Midwife Aotearoa New Zealand by Collegeofmidwives

IN A CORRECTIONS FACILITY

FORUM

4. FROM THE CO-PRESIDENTS

5. FROM THE CHIEF EXECUTIVE

8. YOUR COLLEGE

10. BULLETIN

12. MIDWIFERY PRACTICE GUIDANCE

18. YOUR UNION

20. YOUR MIDWIFERY BUSINESS

FEATURES

21. PARENTS CENTRE

22. NGĀ MĀIA

23. PASIFIKA MIDWIVES

24. WITH WOMEN IN A CORRECTIONS FACILITY

28. DR SALLY PAIRMAN

32. ANTENATAL IMMUNISATION

36. VAPING IN PREGNANCY

38. VANUATU EARTHQUAKE

40. TE AO MĀORI: WOVEN INTENTIONS

42. BREASTFEEDING CONNECTION

46. TAKU WĀHI MAHI I MY MIDWIFERY PLACE DIRECTORY

EDITOR

Hayley McMurtrie

E: communications@nzcom.org.nz

ADVERTISING ENQUIRIES

Hayley McMurtrie

P: (03) 372 9741

MATERIAL & BOOKING

Deadlines for June 2025

Advertising Booking: 1 May 2025

Advertising Copy: 12 May 2025

Welcome to Issue 116 of Midwife Aotearoa New Zealand

In this edition, we explore both the challenges and the joys of providing midwifery care for women in one of New Zealand’s three women’s correctional facilities. We also shed light on the increasing number of incarcerated women and the factors contributing to this rise. Our regular breastfeeding column complements this discussion and examines the barriers to breastfeeding and bonding while in prison.

We extend a warm welcome home to Dr. Sally Pairman (p.28) and celebrate her immense contributions to midwifery—both in Aotearoa and around the world. Her leadership and vision have been invaluable, and we eagerly anticipate her next steps.

The Practice Guidance section covers key topics:

• Cytomegalovirus (CMV) (p.12)

• Postnatal analgesia (p.14)

• Pelvic floor health and assessment (p.16)

I especially valued the opportunity to speak with the amazing wāhine leading the wahakura wānanga for the te ao Māori section of this issue (p.40). It was inspiring to learn about this intentional practice, which weaves a sense of connection alongside a safe sleep space for pēpi.

Finally, we would like to apologise for the incorrect image that appeared within the Antenatal and Childhood Screening Programme advertisement about changes to Newborn Metabolic Screening in the last issue of Midwife Aotearoa (Issue 115, December 2024, p.15); we regret that this error was not identified before printing.

As always, we welcome your feedback at communications@nzcom.org.nz.

Ngā mihi nui, Hayley Square

HAYLEY

Email: communications@nzcom.org.nz

FROM THE CO-PRESIDENTS

BEA LEATHAM CO-PRESIDENT

“Waiho kia kakati te namu i te whārangi o te pukapuka, hei kōnei ka tahuri atu ai” - Te Ruki Kawiti, 1846.

“When the sandfly nips at the pages of the book (He Whakaputanga me Te Tiriti o Waitangi), at that time, you must arise and resist.”

Toitū te Tiriti mobilised Aotearoa last year, not only physically, as tangata whenua and tangata Tiriti united through the hīkoi, but also on a less visible level, as we grappled with the proposed Principles of the Treaty of Waitangi Bill and its potential ramifications for our nation.

Like many others, my own journey with our founding agreement – from receiving the most rudimentary of education about the Treaty of Waitangi in secondary school, through to unpacking Te Tiriti as an adult –has been both challenging and activating. The progress we’re making as a country and profession is no different; some are still very confronted by this conversation and others are hungry for more knowledge and understanding.

The College made a submission opposing the Bill, which most of our membership were in support of. This is the least we can do; a midwifery profession that doesn’t fight to protect the most basic rights of its Indigenous population cannot call itself whānau-centred, nor can it claim to be based on a foundational cornerstone of partnership. And while this conversation may continue to be confronting for some of our workforce, I hope it will also inspire

people to enquire within themselves and open up to new perspectives.

This will no doubt be helped along by the newest iteration of our Tūranga Kaupapa framework, developed by Ngā Maia and due to be rolled out as a compulsory component of midwifery education over the next few years. It’s heartwarming to finally see mātauranga Māori front and centre, working in synergy with our new Standards of Competence, which point to attributes like kaiarahitanga, manaakitanga and tiakitanga as qualities we expect to see Aotearoa midwives embody.

The same ideals should be applied when considering our responsiveness to whānau need; once our entire maternity service becomes reflective of these values, individual midwives – or collectives of midwives – will be enabled to express these attributes more meaningfully, because they’ll be working within a system that supports them to do so. Like all worthy causes, it will require kōtahitanga and vision, which we can aspire to collectively.

Ngākau nui, ngākau whakaiti. Square

DEBBIE FISHER CO-PRESIDENT

Kia ora, Hello, Mālō e lelei, Talofa lava, Taloha ni, Kia orana, Fakaalofa lahi atu, Namaste, Ni sa bula.

As I write this, it’s a hot summer’s day and my thoughts go out to all pregnant and birthing women in this heat! Thankfully, I was only half-way through each of my own pregnancies over summer, but my thoughts meander over the seasons for birthing women and how our mothers, grandmothers, great-grandmothers,

kuia all managed their pregnancies and births in the heat of summer. My grandmother told me so many stories and traditions over the years and I treasure them so much. One of the greatest strengths of whānau or family is the ability to pass down wisdom and tradition from generation to generation.

Our past always informs our present, and the College’s recent critical submission on the Principles of the Treaty of Waitangi Bill acknowledged this. Thank you to members who provided feedback on the submission and if you haven’t read it yet, I urge you to. Understanding why the proposed Bill would reduce the constitutional status of Te Tiriti o Waitangi and, as a result, negatively impact on all people and our future, is important. Your ancestors may have been a bit like mine and traditionally not shared a lot about their understanding of Te Tiriti o Waitangi. I know it’s now my responsibility to lean in; to learn, to understand, to question and to reflect on my own cultural biases and be accountable as a tangata Tiriti partner.

Completing the education on our revised Scope of Practice and Standards of Competence has been helpful in understanding the expectations the public hold around the cultural safety of midwives.

I also feel very honoured to have experienced a taster of the new Tūranga Kaupapa workshop developed by Ngā Māia and delivered at our last College Board meeting, held at Te Mahurehure Marae. We are all in for a rich, transformational, reflective learning experience as the workshops roll out across the motu. Thank you to Ngā Māia for sharing this taonga with our midwifery profession. As Te Tiriti partners, we all have the responsibility to stand up and be the partners we need to be to honour those who have shared their wisdom and gone before us, and those who are yet to be born and who will lead our future. Square

A VISIONARY WOMAN AND LEADER

It was with sadness that I learned of the passing of Dame Tariana Turia, a visionary woman and leader who was guided by her principles and led a movement of transformation, inspired by her belief that whānau could define their own solutions and determine their own futures.

As an invited speaker at our national conference in Hamilton in September 2000, Tariana spoke of the cultural and spiritual significance of birth for whānau Māori, of the crucial role midwives have in supporting healthy pregnancy outcomes, physically, emotionally and culturally, and of her high regard for our profession, which had been garnered in part from her knowledge of the care her whānau members had received from midwives (she had 97 mokopuna and attended all of their births!).

The words she spoke at the conference recognised the importance of cultural knowledge being valued and included within the provision of clinical care, and of her perception that the midwifery workforce had “made yourselves culturally safe by being aware of who you are and therefore being able to respect

the cultural beliefs of the mothers to be who may be culturally different to you”.

And, of course, she also spoke of societal inequalities, which, at that point in time, had grown faster in New Zealand over the prior 20 years than in almost any other developed country. She discussed that Māori (and other population groups) bore the brunt of these disparities, of the need for policies which corrected them, and that midwives had a vital role to play in enacting these policies.

She also made reference to the political rhetoric of the time, stating, “We need to be concerned about these people who [are] playing on fears and are seeking to divide Māori against other New Zealanders by creating the impression that Māori somehow will gain an unfair advantage over them with the policies being pursued by this government”.

ALISON EDDY CHIEF EXECUTIVE

Dame Tariana Turia

Reading the speech again made me reflect on the fact that this situation has not substantially changed in the two decades since she delivered it at our conference. This is evidenced by the proposed Treaty Principles Bill which has recently undergone public consultation in preparation for the Select Committee process.

In December the College provided a draft submission on the proposed Bill for members to comment on through our membership consultation process. The College’s draft submission opposed the Bill on the basis that Te Tiriti o Waitangi provides the foundation for enduring relationship between Māori and non-Māori in Aotearoa. If passed, the Bill could reinterpret the Tiriti, undermine Māori sovereignty and have negative implications for Māori in the way in which health services are organised, funded and delivered. The Bill also has the potential to have a negative impact for Māori on the wider determinants of health, such as education, housing and poverty (which collectively can have a greater impact on health outcomes than the delivery of healthcare itself). This wider context was the impetus for the College making its submission.

The College received a significant number of responses from members to the consultation, all of which were fully considered before the submission was finalised. The vast majority of member responses were in strong support of the stance taken in the draft submission. However, a

minority of members who provided feedback stated their opposition to the College taking a position on what they perceived to be a political issue which is outside of the realm of what the College as a membership organisation, had a mandate to make a submission on.

As a membership organisation, the College upholds the importance of democratic processes. Its work is driven and led by members’ needs and perspectives and our constitutional objectives, with the board providing direction and leadership. Healthcare is inherently political (few professions know or understand this better than midwifery) and healthcare outcomes and inequities are not a result of the healthcare system alone. The determinants of health, government policies and political decisions all have an important role to play in how equitable (or not) our societies are. Societal inequities can often disproportionately disadvantage women and children, so advocating against a Bill which has the potential to entrench inequities is in line with the College’s objectives.

The College has always involved itself in political issues which can affect midwifery practice and which relate to wider women’s health or rights, societal equity or fairness. For example, over recent years the College has provided submissions on a range of issues such as Oranga Tamariki legislation, smokefree environments and tobacco regulation, the sale and supply of alcohol, climate change legislation, public health legislation and healthy housing legislation.

