protecting, supporting and promoting normal birth in New Zealand

In New Zealand we have a National Strategic Plan of Action for Breastfeeding. At the same time intervention rates in birth are skyrocketing, as they are internationally. Breastfeeding is an important health issue for women and their babies, and it is right that we should do all in our power to support breastfeeding in our communities. There is however general lack of acknowledgement of the health risks of birth intervention to women and their babies. Caesarean section is accompanied by significant morbidity to women and to neonates. It also siginificantly increases risks for future pregnancies. This is an issue of concern for me, as it is for many midwives.

I have taken the first couple of pages of the Action Plan for breastfeeding and have substituted Normal Birth for the word breastfeeding. One or two sentences needed to be removed as they were not relevant to normal birth. I would be interested to know what you think of this. If only we could inspire a movement to protect, promote and support normal birth. Is there any way that you think that we could make this happen?

So read on::
The vision for the National Strategic Plan of Action for Normal Birth

Aotearoa New Zealand is a country in which Normal Birth is valued, protected, promoted and supported by the whole of society.
The statements on this page set out the achievements that will show that the vision has been realised in New Zealand.

Women and their wha¯nau/family have the information they need to make confident and informed decisions about Normal Birth, and live and work in an environment that enables and supports their decisions. Women and families have access to support to help them gain, practise and pass on knowledge of Normal Birth to family, friends, and successive generations. Communities, along with health and social services, provide accessible, consistent and knowledgeable support to women and families who need it. Normal Birth rates show a significant improvement across all population groups, and there are no longer any significant differences between the Normal Birth rates of different ethnic, socioeconomic or geographic communities. There are accessible and appropriate Normal Birth education and support services for all eligible women, fathers/partners, families and wha¯nau from all cultural and ethnic groups, and for migrant communities, low-income families and young mothers. Government planning, policy and service delivery decisions are thought through with a view to actively protecting, promoting and supporting Normal Birth. This occurs across all relevant government agencies in ways that fully involve and respond to communities. Where it is necessary, legislation actively and explicitly protects, promotes and supports Normal Birth.
1.1 Priority areas for action for the short term: 2008–2010
The Committee has identified a group of issues that need to be addressed in order to make demonstrable progress in improving Normal Birth rates in New Zealand. The priority areas are listed below:
Government
• Objective 1.1(a): The Ministry of Health provides the leadership for Normal Birth strategy and policy.
• Objective 1.2(a): The Ministry of Health continues to strengthen the accuracy and completeness of the existing dataset on Normal Birth.
• Objective 1.3(a): Identification of New Zealand-specific Normal Birth research needs.
• Objective 1.4(b) The Ministry of Health supports a programme of research into intervention in the normal birth process. National Strategic Plan of Action for Normal Birth 2008–2012 page


Family and community
• Objective 2.1(b): The Ministry of Health works with District Health Boards (DHBs) to assess and plan for improving access to ante-natal education.
• Objective 2.2(b): Communities work with DHBs and other providers to establish new or support existing peer support programmes for Normal Birth.
• Objective 2.3(a): the second phase of the national Normal Birth social marketing campaign promotes positive attitudes to Normal Birth in the community and public places.

Health services
• Objective 3.1(a): All DHBs achieve and maintain Normal Birth Friendly Hospital accreditation.
• Objective 3.2(b): DHBs are aware of and act on the Normal Birth support needs of their Māori, Pacific and other ethnic communities.

Workplace childcare and early childhood education
• Objective 4.1(a): The Ministry of Health continues to link with other agencies (for example the Families Commission, Department of Labour) to support the development of a policy framework for options for extending current paid parental leave entitlements.

1.2 The need for the National Strategic Plan of Action on Normal Birth
Normal Birth is important for the physical, social, emotional and mental health and wellbeing of infants, mothers, fathers/partners and families. There are risks identified with intervention in birth. Normal Birth is important to the health of individuals and communities. [We] now require[s] DHBs to actively work towards improving Normal Birth rates as one way of improving the health status of communities. Concern over declining Normal Birth rates is not unique to New Zealand.