The College takes a democratic and values-based stance when developing a position on politically sensitive issues on which there may be diverse views amongst our members. One example is the College’s submission on abortion law reform. The vast majority of members were strongly in favour of the College taking a position which supported the law change (to remove abortion from the Crimes Act and legislate it within the context of health services), while a minority of members strongly opposed this position. To honour members’ feedback, the College’s approach was to ensure that our position reflected the views of the majority, whilst acknowledging within our submission (as we did in our Treaty Principles Bill submission) that a minority of members held a different view.

As an almost entirely female profession we can be quick to criticise ourselves or internalise the criticism of others, and not

always quick to celebrate or congratulate ourselves on what we do well. The words Tariana shared at our conference drew a line between a midwife’s individual practice and professional interactions with women and whānau, and the wider political and systemic issues which underpin societal inequities. Developing culturally safe practice at an individual level is an ongoing process of learning and reflection, and clinically and culturally safe midwifery care has much to offer in reducing disparities. For example, international observational research has demonstrated that caseload midwifery care to high needs or ”vulnerable” populations (in countries where this model is not universally available) has reduced the incidence of preterm birth. While midwifery care can act as a buffer to inequities to a degree, individual midwives are not responsible for the wider political policies or societal conditions which have created disparities. Colonisation, the various policies of successive governments, and international and national economic conditions have all created our current societal inequities. It is the College’s role to raise our voice on behalf of the profession to advocate for change at political and policy levels, so that we can make progress towards eliminating health inequities at a systemic level.

It can feel almost impossible to achieve change in a positive direction at times, particularly at present within the health system, where political imperatives are apparently more intent on reducing costs and increasing efficiency than the quality of care. However, recently Health New Zealand has allocated funding for midwives to provide maternal immunisation. This is welcome news and a result of some sustained advocacy by the College on behalf of the profession. There are some instances where midwives have already been successful in establishing and providing maternal immunisation services in community and hospital settings (see the article on p. 32). This funding will enable midwives who wish to provide antenatal immunisation services (and where it is logistically feasible) to be enabled to do so, to improve women’s access to antenatal immunisation for pertussis and influenza.

Further positive news was the final clinical leadership structure for Health New Zealand, announced at the end of 2024. The final agreed model (which was advocated for by the College in our submission on the proposed restructure) means that every

district in New Zealand will now have district level senior midwifery leadership positions which will not be required to report through nursing. No midwifery leadership positions are being disestablished, and midwifery leadership capacity will be increased in some districts. New regional midwifery leadership roles will also be established. This is no small feat, given the overarching drive to reduce spending in the health system by reducing the number of positions in many professions.

Although these are reasons to celebrate (and an acknowledgement of the effective role advocacy can play), there are further challenges on the horizon in 2025, with the proposed major restructure or ”reset” within nationally employed Health New Zealand teams (including Hauora Māori, data and digital, public health and commissioning), as well as the health workforce plan recommending the establishment of a midwifery assistant role.

These restructuring proposals suggest a significant loss of national capacity and a rapid move to a more regional approach for the system overall. It feels as if there is still a long way to go before we have a system which will be able to work in a co-ordinated way in a regional model. Without careful planning there is a risk of having four different regional approaches and losing national consistency. The detail in the health workforce plan about the proposed midwifery assistant role is scant; however, it is concerning that this proposal has been signed off without any apparent consultation with the sector. The need for the profession and the College to remain aware of and respond to the wider context, guided by our objectives and principles, is as pressing as ever. Square

Contact NZBA for all your www.babyfriendly.org.nz/resources your baby friendly resources

Newborn Metabolic Screening Programme update

SMA is now one of the disorders

screened for in newborn screening

We are delighted to let you know that newborn screening for spinal muscular atrophy (SMA) started on 12 February 2025. It has been added to the panel of disorders screened for in the Newborn Metabolic Screening Programme. Screening for SMA will improve outcomes through early detection and timely access to treatments that have recently been funded by Pharmac.

Thank you again for your dedication and important contribution to better outcomes for pēpē and their whānau through your support of newborn screening.

The pamphlet, Your newborn baby’s blood test has been updated to include SMA as one of the disorders screened for. When gaining informed consent for newborn screening please make sure whānau are aware of the disorders being screened for , as outlined in the pamphlet.

Please ensure you order and give whānau the new pamphlets ASAP and dispose of any old versions so whānau have the most up to date information to inform their choice for screening. It can be downloaded or ordered from HealthEd at healthed.govt.nz/products/your-newborn-babys-blood-test- the-newbornmetabolic-screening-programme

Supporting information on SMA is available on the Health NZ website tewhatuora.govt.nz/health-services-and-programmes/newborn-metabolic-screening-programme/spinal-muscular-atrophy/ A webinar that provides information on SMA and newborn screening is available to watch on the New Zealand College of Midwives website, midwife.org.nz/

Other guidance and reminders are on the Health NZ website tewhatuora.govt.nz/health-services-and-programmes/newborn-metabolic-screening-programme/guidelines-updates-practice-reminders/

YOUR COLLEGE

ACC births injuries online lodging

The College has recently raised its concerns to ACC that after nearly 2 years since the passing of the Maternal Birth Injuries amendment to the ACC bill, midwives are still unable to lodge ACC45 claim forms online. If an ACC45 form for a maternal birth injury is lodged at the time of birth when the injury was sustained, women are able to access funded or ACC subsidised treatment at a later stage. Currently if a midwife wishes to lodge a claim she needs to complete a paper version of the ACC45. ACC have confirmed that they are working to enable online claim lodging for midwives, but as yet have not confirmed the timeframe for this to occur. We will keep members updated. Square

Updated consensus statements and format coming soon

The College has been updating its consensus statements through an organised work programme. As part of the update, we have revised the presentation and format of the statements. Please keep an eye out for the updated versions which will go through our usual member consultation processes. Square

Restructuring submissions

The College provided written submissions to Health New Zealand on several of its recent restructuring proposals. These proposals were seeking to disestablish a number of positions across the Hauora Māori services, the national Public Health service, the Data and Digital team and the national Commissioning team. The College’s submissions highlighted the need for sufficient capacity to ensure there is no disruption to services which are currently provided by many of the roles which the proposals were seeking to disestablish. Examples of some of the roles which the proposals were seeking to disestablish include; backroom data and digital support, support for the roll out of the national maternity digital system and roles which ensure the functioning of antenatal and newborn screening programmes. Square

The Pae Ora (Healthy Futures) (3-Day Postnatal Stay) Amendment Bill

A new Government Bill proposes to increase access to postnatal care for all women in maternity facilities up to 72 hours as an expected entitlement. The College has provided feedback which highlighted the importance of policies and legislation that improve the maternity system, while also pointing out the chronic issues facing our maternity systems in terms of midwife shortages, limited bed spaces and the lack of support for primary birthing by successive governments. The Bill omits recognition of the lead maternity carer system which provides postnatal midwifery care in the community, but it includes the requirement that

all lead maternity carer providers must inform women of the entitlement to 72 hours minimum inpatient care. As midwives already operate within a fully informed model of care, we consider a legal mandate for this information to be excessive and unnecessary. Square

Call for nominations – Independent Finance Committee member

The College’s finance committee consists of the co-presidents and four midwife representatives (three representing their regions and one elected independent member). The independent finance committee member is elected by the membership for a three-year term. The College’s Chief Executive and Business and Finance Advisor also provide ex-officio support to the committee. The College is now seeking nominations for the independent committee member role. If more than one nomination is received, an online ballot will be undertaken.

The finance committee meets either face-to-face or virtually, for up to two hours prior to each national board meeting (three times per year) with virtual meetings in between these times as necessary.

The finance committee has delegated responsibility from the national board to provide advice and make recommendations to management in order to achieve the College’s strategic goals. Committee members contribute to the discussions to enable sound financial oversight by providing high level oversight and strategic advice on financial management, reporting, risk management and audit.

Nominations – including a cover letter and CV – to be emailed to Lynda.o@nzcom.org.nz by 6 April 2025. Square

Whakatāne maternity service transition

In January this year, Whakatāne hospital transitioned from a secondary to a primary maternity facility due to the resignation of its four obstetricians. Health NZ I Te Whatu Ora has made assurances that recruitment for obstetricians is underway with the aim of transitioning back to a secondary service in 12–18 months.

Community and hospital midwives working in the Eastern Bay of Plenty continue to provide a high-quality service while adjusting to the logistics of accessing necessary acute obstetric services in Tauranga hospital. Whānau and community members are understandably concerned about longer travel times, particularly for those residing further east.

The College is working with the midwives in the region who have risen to the challenge and demonstrated leadership to ensure their services are sustained and whānau are reassured they will continue to receive safe care. The College is also advocating for Bay of Plenty midwifery at a district and national level with Health NZ I Te Whatu Ora, to ensure prompt re-establishment of the obstetric service and clear policies, processes and support are available. Square

FAREWELL LISA, WELCOME JULIE

The bags are almost packed and the travel plans in place, we are sad to see Lisa Donkin leave the College after eleven years taking care of membership. Lisa says she will miss her colleagues but it is the members who have kept the role interesting over the years. Lisa joined the College in 2014 and intended to stay for a ‘couple of years’. Not sure where the time has gone, Lisa is excited to embark on a two month trip around Europe with husband Cliff, followed by a ‘life on the road’ back here in New Zealand.

We wish Lisa all the best and welcome Julie into the role. With some pretty big shoes to fill we know Julie Williams will continue to serve members with the same pride and passion as Lisa has. Julie’s background in customer services, most recently with the Waimakariri District Council, will enable her to slot into those shoes easily. Julie likes to spend time in the garden of her North Canterbury property where she lives with her husband and two adult children. Julie’s work history also includes time at an electical firm and several years with Telecom (now Spark).

Julie is looking forward to meeting the membership over the phone and via email, once she learns the ropes and I am sure you will all join me in saying a huge welcome. Square

We wish Lisa all the best and welcome Julie into the role. With some pretty big shoes to fill we know Julie Williams will continue to serve members with the same pride and passion as Lisa has.

Farewell Lisa Donkin (left), welcome Julie Williams (right).

BULLETIN

Voluntary

Bonding scheme on hold

Health New Zealand has confirmed that no decisions have been made regarding the Voluntary Bonding Scheme (which provides payment following a minimum of three years’ service) for health professional graduates.

At the time of this magazine going to print no decisions had been made by Health Workforce about the scheme for 2025, or about funding for those who have applied for the programme in 2024. The College continues to advocate for provision of this funding support for our midwifery graduates. Square

College representatives meeting with midwives affected by the vaccine mandate

On July 30th 2024, representatives from the College met with members of Aku Huia Kaimanawa (AHK) in Tauranga for a facilitated meeting. AHK is a grassroots midwifery collective formed in 2022 to represent some of the midwives who were required to leave practice when the Covid-19 vaccine mandates came into effect. The College was aware that some midwives who had been impacted by the mandate had felt unsupported by

the College at the time the mandate was implemented and subsequently felt alienated from the wider profession. The meeting was sought with the intent to hear these concerns and to rebuild relationships and trust between the College and its members.

This hui provided an opportunity for the College to hear the experiences of midwives, women and whānau significantly impacted by the vaccine mandate, and to discuss and clarify some of the College processes, decision making and position around that time.

During the hui midwives from AHK shared that they continue to feel a deep sense of grief and loss at having to leave practice, and talked about their perceived lack of support from the College and a disconnect between the mandate and the foundational principles of autonomy and informed decision making.

At the conclusion of the hui, AHK suggested a number of actions that they would like the College to facilitate. These actions were presented to the College board in November. A working group of representatives from AHK and the College has been formed to discuss how these will be considered. Both groups agreed that it is important to use this experience to inform the College’s future work, particularly in the event of another pandemic. Square

Carosika collaborative update

The Carosika Collaborative was established in 2020 to address inequities and improve outcomes in preterm birth across Aotearoa. In 2024, they launched their website, designed for midwives, healthcare professionals, and whānau seeking evidence-based guidance on improving preterm birth care.

A key focus of the Collaborative is the development of Taonga Tuku Iho | Best Practice Guide for Equity in Preterm Birth in Aotearoa. This guide, currently in progress, responds to the need for national guidance on best practice in preterm birth care. The rollout began with the launch on 13 November 2024, with additional guidelines and resources being introduced over the next 6–12 months.

The process being adopted by the guideline development group does not allow the College to follow its usual process of member consultation and feedback. However, the College has representation on the steering group and the Best Practice Guide review panel.

Visit the Taonga Tuku Iho website, where you can explore resources and follow updates https://bestpracticeguide. carosikacollaborative.co.nz. Square

Practicalities of mentoring in Aotearoa

The College has developed this course as a resource to inform and support you in a professional mentoring relationship.

Te Tiriti o Waitangi

This course delves into Aotearoa’s rich past and present, offering insights that foster understanding and support informed, thoughtful decisions for the future.

COLLEGE eLEARNING PROGRAMME

The College is currently offering two eLearning courses, with more planned for launch over the next few months. The courses available are Practicalities of Mentoring in Aotearoa and Te Tiriti o Waitangi. We are receiving great feedback about both courses.

Te Tiriti o Waitangi is subsidised for members and can be applied to the Midwifery Council’s mandatory cultural safety education requirements for the 2024–2027 cycle. This course includes an online learning module, followed by an on-line community session where participants can explore the eLearning content in greater depth and engage in the elements within the eLearning and have the opportunity for open discussion.

Practicalities of Mentoring is a pre-requisite for any mentoring programme with the College and has a great deal of useful information for any midwife supporting another professionally. This eLearning course is fully funded for College members. The courses are available through the College website education tab. Square

WHAT IS CYTOMEGALOVIRUS?

VIOLET CLAPHAM MIDWIFERY ADVISOR

KEY MESSAGES

HOLLY TEAGLE, AUD UNIVERSITY OF AUCKLAND THE HEARING HOUSE

ANGELA DEKEN, RM NEWBORN HEARING SCREENING PROGRAMME COORDINATOR

• Cytomegalovirus (CMV) is the most common viral infection in pregnancy and is the leading cause of non-genetic hearing loss in infants and one of the main causes of childhood disability

• Vertical transmission of CMV may occur from mother to baby during pregnancy

• Past infection with CMV does not confer complete protection against reinfection or congenital CMV

• Risk of mother to baby transmission of CMV is highest in the first trimester of pregnancy

• CMV is not currently part of routine antenatal or newborn screening in Aotearoa

• Midwives should discuss CMV with whānau at first antenatal appointment

• Hygiene measures considerably reduce the risk of contracting a primary maternal CMV infection

• Whānau with a child in daycare (or those working with young children) carry the highest risk of exposure to CMV

Human cytomegalovirus (CMV) is part of the herpes family and is the most common congenital viral infection. The CMV virus can remain dormant in the body over a long period after initial infection and women who have been exposed to CMV prior to pregnancy may have naturally acquired immunity. Transmission of CMV occurs through direct contact with bodily fluids (such as saliva, urine, blood, semen and breast milk) from individuals who are actively shedding the virus. CMV is extremely common and is found throughout all geographical locations and socioeconomic groups. Congenital cytomegalovirus (cCMV) infection is the most common congenital infection globally and has potentially severe consequences for infants. cCMV is the leading cause of non-genetic hearing loss in infants and one of the main causes of childhood disability.

CMV is excreted in the bodily fluids of

infected people, and children under the age of two (particularly those in day care environments) will carry the highest viral loads (Cannon et al., 2011). CMV can be transmitted from bodily fluids to hands, then to mucosal surfaces (such as the mouth).

Cytomegalovirus is destroyed by soap and water

IMPACT OF CMV INFECTION

Most healthy adults and children who become infected with CMV will be asymptomatic and will not experience any long-term effects. Some infected people may display flu-like symptoms. If women contract CMV during pregnancy, the infection can pass directly from the mother to the baby (vertical transmission), and the earlier in pregnancy this occurs, the more risk there is to the baby. The highest likelihood of mother to baby transmission is following maternal primary infection in the first trimester (32% risk of intrauterine transmission; Leruez-Ville et al., 2024).

cCMV infection carries a significant burden with a 0.64% global prevalence (Leruez-Ville et al., 2024). cCMV is the most common infectious cause of disabilities in newborn babies and is associated with an increased risk of stillbirth, sensorineural hearing loss, visual problems, cerebral palsy, physical impairment, autism and learning disability.

Meta-analysis shows that although long-term sequelae, especially sensorineural hearing loss (SNHL), are more common in those with clinically detectable disease at birth, they are also found in 13% of those without clinical features attributable to cCMV on initial examination (Dollard, Grosse, & Ross, 2007).

PRIMARY VERSUS SECONDARY INFECTION

The highest likelihood of adverse perinatal outcome occurs following maternal primary infection during the first trimester (associated with a 30–40% risk of intrauterine transmission; RANZCOG, 2023).

Secondary infection with CMV (also referred to as reinfection or reactivation of latent infection) during pregnancy is associated with a 1–3% risk of fetal infection; however, when fetal infection does occur during a secondary maternal infection with CMV, the potential for and severity of morbidity for the baby is similar to cases of primary infection. Although we don’t have reliable prevalence rates of CMV seropositivity in Aotearoa, in Australia the rate of seropositivity is 40–60% within the childbearing population (RANZCOG, 2023).

SCREENING

Although universal serological screening for CMV is not currently recommended in Aotearoa, early pregnancy screening with CMV IgG may be considered for women who are at high risk of infection. This includes women who work with young children, those displaying flu-like symptoms during pregnancy, and those who receive abnormal ultrasound results (such as periventricular echogenicity, ventriculomegaly and intraparenchymal calcifications). CMV is included within a TORCH screen.

Early determination of CMV serostatus may help in distinguishing between primary infection and reactivation/reinfection during pregnancy if clinically indicated, but does not remove the need to follow recommended hygiene measures. Women with suspected CMV infection in pregnancy should have CMV serology testing for IgG and IgM (and IgG avidity if CMV IgG and IgM are positive). Past infection with CMV does not confirm complete protection against reinfection or congenital CMV.

Immunoglobulin M (IgM) antibodies are short-lived and their existence in the blood confirms that a new (primary) infection is present.

Immunoglobulin G (IgG) antibodies express their predominant activity during a secondary antibody response.

HOW TO AVOID INFECTION WHILE PREGNANT

WASH HANDS OFTEN WITH SOAP AND WATER

CLEAN TOYS AND SURFACES CHILDREN HAVE PLAYED WITH

The European Congenital Infection Initiative (ECCI) advocates for implementation of universal antenatal screening for CMV, followed by anti-viral therapy for mothers with a primary CMV infection in the first trimester of pregnancy (citing evidence of a 71% reduction in vertical CMV transmission, (Leruez-Ville et al., 2024). For further guidance on diagnosis and management see the RANZCOG Statement ‘Prevention of congenital cytomegalovirus (CMV) infection’, available from www.ranzcog.edu.au

PRACTICE GUIDANCE

The College recommends that midwives:

• inform women about CMV at the first antenatal appointment

• offer resources to provide further information about CMV, risk factors and preventative measures (see below for links to resources)

• ask women if they are in frequent contact with young children (especially those in day care) and, if so, explain the increased risk of CMV infection

• discuss how women can reduce the risk of infection (see infographic)

• consider the possibility of CMV infection if women present with a flu-like illness during pregnancy

• consider offering serological testing for high-risk women (close contact with children or those flu-like symptoms)

• as per the referral guidelines, recommend referral to an obstetric specialist when congenital CMV infection is suspected

DON'T SHARE FOOD AND DRINK WITH CHILDREN AVOID KISSING CHILDREN ON THE MOUTH. KISS ON THE HEAD

on the basis of maternal serology or fetal ultrasound abnormalities. NB: Acute infection with CMV is a transfer under these guidelines

• recommend PCR testing (saliva or urine) for babies of mothers diagnosed with primary CMV infection during pregnancy (for babies older than three weeks the newborn metabolic heelprick sample can be used to test for cCMV but this method has lower sensitivity)

• recommend paediatric consultation for babies diagnosed with congenital CMV and ensure that a hearing screening risk factor surveillance form has been completed

• ensure the local newborn hearing screening team are aware when a mother has had a primary CMV infection during

POSSIBLE SYMPTOMS OF cCMV IN NEW BORNS

Petechiae

Congenital jaundice

Fetal growth restriction

Hepatosplenomegaly

Microcephaly

Lethargy or hypotonia

Poor suck

Eye inflammation

Seizures

pregnancy and when a baby is being tested for cCMV (including completing a risk factor form)

• inform general practitioners and Well Child providers of a diagnosis of cCMV

Antiviral treatment for infants with cCMV is only recommended if started in the first four weeks of life. Infants older than three weeks with symptoms of cCMV should still be investigated as their ongoing management may be informed by this diagnosis. Babies diagnosed with cCMV should be offered specialist follow up and are followed up in audiology until the age of five, due to the high risk of progressive hearing loss.