Virtual International Day of the Midwife, May 5th

May 5th is the International Midwives Day. Here is what the International Confederation of Midwives say about this day:

"The International Day of the Midwife is an occasion for every midwife to think about the many others in the profession, to make new contacts within and outside midwifery, and to widen the knowledge of what midwives do for the world. In 2010 and in the years leading up to 2015, ICM will use the overarching theme The World Needs Midwives Now More Than Ever as part of an ongoing campaign to highlight the need for midwives. This reflects the WHO call for midwives and the need to accelerate progress towards the achievement of MDGs 4 & 5."

How about participating in the Virtual International Day of the Midwife. This is a free conference for midwives. An opportunity to come together from the comfort of your own home or from your workplace. You can access all the sessions online through the links that you will see beside the sessions. Come and join us. You will have an opportunity to ask the presenters questions or to share your own thoughts.

Wiki for midwifery education.

Some time ago, way back in 2007 I did a course called facilitating online learning communities through Otago Polytechnic and Manakau Institute of Technology. I became very interested in open access education and making resources available for those who have an interest to study. I started this blog at that time and, for a while, was an enthusiastic contributor to online discussion fora etc. Laterly I have been very involved with developing a new programme through Otago Polytechnic for undergraduate midwifery education and have not been very active at all online discussions or posting on this blog. It all just takes too much time.
However I did start a repository for material that I felt could be useful for midwifery education. I commenced a wiki in wikieducator to store this material and to make it accessible to any who wishes to use it. I have tinkered with this wiki from time to time and it has grown over time.
I am aware that this wiki does not get much exposure. I know this blog is rarely frequented also but, in an effort to raise the profile of this wiki I am posting here. Any midwives, or midwifery educators who wish to add content to the wiki are welcome to do so.
Go and have a look and see what you think, follow this link.

Wise womens' web: rural midwives communties of practice

I have just realised how to post a document in google docs as an open document on the web and have loaded up my thesis.
So if you are ready to be bored here it is

Opportunities for postgraduate study for midwives in New Zealand

On the 5th of August 2009 I attended and educators forum, organised by the new Zealand College of Midwives. The principal focus was to brainstorm ideas about how government funding for formal midwifery postgraduate education could best be directed. This was an exciting day and one I had waited a long time to see.

Way way back in 1994 I embarked on a long process of self development. I was working at Balclutha Maternity as an LMC midwife and the new direct entry degree midwives were just graduating. I realised that my midwifery education had been a very long time ago, in a different time and a different country. I never went to college of University, in fact i left school when i was 15 years old with just enough qualifications to get into practice based Registered Nursing when I was 17. In 1994 I went to Polytech for the very first time and started papers towards a Bachelors Degree in Midwifery which I obtained in 1998. Around 2002 I started doing papers towards a Masters Degree in Midwifery. In 2004 when I became a midwifery lecturer my employer paid the remaining costs of my Degree but all the other study I did was self funded.

I could see that this was inequitable back then. Nurses at Balclutha were able to do a Masters Degree and have their education funded but the Clinical Training Agency. Local doctors too got funding from the government through this source but midwives did not have access to this funding, we had to pay for it ourselves.

Since 2007 the government have started to make small amounts of funding available to support continuing education for midwives. Making sure that this funding is dispersed equitably is a challenge. The midwifery workforce is about equally divided between those who are employed by a facility and those who are self employed and claim directly form the government. Funding needs to reach all midwives not just those who are employed by a District Health Board. First of all the Midwifery First Year of Practice programme began. This has provided a mentorship relationship for midwives who are newly graduated. In 2009 a new postgraduate course was funded for employed midwives who are caring for women with complex health problems. Now the CTA are looking at what they can offer to other groups of midwives, particularly rural midwives. The details have not been completed and however next year there will be further opportunities for midwives to engage in study without having to meet the whole cost of this themselves. Exciting times!!
Find out a bit more about midwifery education in New Zealand here