ADDITIONAL CMV RESOURCES

Resource Hub: www.cerebralpalsy.org.au

CMV Australia: www.cmv.org.au

CMV Action: www.cmvaction.org.uk

CMV Foundation: www.nationalcmv.org

RANZCOG guideline: www.ranzcog.edu.au Square

References available on request.

OCCUPATIONS AT HIGH RISK OF EXPOSURE TO CMV

Primary caregivers of pre-school aged children

Childcare workers

Paediatric health workers

Midwives

Teachers

POSTNATAL ANALGESIA

CLAIRE MACDONALD MIDWIFERY ADVISOR

Postnatal pain assessment and management are important aspects of midwifery care, both immediately after birth and during the following days and weeks. This practice update covers some of the midwifery considerations and current evidence when offering medications for pain management. While non-pharmaceutical pain relief options are important, they are not the subject of this article.

Postpartum pain includes pain from perineal trauma (tears or episiotomy), caesarean surgery, afterpains, breast pain and musculoskeletal pain (e.g. coccyx). Ongoing and poorly managed pain may delay recovery and return to usual function and activities. It can negatively impact motherbaby attachment, breastfeeding and maternal psychological wellbeing (Roofthooft et al., 2021). Pain which is not well managed can also increase the risk of sensitisation to pain and the development of chronic pain and postnatal depression (Fahey, 2017; Gamez & Habib, 2018). When pain impedes mobility, the risk of other postpartum complications is increased (Fahey,

2017). Effective postnatal pain management is therefore important to support the birthing woman’s/person’s recovery, rest, breastfeeding and parenting journey.

Before making a pain management plan, it is essential to fully assess what is causing the pain, and to reassess over time. Post-birth pain from a perineal or caesarean section wound is anticipated and should gradually require less analgesia. Ongoing visual assessment of wound healing is important to detect signs of infection or poor healing, which may require additional treatment (e.g. antibiotics). Abdominal discomfort may be related to afterpains, but could also signal retained placental tissue, endometritis, constipation or a urinary tract infection. Making a full assessment is necessary, including the woman’s symptoms, clinical findings (palpation, observations, visual assessment) and laboratory investigations if required. Determing the cause of pain enables appropriate treatment to be provided.

POSTNATAL ANALGESIA

Midwives have a responsibility to prescribe appropriately, according to the individual’s needs and informed consent. Midwives are encouraged to familiarise themselves with the Principles for quality and safe prescribing practice, a joint publication by Te Tatau o te Whare Kahu | Midwifery Council and six other regulatory authorities.

The World Health Organization’s pain ladder has been in use for four decades and provides a useful framework for clinicians planning an analgesic regimen with a client/ patient. The enduring approach is a three-step process whereby pain is treated with first-line analgesics – paracetamol and non-steroidal

anti-inflammatory drugs (NSAIDs) –and if pain persists, a weak opioid is added as step 2. This is changed for a strong opioid for moderate to severe pain as step 3. The concurrent use of analgesics with different modes of action is known as multi-modal analgesia (BPACnz, 2018). As pain levels decrease during the recovery period, the opioid should be stopped first, while nonopioid analgesia is continued until pain has resolved.

When planning analgesic dosing with postpartum women and people, consideration should be given to recommending fixedinterval, rather than on-demand, paracetamol and NSAIDs (ibuprofen or diclofenac). This is particularly important for post-surgical pain. One randomised control trial found that compared with on-demand analgesia, the patient group assigned to receive analgesia at six-hourly intervals had lower mean pain scores, higher satisfaction rates, more breastfeeds and less use of supplemental formulas, with no adverse effects reported for neonates (Yefet et al., 2017). In practice, this means explaining that paracetamol and NSAIDs are most effective when taken at regular intervals, rather than waiting for pain to emerge. Regular paracetamol and NSAIDs should be continued if an opioid analgesic is also needed; not only do they reduce the need for higher doses of opioid analgesia, but some evidence indicates that paracetamol has a synergistic effect on other analgesic medications (particularly opioids) – making them more effective (Freo, 2022).

Women who have had a surgical birth should receive appropriate prescriptions for postnatal analgesia from the obstetric or anaesthetic

service for discharge home. If midwives are in the position of needing to prescribe a multi-modal analgesic regimen, as always, they should prescribe within their knowledge and expertise. This includes understanding the effects, side effects, interactions and contraindications of the drugs (New Zealand College of Midwives, 2014), and gaining the woman’s informed consent for prescribed medications. The NZ Formulary is the authoritative resource for current prescribing information (nzformulary.org). The only opioid within a midwife’s scope of practice to prescribe is tramadol. If required, it should be prescribed as a short course (Waitaha Canterbury guideline recommends a maximum of 20 x 50 mg tramadol) to be used as an adjunct to regular paracetamol and NSAIDs.

Midwives may need to assure whānau that postnatal analgesia is safe to take while breastfeeding. Midwives can support postpartum women/people to know what to take and when, with a written analgesia plan.

Written medication plans help to minimise medication errors and optimise pain management with regular, adequate dosing (BPACnz, 2018). BPACnz recommends that the most important aspects to include in an analgesia plan are:

• The regular dose, frequency and dosing interval for each medicine, including medications that could be taken for breakthrough pain

• Adverse effects that may occur and how these should be managed, e.g. taking with food or seeking medical advice

• The likely timeframe for pain resolution and instructions on how to reduce the dose and stop medicines as pain improves

• Non-pharmacological treatments and comfort measures can be added to the pain management plan.

If pain persists, worsens or takes longer to resolve than expected, a full clinical reassessment is necessary. Square

References available on request.

Are you a dedicated LMC with a passion for rural care, eager to join a close-knit, small rural team based in Dannevirke?

Tararua Health Group offers a 3-bed maternity unit within the Dannevirke Community Hospital. We provide comprehensive continuity of care for women throughout antenatal, labour, birth, and rural/remote postnatal care.

About your new role:

Roster: A balanced schedule with a 24-hour roster of 4 days on/4 days off.

Accommodation: The option to stay at our Maternity Cover House at no cost. Team: Be part of a supportive and welcoming team committed to exceptional rural and remote care.

Travel: If you’re from out of town and need assistance with your travel expenses, we’re happy to discuss a travel allowance.

You will have the following skills:

Experience: An experienced midwife seeking a move to a rural environment. Skills: Strong clinical skills and a compassionate approach to care.

Professional Requirements: Current APC, Indemnity and Vulnerable Children’s Check.

You will be a team player with a sense of humour, excellent bedside manner and bundles of enthusiasm. Your energy and understanding will be vital in providing exceptional care for our newest arrivals and their mothers.

Apply today and become a valued member of our team to tanya.holak@omnihealth.co.nz or call Tanya on 027 320 5616.

PELVIC FLOOR HEALTH AND ASSESSMENT

BRIGID BEEHAN MIDWIFERY ADVISOR

The pelvic floor is a vital anatomical structure that supports the bladder, uterus and bowel. Pregnancy and childbirth can place significant strain on the pelvic floor, leading to issues such as incontinence, pelvic organ prolapse and sexual dysfunction. These conditions can have far-reaching physical and psychosocial impacts, including reduced quality of life, intimacy challenges and mental health concerns such as anxiety and depression. Untreated pelvic floor injury and dysfunction can impact the planning of future pregnancies for whānau.

Research highlights that among women who have given birth, one in three will experience urinary incontinence following birth, and one in 12 will experience pelvic organ prolapse during their lifetime. In the postnatal period, timely assessment and intervention can prevent these complications, yet pelvic floor health is often under-assessed. Midwives play a pivotal role in bridging this gap, ensuring early identification of concerns and empowering women/ people to engage in preventative and restorative care.

ACC MATERNAL BIRTH INJURY COVER

In 2022, ACC introduced Maternal Birth Injury Cover to support those who sustain specific injuries during childbirth. This includes funding for injuries such as perineal tears, pelvic floor trauma and prolapse. Midwives have a responsibility to inform clients about this cover and lodge claims (using ACC45 form) early after injury diagnosis.

For detailed information, refer to the ACC Maternal Birth Injury Quick Guide

THE IMPACT FOLLOWING BIRTH

The physical effects of pelvic floor trauma following birth can include urinary or faecal

incontinence, dyspareunia and chronic pelvic pain. Psychosocially, many women/ people experience embarrassment, isolation and diminished self-worth, which can negatively impact relationships and mental health. Midwives are uniquely positioned to provide individualised whānau-centred, holistic care in the home.

The continuity of care model in Aotearoa, which enables midwives to support women/people throughout the perinatal period up to six weeks postpartum, offers midwives unique opportunities for education and screening throughout the period.

CULTURAL SAFETY

A culturally safe approach is critical in providing equitable and responsive care to improve outcomes in pelvic floor health. Guided by Tūranga Kaupapa, midwives can create culturally safe environments, where they acknowledge and respect cultural values, incorporating input from whānau according to the wishes of the wahine.

INEQUITIES TO ACCESSING SERVICES

Ensuring equity in access to services, particularly for disadvantaged and underresourced populations, remains a vital focus of midwifery care.

However, there are significant inequities in accessing publicly funded pelvic health physiotherapy following a birth injury. Health NZ | Te Whatu Ora services have long waitlists; there is a shortage of pelvic health physiotherapists, especially in rural communities; and the co-payments charged for physiotherapy all contribute to significant inequity. Healthpoint and Physiotherapy NZ offer directories of both public and private pelvic health physiotherapy services. Midwives can provide this information to support improved access to care.

SUPPORTING ONGOING PELVIC FLOOR HEALTH

Pelvic health awareness is ongoing during pregnancy, birth and post-pregnancy recovery, and midwives can lay the foundations for access to information, guidance and support for whānau. This includes encouraging all women to prioritise their health by incorporating pelvic floor exercises into their daily routine. This also includes ensuring they know how to access additional pelvic health care if they experience ongoing or new symptoms of incontinence, discomfort or prolapse.

Despite challenges such as the current inequities of access to care, midwives can make a difference in normalising regular conversations about pelvic health. This in turn will help reduce whakamā | embarrassment and instead encourage women to ask for help, with the aim of preventing long-term dysfunction and improving their health and quality of life.

KEY MESSAGES

• Promoting pelvic floor health is an integral part of midwifery care.

• Normalising conversations about pelvic floor health can reduce whakamā | embarrassment that some wāhine | women may feel.

• Culturally safe care is essential.

• Early identification, information sharing and management of pelvic floor issues can significantly improve outcomes.

• Pelvic floor assessment is critical to preventing long term complications following birth.

• Midwives have a vital role in lodging claims for birth injuries with ACC. Square

References available on request.

KEY PRACTICE POINTS FOR MIDWIVES

Antenatal and postnatal assessment: Incorporate pelvic floor assessments into routine antenatal and postnatal care. Ask questions about urinary and bowel function, pain and sexual health. Normalise these discussions to reduce stigma.

Referrals: Recognise when to recommend referral to pelvic health physiotherapists and or specialists. Referral guidelines, 7012 Vaginal or perianal prolapse, require a midwife to offer a consultation following birth.

ACC claims: Proactively discuss the ACC Maternal Birth Injury Cover in the antenatal period. Assist in documenting birth injuries and submitting claims in a timely way to ensure postnatal women/people can access available support in the short and long term. Consider the benefits of lodging a claim for every birth injury covered by ACC to ensure easy access to care in future years.

Culturally safe care: Embed Te Tiriti o Waitangi framework into midwifery practice, ensuring equitable and culturally responsive care in the assessment and support of pelvic floor healthcare. Recognise the unique needs of Māori and Pasifika people, migrant communities, low-income families, rainbow communities and other groups facing ongoing healthcare access barriers in Aotearoa.

Psychosocial support: Be attuned to the emotional impact of pelvic floor trauma. Provide a safe space for women and people and their whānau to share concerns and consider referrals to mental health support services when needed.

Education: During antenatal and postnatal care, educate about pelvic floor health and the benefits of pelvic floor exercises. Use resources like the Continence NZ Pregnancy Guide to guide conversations. In the postnatal period, advise waiting at least three months before high-impact activities, as these can worsen pelvic floor dysfunction or lead to prolapse. Use trusted resources from websites such as Physiotherapy New Zealand, Continence NZ, and Pelvic Floor First for guidance on exercises and recovery post birth and for the years ahead.

Upskilling: Consider engaging in professional development opportunities focused on pelvic floor health, such as workshops or webinars, to strengthen skills in assessment and care provision. The College workshop ‘A- Z of Perineal Care’ provides midwives with skills and knowledge in managing and assessing pelvic health, covering the spectrum of care through the antenatal, intrapartum and postnatal periods.

MIDWIFERY-LED CARE IN A HOSPITAL SETTING

WHAT ARE THE OPPORTUNITIES FOR EMPLOYED MIDWIVES?

Late in 2024 an emerging obstetric workforce shortage started to be evident in some of the country’s secondary maternity units. There is also a shortage of LMC midwives in some communities, with a corresponding increase in women receiving care from Health NZ midwifery services.

The Maternity Service tier 1 specifications anticipate services that support continuity of care. Even when women/people receive care from Health NZ maternity services, there are opportunities to support continuity of care through the provision of midwiferyled services provided by employed midwives. In some districts there is a wide range of midwifery-led services provided; yet, in other districts these opportunities are not being fully realised. Maximising the provision of midwifery-led services not only enables continuity of care to be provided for women/people receiving hospital maternity services, but also allows midwives to utilise their scope of practice more fully and eases pressure on obstetric staff.

Midwifery-led care does not need to be limited to community and outpatient settings, as there are opportunities for the provision of midwifery-led care within primary, secondary and tertiary facilities. In some districts there are not local primary maternity facilities available, and women/ people only have the option of a secondary or tertiary maternity unit unless they choose to birth at home.

Just because women/people receive care at a secondary or tertiary facility, it does not necessarily mean that they then meet the criteria for consultation or referral to an obstetrician. Midwifery-led services should be available in these settings, with midwives

providing care within their scope of practice and only consulting or referring to obstetric and other secondary care services when there is a clinical need. There is nothing in the maternity specifications that requires obstetric oversight of all women in a secondary or tertiary setting.

THE MERAS COLLECTIVE

The MERAS Collective anticipates that MERAS will work closely with midwifery leaders across districts and nationally to support the development of employed midwifery-led services where these are needed. MERAS can ensure there is a consistent approach to midwifery roles, that these are consistent with the Midwifery Career Pathway (appendix c MERAS SECA), that there are appropriate pay grades applied (MERAS SECA 10.1 and 10.2) and there is consistency in terms and conditions.

MERAS Collective clause 1.2: MERAS and Te Whatu Ora share a strong interest in getting health workforce development right by building a midwifery workforce and work contexts that are flexible, productive, sustainable, and able to deliver on health goals. The parties recognise the value of working co-operatively and constructively together to achieve the over-arching goal of maintaining and advancing the midwifery workforce that takes shared responsibility for

providing high quality healthcare on a sustainable basis.

The range of Health NZ midwifery-led services varies across the country. Table 1 shows examples of what can be included.

EXTRACTS FROM THE MATERNITY SERVICE TIER 1 SPECIFICATIONS

• Maternity Services funded by DHBs include primary, secondary and tertiary maternity care for pregnant women and their babies until six weeks after the birth (The Service). The Service supports continuity of care, and is delivered in community, outpatient and inpatient settings.

• The definition of LMC includes practitioners funded under the Primary Maternity Services Notice and practitioners funded by DHBs to provide an LMC model of primary maternity care.

• The Service may be provided in community, outpatient and inpatient settings.

a. The community setting includes private residences, community clinics and other community settings, including marae.

b. The outpatient setting includes primary, secondary and tertiary maternity facilities.

c. The inpatient setting includes primary, secondary and tertiary maternity facilities.

Secondary Maternity Services are those provided where women or their babies experience complications that need additional maternity care involving obstetricians, paediatricians, other specialists and secondary care teams.

Secondary Maternity Services are provided to women and babies, based on clinical need, until six weeks following birth.

Secondary Maternity Services include routine and urgent specialist consultations, elective and emergency caesarean sections, vaginal and assisted deliveries, all treatment required in emergency situations, allied health services, and support from a lactation consultant for women and babies who experience breastfeeding complications.

IN CONCLUSION

At a time of workforce shortages and budget constraints it makes sense to enable Health NZ midwives to practise to the full scope of practice. There are clear consultation and referral guidelines to guide practice and indicate when obstetric and other medical consultation or transfer of clinical responsibility is needed.

If you can see opportunities for more midwifery-led care in your maternity service, discuss with your local MERAS workplace representative, your Director of Midwifery or the MERAS Co-Leader (Midwifery). Square

For MERAS Membership merasmembership.co.nz www.meras.co.nz

TABLE 1: MIDWIFERY-LED SERVICES

Caseloading midwifery services

These are midwifery teams of two to four midwives providing continuity of antenatal, postnatal and intrapartum care. Some of these teams have been established to focus on meeting the needs of particular women/people, including those wanting to birth at primary maternity units, wāhine Māori or rural women/people.

Community midwifery services

Midwife specialists

Midwifery-led

• Day assessment units

• Acute assessment care/ units

These services provide continuity of antenatal and postnatal care and are often the first to be established when there is a shortage of LMCs.

These midwives provide midwifery care for women/people with more complex pregnancies, alongside obstetric and medical colleagues. The midwives coordinate the care and provide ongoing follow up of women with diabetes, high risk pregnancies and other complexities.

These services have become an increasingly common way of providing ongoing outpatient and acute maternity care to women/ people between antenatal appointments. They can be provided at primary, secondary or tertiary facilities.

In primary facilities and smaller secondary facilities the services may be combined and may be provided as part of the overall inpatient service. In larger secondary and tertiary units these services may have designated rooms and midwives allocated each shift.

• Day assessment units tend to provide scheduled appointments for services such as ferritin injections, BP & CTG monitoring, and follow up from SMO clinics during weekday hours.

• Acute assessment units or beds focus on acute presentations such as reduced fetal movements and SRM assessments and are available 24/7. These services reduce the busyness of the birthing suite.

Midwifery-led labour and birthing services

Midwifery-led postnatal services

Women/people receiving care from employed community midwifery services should still be able to birth at primary, secondary or tertiary maternity services with midwifery care from the midwives on duty that shift. They should not need to be reviewed by obstetric staff unless they meet the consultation or referral guidelines.

Women who have required consultation or referral to obstetric care during the antenatal or intrapartum period can usually be handed back to midwifery care as they leave the birthing suite or within 24 hours, unless they continue to be medically or obstetrically unstable.

Midwifery-led care on a maternity ward enables more timely transfer to primary maternity facilities or assessment of the overall wellbeing of the mother/parent and baby before a midwifery discharge home.

So many great digital tools saving you time and $ including: • Clinical documentation • Claiming and payments • Healthlink • • A Midwifery Practice Calendar • Quickly sending personalised referrals • • Staying connected • Getting tasks done • Sending group (Caseload) SMS • • Completing a video consultation • Taking notes on the go • • PLUS realtime access to extensive personalised support •

PARENTS CENTRE TRUST CLOSING

The College was saddened to hear the devastating news in November that the Parents Centre Trust was closing at the end of 2024. The College has had the privilege of being in a strong partnership with Parents Centre for 35 years, with Parents Centre Christchurch becoming a member of the College in 1989. This vital service which has been provided for parents for many years will be a significant loss.

Parents Centre has been active for over 70 years in Aotearoa and is a charitable trust that has provided childbirth and early parenting classes across the country. Fifteen volunteer-led independent Parents Centres across the country provide additional services in their local communities and will hopefully be able to continue operating these services.

The roots of Parents Centre go back to the 1950s and involve women such as Nancy Sutherland who was a children’s rights champion, consumer advocate, political activist, and advocate for natural childbirth, breastfeeding and midwifery. Nancy died age 93 in 2002 and in her New Zealand Herald obituary there is a story about how she was the first mother in New Zealand to use the Grantly Dick-Read method of natural childbirth, and how she was separated from her full term healthy newborn twins after their birth in 1938. The twins were brought to Nancy on day three and the matron is reported to have said, “here are your babies”, to which Nancy replied, “but how do I know they’re mine?” Nancy’s advocacy for natural childbirth has been part of the positive changes for women and babies in the New Zealand maternity system.

Another key figure in Parents Centre history is Mary Dobbie, who wrote The Trouble with Women, commissioned by the Federation of NZ Parents Centres to ensure its history was recorded before records, and memories, were lost (Dobbie, 1990). Of interest to midwives is that Joan Donley shared her resources with Mary while she was working on her own book, Save the Midwife. Mary’s book has a foreword written by the then Minister of Women’s Affairs, Associate Minister of Education and former member of Parents Centre, the Hon Margaret Shields, who noted how timely the story of Parents Centre was because the book was published in 1990 when the Nurses Amendment Act was passed. Shields said the Act marked, “… an important turning point in the availability of birthing choices in this country” and it “will allow a midwife to take responsibility for the care of a woman through her pregnancy, childbirth and the post-natal period. I cannot think of another time in a woman’s life when the continuity of care and the support of another woman is more important” (Dobbie, 1990, p. viii).

There are many other key figures in the history of Parents Centre, including Christine Cole Catley who was a leading independent publisher

of the late twentieth century and co-founder of the Parents Centre movement in the 1950s.

Another key figure is Christine’s friend Helen Brew, a trail blazer who strongly believed women should be given choices about pain relief, information about natural birthing techniques, and the opportunity to have a say in how their babies were born. Helen was a speech therapist, child psychologist, parent, actress and documentary film maker. She met the psychiatrist R.D. Laing in 1972 in London and again the following year when he lectured at Victoria University. Laing was critical of “modern” birth practices such as induction and cutting the umbilical cord too soon. Their shared views on birth led to Helen making the film Birth with Laing in 1978 (see www.nzonscreen.com/title/birthwith-dr-rd-laing-1977). The film aimed to use shock tactics to draw attention to childbirth issues and show that vigilance and protest were still needed (Dobbie, 1990).

Mary Dobbie’s book is a fascinating history about the development of Parents Centre groups all around New Zealand, of women and their supporters fighting for their rights in childbirth, maternity politics and reform, support for midwives and midwifery, and issues such as the long fight for mothers to visit their hospitalised children. Parents Centre has continued to support childbirth and parenting and as described on their website they have been “weaving communities of informed and connected parents”. In the 138 pages of Mary Dobbie’s book there are too many extraordinary and courageous women and men to mention but we should be eternally grateful for what they did for childbirth, mothers, babies, children and families.

Hard to understand that women had to fight to access their sick children in hospital, hard to imagine that mothers did not see their newborn babies for three days, and hard to believe that women were anaesthetised in second stage of labour without their consent. The loss of Parents Centre is tragic, and we should never forget the significance of this social movement as we have a lot to thank them for. It matters to remember history. Square

References available on request.

CAROL BARTLE POLICY ANALYST

TŪRANGA KAUPAPA EDUCATION PROGRAMME: WORTH THE WAIT

TAMARA KARU NGĀ MĀIA GENERAL MANAGER

Ngā Māia is thrilled to announce the launch of the Tūranga Kaupapa Education Programme on 1 March 2025. While the debut has been slightly delayed, we believe the adjustments—driven by stakeholder feedback—underscore the importance of making CPD more accessible, affordable and practical without compromising high-quality learning. The Council has generously allowed midwives three years to fulfil their compulsory requirements for Cultural Safety, including Tūranga Kaupapa.

LIVE SESSIONS

To ensure your professional development fits seamlessly into your busy life and to reduce overheads, we've tailored an 8-hour programme for midwives:

• Module One: 4 hours of self-directed learning. Engage with e-learning packages at your own pace, featuring video lectures, readings and guided reflection assessment.

• Module Two: 4 hours of online live wānanga. Join live, interactive sessions with national facilitators who will guide you through

applying Tūranga Kaupapa in practice. Bring your questions and deepen your understanding.

CONVENIENT SCHEDULING

Over 50 sessions will be made available from March to November 2025, scheduled on Tuesdays, Wednesdays and Thursdays from 9:30 am to 1:30 pm. Look out for early bird incentives once the portal is ready!

REGISTRATION PROCESS

Our online registration portal is under development and will include a payment pathway, access to self-directed learning packages and links to live sessions. In-person 8-hour sessions are available upon request, at your cost.

UNIQUE BENEFITS:

• Cost-effective and resource-efficient, right to your home

• Convenient and accessible

• Small, welcoming sessions with a maximum of 25 participants

• Designed by midwives for midwives

• Newly developed resources to support your practice

We are excited to embark on this journey with you in 2025–2027, enabling midwives nationwide to blend the latest knowledge with practical tools to enhance Tūranga Kaupapa in midwifery practice —a need more vital now than ever. Stay tuned for more details, and visit our website or contact the Ngā manaakitanga, The Tūranga Kaupapa Education Programme Team at admin@ ngamaiatrust.org for feedback or inquiries. Square

Tamara’s grand-daughter (@2 hours) Ngā Ueaurongo-a-Hineraukatauri Manuirirangi born at home.

INTERNATIONAL STUDENTS: A THREAD IN AOTEAROA'S CULTURAL FABRIC

NGATEPAERU MARSTERS AUT PASIFIKA EDUCATOR

International students are part of New Zealand’s economy – their presence and inclusion a thread in Aotearoa’s cultural fabric.

According to Education New Zealand | Manapou ki te Ao there were 37,685 international tertiary students | tauira in 2023 an increase almost 30% from the previous year. Although recovery has been slow postCovid, the momentum generated has seen a 67% increase in total international student enrolments (2023) compared with the previous year, with midwifery a small contributor.

The international tauira pathway is not the normal route of Pasifika peoples in midwifery but has been for Jein Waker. Originally from Puncak Jaya, Jein was raised in Wamema, West Papua – a large town in the Western New Guinea region of Indonesia, with an estimated population of approximately 66,000.

Wa kinaonak (hello) Jein, who is one of the five international midwifery students enrolled at AUT and in her final year. Ngā mihi nui for sharing your story.

Jein pointed out that West Papua is not seen as a Pacific nation but part of Indonesia. This fact underpins the ongoing political unrest, as indigenous Papuans have strived for decades to become an independent state. The formation of Free Papua Movement in the early 1960s has seen a growing force, with offshore support.

As a scholarship recipient of an Indonesian government initiative established in 2014 and with a broad kaupapa of exploring educational opportunities, Jein arrived with four other students in mid-2017. She became a Year 10 student at Edgewater College (east Auckland), boarding with a host family whom she continues to live with today.

Political neutrality has to be maintained to safeguard her scholarship, which covers tuition-related costs, living expenses and a small koha. She also works part-time to meet transport costs for clinical placements.

Jein’s journey in Aotearoa began with severe homesickness that affected her physical and mental wellbeing, causing hair loss.

The pressure of a western society’s expectations saw a high-achieving student from West Papua interpreted as underachieving against New Zealand’s academic standard. Jein’s cultural transition from living in a communal way of sharing with neighbours to a foreign individualised suburban existence has taken some adjustment. Fortunately, improved technology in her 2nd year has meant more accessible communication with whānau, especially her grandparents who raised her.

Jein’s midwifery calling is typically driven, like many, to serve her people. However, her experience is not typical of her classmates, as

West Papua’s health system is very basic and maternal and fetal death is common. She shared that there is a lack of understanding why these deaths occur. What is accepted is the cultural belief that it’s the woman’s fault because she must have done something to deserve that, a frustrating aspect for Jein. Ancient superstitions are still a living part of their belief system.

Jein has a desire to use her midwifery knowledge to educate her people, but her immediate goal is to complete the degree and work in Aotearoa – ideally, in a rural location as a more appropriate context to consolidate practice before returning home. To enable her to work at home, Jein will have to complete a bridging RN qualification to become a nurse/midwife. This nurse/midwife role is the norm across most Pacific nations due to their remoteness and broad clinical context.

Jein’s final words are of home and her mother, a single parent. “A goal is to build a house for Mum,” she says. Square

References available on request.

Jein Waker, who one of five international midwifery students enrolled at AUT.

WITH WOMEN IN A CORRECTIONS FACILITY

As midwives, being ‘with women’ is our natural state. But what happens when the working environment is externally controlled, restrictive, and the women we’re caring for are facing unimaginable complexity? Kelly McConville has been caring for women in Auckland Regional Women's Corrections Facility (ARWCF) since 2014 and shares her unique perspectives with Amellia Kapa.

Kelly McConville did her first booking visit in ARWCF 10 years ago, following a secondment to the Counties Manukau community high risk midwifery team. It wasn’t the first time her nonjudgmental, easy-going nature had caught the attention of her colleagues, who approached her about working in the prison; a role which had historically been challenging to fill.

“It’s a logistical nightmare,” Kelly begins.

“If you're an LMC, or community midwife, you can't take your phone inside the facility. So who backs you up while you’re in there? Plus, you might go in with the intention of seeing five women that day, but only end up seeing two. Or you might see none at all, because all sorts of things can happen on any given day and prison is a complex place to navigate. So it's just not an efficient place for a midwife to work.”

Midwives might not be surprised to discover the number of pregnant women Kelly cares for annually has risen over time. “When I first started, the caseload was quite small. I saw about 28 people in my first year. Now, I see around 40-50 women a year and those numbers have been consistent for about eight years now. However, the pregnancy outcomes once women in ARWCF engage in midwifery care are very good.”

Anecdotally, based on the experience she has accumulated over the past decade, Kelly lists a

number of possible reasons why numbers have been on the rise. “Women living in poverty; women living with addiction; increasing mental health issues; the experience of family violence and the impacts of physical and sexual abuse.”

She also points to specific substances and the devastating effects they are having on whānau and entire communities as a result. “Before 2000, we didn't have a problem with methamphetamine in this country and very few women used opioids. Methamphetamine has become the drug of choice since about 2010. So I believe that's a major contributor, because more women are now involved in crime as a result.”

Many of the complications of pregnancy she sees among her clients can be attributed to drug misuse.

“We have a high rate of previous and current SGA, IUGR, pre-term birth, as well as women with a history of stillbirth – at times more than one stillbirth. Anxiety, self-harm, emotional dysregulation along with previous suicidal ideation and attempts are also common.”

Kelly also notes a couple of lesser known, but no less concerning, trends. “We’re seeing increasing rates of psychosis and cardiomyopathy associated with methamphetamine use. It's not unusual to find maternal tachycardia often related to high use of methamphetamine.”

AMELLIA KAPA REGISTERED MIDWIFE

see me, and I know I can book those women straight away, because they’ll open up and tell me their life stories. And then with others, I'm more cautious. Some women don't trust people, maybe because they've never had a trusting relationship in their whole lives. So it takes them a little while to get to know me and to talk about what's important for them. And it might be that I see some of those women two, three or even four times before I actually do their booking.”

“Some women can come across as quite aggressive, or intimidating, but when you've dealt with women like that before and you've got that experience behind you, it's really helpful,” she continues. “If I'm with someone, for example, and I can see that they're distracted and getting agitated, I can pick up on that and suggest that we've done enough for that appointment. I’ve had women in clinic ask me when they can leave, and I tell them they can leave right away if they want to. Instead of insisting they stay in order to finish the visit, you learn to be flexible and you realise how important it is to know when to end the conversation. That's just as important as knowing when to start a conversation in this environment.”

elucidates. “Quite often, these women will not present because there are things going on their lives that are more important to them, or they face barriers that mean they're unable to engage straightaway. I suggest that these women represent some of our most at-risk families nationally and many will have complex health risks and social concerns. They’re described as vulnerable, but actually I believe I work with some of the most resilient women in the country.”

Resilient or not, however, women in prison are isolated – disconnected from their usual support networks – the reality of which is probably most pronounced postnatally. “I usually do an average of about 11 postnatal visits in ARWCF, because women don't have their whānau around them,” Kelly explains. “It's a totally different process for these women, so even though it's obviously really important to maintain a professional relationship when working with prisoners, I think the caring relationship probably goes a little bit deeper.”

What Kelly has been exposed to over the last decade has undoubtedly influenced her approach to midwifery care and she highlights the very beginning of the journey as crucial. “When I began working in the prison, I used to try and book women the first time I met them. But I don't do that anymore because I’ve learned how important it is to focus on whakawhanaungatanga. Providing a meaningful meet and greet with a woman is important, as they're often in quite a vulnerable space.”

The initial visit with Kelly can be understandably emotional for incarcerated women, as she highlights. “It's not unusual for me to meet women for the first time and they'll cry. And they might not cry with anyone else. They don't cry in their cells, they don't cry with their whānau, but they meet me and that's an opportunity. The door closes and I say ‘Hi, my name's Kelly, I'm a midwife’, and then the tears start flowing.”

Kelly’s intuition around what to do, and when, has developed over time and, as she explains, it’s practice wisdom that can’t necessarily be taught. “I individualise my approach depending on the woman and her circumstances. Some women are happy to

Although the vast majority of midwives in Aotearoa may never work within the physical confines of a prison, Kelly is keen to remind other midwives that they are interacting with these women, whether they’re aware of it or not. She highlights the sensitivity that’s required when working with all women, “because, actually, these women are also in the community. Whether midwives are aware of their full history or not, they are meeting these women all over the country.” She reiterates how experience has taught her that a booking is not necessarily the first point of contact a midwife needs to make with women. “It's actually about saying ‘Hi, who am I? Who are you? And what do you expect to gain out of this relationship?”

“I think that's a really important way to start off,” she continues, “because the overwhelming majority of women who present at Corrections are un-booked, regardless of their gestation. Whether they present in their first, second or third trimester, over 90% of them are un-booked. I suggest that, nationally, these could be women who might present somewhere in labour, having been unable to access antenatal care.”

Having a non-judgmental approach and even reviewing the language we’re using as midwives is also vital, as Kelly further

For women whose babies remain in their care, Kelly says breastfeeding rates are high and shares her view on why the outcomes are so positive. “Babies in Corrections rarely lose weight in their first week and it’s made me question whether the weight loss we’ve come to accept as normal is actually due to the social impact of the kind of lives we live – due to having other children for example, or other responsibilities. Women who have babies in a Corrections facility are there 24 hours a day, seven days a week and their sole purpose is to feed and care for their babies. Most babies either maintain their weight in the first week, or put weight on, which is really interesting and may surprise some people.”

While not all women’s babies remain in their care, there are provisions for the dyad to be kept together. “Over the last six weeks, I've had seven women give birth. Of those seven women, three are in the Mum and Baby Unit in the Corrections facility, which means they have their babies with them 24/7. This self-care unit is made up of two houses within the prison complex and each can accommodate three women and three babies. So you can have up to six women and six babies living in those houses at any given time. The whole idea of the unit is that women can reside there with their babies up until they’re two years of age.”

Women apply to go into the unit and a multidisciplinary team, of which Kelly is a part, reviews the applications, actively

looking for reasons to support it. “But if a woman isn’t approved for the Mum and Baby Unit”, Kelly explains, “they can apply for ‘feeding and bonding’, which means someone can bring their baby into prison so that they can spend periods of time with them, either breastfeeding or formula feeding. It's an opportunity to still bond with their babies.”

Recently, Kelly advocated for a woman whose baby was being removed to alternative carers by Oranga Tamariki. She advocated for the baby to remain with mum for at least 24 hours following birth, until a caregiver had been arranged. “Postnatally, I asked the woman how the experience was for her and she's actually over the moon. She's more accepting now of what happened. She knew her baby wasn't going to be in her care, but now she's working to see whether her whānau can have her baby and if, when she's released, she can go back and be part of that baby's life. So it’s been an enabling experience for that woman. Kelly stresses that it's important to respect women who are in Corrections. “They should have the same rights to dignity, privacy and confidentiality as any other woman.”

Advocacy is a constant in Kelly’s role but, as she illustrates, the work is rewarding. “It's not easy at times, but I've combined efforts with Corrections staff to improve equity to healthcare. For example, I worked with the administrator to improve access to ultrasound scanning outside of prison because, when I first started, women in prison were not being given appropriate access to scans. We worked hard to make sure they were done in a timely manner and Horizon Radiology understood the logistical nightmare of arranging community-based scans for pregnant women being escorted from a Corrections facility.”

And whilst there have been some wins, Kelly is acutely aware that the reality for these women doesn’t necessarily change, or improve, once they are released. She makes a plea to her colleagues, to go the extra mile for these women once they’re outside prison walls. “When women are released from prison, they often don't have a phone, so I can't pass on a contact number, and I'm relying on the address I’ve been given from the court, which may not be current by the time they’re picked up by an LMC or community midwife. What I’d love to

see is midwives in the community doing everything they can to engage these women for care after their release. These women have complex psychosocial issues and they’re facing huge barriers, so physically knocking on their doors to see whether they'd like to connect for some healthcare is hugely valuable. I know it's tough for everyone out there and many midwives are working in areas with staff constraints, but it’s important to remember that these women aren’t going to actively seek care. They are facing a very unique set of circumstances, so exercising compassion and understanding, tailoring the care to these women’s lives would be really great to see.”

After a decade of working with women in Corrections, Kelly acknowledges the profound impact they have had on her, as both a woman and a midwife. “I wouldn't be the person I am today if I hadn't had the opportunity to care for these women; they’ve taught me a lot about communication and compassion. Women in prison engage well and value the role of a midwife, and I’ve appreciated the opportunity to work in partnership with them.”Square

A HOMECOMING FOR MIDWIFERY’S ‘BIG VISIONARY’

DR SALLY PAIRMAN RETURNS TO AOTEAROA

JOURNALIST

Across four decades, Dr Sally Pairman has been an absolute trailblazer for both midwives and women, not just in Aotearoa but across the globe, says Karen Guilliland, friend and colleague for over 40 years.

Sally’s credentials speak for themselves, spanning midwifery practice, education and regulation.

She holds a Master’s and a Doctorate degree in midwifery and spent 16 years at Otago Polytechnic in a variety of roles, including Head of the School of Midwifery, Professor of Midwifery and Director of Learning and Teaching.

Sally and Karen met in 1984 when both women joined a training course to become midwifery educators. Together they went on to establish the College of Midwives in 1989. They were instrumental in the law change that saw midwifery become an autonomous profession in 1990. They also played a vital role in reforming the education system to create Bachelor and Master’s midwifery degrees.

“Sally is honestly an incredible intellect, and a big visionary. Her whole passion at the time was education. She was just passionately aware that we needed to change,” says Karen.

After completing their educator training, Sally and Karen, together with Karen’s sister, a physiologist, established that there needed to be more science in the midwifery curriculum – because without the knowledge of how a body works, you were no different from anyone else showing up to the birth, says Karen.

“Sally was amazing, she just wrote the curriculum essentially. Her vocabulary, her way of expressing

herself, she was really good at that and she could articulate her plan, write it and put it into a framework.”

As well as setting up a direct entry Bachelor of Midwifery programme and later a Master’s programme, Sally also spent five years as the president of the College and nine years as the first chairperson of the Midwifery Council. She was also co-chair of the International Confederation of Midwives’ (ICM) Regulation Standing Committee from 2008 to 2017 and has been a member of ICM’s Scientific Professional Programme Committee.

For the last eight years, Sally has been at the helm of ICM as Chief Executive (CE), based in The Hague in the Netherlands, where she has transformed the 100-year old confederation from a small organisation of five. With very little money, to a team of over 20 with core funding from global organisations and regular contracts.

Now it’s time for Sally to return home to Aotearoa and take the opportunity to reminisce on how her midwifery journey unfolded.

It all started after she completed a Bachelor of Arts degree, majoring in English Language and Literature, at the University of Otago in 1976.

She says, “Then, I didn’t really have a clue what I would do”. Sally looked to nursing, which she thought

ZAHRA SHAHTAHMASEBI

The combined voices of women and midwives (before government) made a powerful movement that couldn’t be dismissed as just professional interest. So, while it was a challenging time, there was nothing more reassuring than the knowledge they were pushing in the right direction.

The first stop was for a shave and an enema, before being put in a gown and moved somewhere else for labour, then into a theatre to give birth.

“The bell would ring and all the students would roll in and line up against the wall to watch and the woman was never asked. The doctor would come in wearing a rubber apron and gumboots,” says Sally.

“It was awful in the sense of the lack of women-centredness and lack of informed choice and consent. But it was the childbirth process itself I was really interested in.”

So, she went to London to complete an 18-month midwifery training programme. At the same time, mindsets were starting to shift towards birth being a normal life event, and the second wave of feminism was sweeping the globe.

“In New Zealand, women were really ramping up their protests about the maternity service that they had access to. Women started complaining about the maternity service back in the ‘20s even, but by the mid-80s, there were quite a few consumer groups set up to try and bring about changes,” says Sally.

These consumer groups in particular, Parents Centre, Home Birth Aotearoa and Save the Midwives, saw midwives as professionals who could provide care to women on their own responsibility, right through pregnancy, labour, birth and postnatally up to six weeks.

there was nothing more reassuring than the knowledge they were pushing in the right direction, Karen says.

Both Sally and Karen acknowledge thenMinister of Health, Helen Clark, who pushed through the necessary changes in the Nurses Amendment Act, achieved pay equity and paved the way to direct entry midwifery education. They also acknowlege the female politicians from both sides of the house who supported their efforts.

“All the men sat down and voted with the women in their parties – it was pretty cool actually,” says Karen.

Of Sally, Karen can’t state enough how impressive she is: “She is a hard taskmaster but of course that’s why she gets there. She’s relentless about getting to the end, whereas I’d probably have given up a couple of times.

“We used to go along and I’d be the bad cop and she’d be the good cop, and it was actually the opposite. I mean I’d fall over no trouble but Sally wouldn’t give in no matter what.

“I’d say, ‘I’m not standing for this, this is just not good enough,’ and Sally would go, ‘I think we could probably address it if we looked at this,’ and so they all turned to Sally and did what she wanted,” Karen laughs.

After lengthy political action, the Nurses Amendment Act was passed in 1990 and it stated that a woman could have a medical practitioner, or a midwife, or both – “in short, they could choose,” says Sally.

would be a good ticket to travelling the world.

But midwifery caught her eye during a six-month obstetric rotation in the third year of her nursing programme. The tutor, a British midwife, regaled students with stories of working in London during the Great Depression – how they coped with a lack of both iron-rich foods and meat, and how people cooked and ate their placentas postbirth.

Sally was attracted to the autonomy the midwives seemed to hold, as well as the connections they forged in the community. She also enjoyed being with women during birth; however, birthing looked quite different in the 1970s compared to now. With maternity care very medically dominated in both New Zealand and Australia, women would arrive in hospital and be bounced from room to room, clinician to clinician.

When Sally returned to New Zealand from the UK and met Karen on that fortuitous day in educator training, their goal became to reinstate midwifery as its own profession.

This meant pulling away from the New Zealand Nurses Association and creating the New Zealand College of Midwives in 1989, where Karen served as CE until 2018.

Simultaneously, Sally and Karen worked with other midwives and consumer and women’s groups across Aotearoa to try and reinstate midwifery autonomy.

“We had midwives and women together and we’d normally go in pairs and regularly visit every politician in the country and talk to them about why the maternity service needed to change,” says Sally.

The combined voices of women and midwives made it a powerful movement that couldn’t be dismissed as just professional interest. So, while it was a challenging time,

Of course, a lot of other legislation had to be changed to make the Nurses Amendment Act a reality, but it was those three words “or a midwife” that granted midwives autonomy, she adds.

It also caused a wave that saw obstetric care fall out of routine education for both nurses and GPs – something Sally never anticipated but it reflected what women wanted.

“When women could choose, they literally walked with their feet and they chose midwives. Because they wanted birth to be a normal life event, they wanted the relationship of having the same person or small group of midwives that they could get to know throughout the whole process,” says Sally.

Previously, maternity care had been routine, anonymised and lacked continuity. So, when given the option of personalised care, it was a no brainer for women, she adds.

Throughout the 1980s, the ICM had been a source of inspiration for Sally – she

frequently looked to the confederation and its scope of practice statement.

“ICM’s core focus is to support midwives’ associations, to help them be the voice for the profession and help them strengthen the professional framework in their country,” explains Sally.

“Every association is in a different place, depending on where they are in the world, but there are core elements that all midwives hold strongly to.”

These core elements speak of birth as a normal life process, that women should always be placed at the centre of care and of the partnership between mother and midwife.

And it’s these tenets that formed the foundations of the midwifery model in Aotearoa, says Sally.

As CE of ICM she was able to take her experience of completely changing midwifery back home and share those learnings with the world – a fact that kept her grounded throughout her time in The Hague.

One such learning was the political power of women’s organisations, she says.

“And so I’ve been spending a lot of time encouraging midwives, professional organisations and countries to locate and work with women’s groups to get this political activity happening,” says Sally.

While Sally’s time at ICM has come to an end, she looks back on the last eight years with pride.

“Sometimes you do feel like you’re hitting your head against a brick wall because there’s so much gender inequity, there’s so much domination of nursing, women as second class citizens, midwives as second class professionals. These things are alive in many, many countries.

“But in the last few years, there seems to be more of a recognition, partly due to the ICM leadership, of the importance of midwifery and its impact on preventable maternal and newborn mortality and morbidity, and improving the services and satisfaction of women,” says Sally.

The ICM team are members of the WHO’s midwifery models of care working group, whose purpose is to encourage ministers of health around the world to change their maternity services and use midwives more effectively.

Last year, the working group developed a global position paper, Transitioning to midwifery models of care, which provides guidance to countries looking to do just that.

It describes midwifery models of care where the main care providers for women and newborns are educated, licensed and regulated midwives who practise autonomously. They use an approach that is person-centred, values the relationship between woman and midwife, optimises physiological, biological, psychological, social and cultural processes and uses interventions only when indicated.

This work is ongoing but Sally can see the thread back to her history here in New Zealand and to other countries that have demonstrated that midwives provide a different quality of care.

“There’s a lot of political will in countries at the moment to make changes, which is really fantastic,” says Sally.

“For example, the Egyptian government recently invited ICM to help with a

re-establishment of a whole midwifery profession. They want to revitalise and bring back a professional midwife because they believe that will improve their maternity services.”

When Sally returns to New Zealand, she’ll continue working as a consultant for ICM but apart from that she’s looking forward to spending time with her friends and family.

“We have a new granddaughter who will be just on a year when we come back... just being able to be with friends again, take a little bit more time in my life.

“But a lot of it is unknown, what will I get into? Because I can’t imagine just sitting around,” says Sally with a laugh.

Welcome home Sally and thank you for all you have done for midwifery globally and at home. We look forward to seeing what the future holds. Square

WHAT IS INTERNATIONAL CONFEDERATION OF MIDWIVES (ICM)?

Established over 100 years ago, the International Confederation of Midwives (ICM) is a global organisation, representing over 130 midwifery associations from around the world. ICM’s vision is a world where every childbearing woman has access to a midwife’s care for herself; its mission is to strengthen midwifery associations and advance the profession globally.

HOW DOES IT SUPPORT MIDWIVES?

ICM works with its member associations and key partners (including organisations such as the World Health Organization) to grow, strengthen and promote the midwifery model of care. It works to embed midwife-led care into health systems, inspire leadership and improve midwifery education, ultimately leading to better sexual reproductive maternal and newborn health outcomes.

WHAT ARE SOME OF ITS KEY RESOURCES?

ICM provides midwives, midwifery associations, regulators and governments around the world with the tools they need to strengthen and develop the profession in their own setting. Its resources include definition and scope of practice of a midwife, essential competencies for midwifery practice, global standards for midwifery education and regulation, professional framework and many guidelines and implementation resources, all of which are freely available on its website internationalmidwives.org.

ANTENATAL IMMUNISATION

GROWING THE MIDWIFERY ROLE

In early 2023, three whānau grieved the loss of their babies to pertussis, a vaccine-preventable disease also known as whooping cough. This was despite relatively low levels of the disease in the community at the time, and no evidence of any unusual strains of the bacterium that causes pertussis infection.

Pertussis is always circulating in the community, but waves of increased cases occur in cycles every few years. Concern had been rising, since the Covid-19 pandemic eased, that a pertussis epidemic was on the way; low antenatal and infant immunisation coverage further raised concerns that young infants would be at higher risk of severe disease. Antenatal TDaP (tetanus, diphtheria and pertussis) immunisation, introduced in 2013, provides babies born to immunised mothers with significant protection against pertussis infection and death during the first six weeks, before they can receive their infant immunisations. Pertussis cases began increasing in 2024, and the expected epidemic was announced in November. Sadly, a baby died from whooping cough over the recent Christmas period. Antenatal pertussis immunisation is extremely important for all pregnant women and people this year.

In addition, pregnant women are at greater risk of influenza-related complications than non-pregnant women of reproductive age (Prasad et al., 2019; Marshall et al., 2016). In a population study covering 16 years of births, Aotearoa researchers found that women who had a hospital admission with influenza had a greater risk of preterm birth and low birthweight. Across the whole pregnant population, antenatal influenza vaccination was associated with a reduced risk of preterm birth, low birthweight and stillbirth compared with unimmunised women (Duque et al., 2023). Introduced in 2010 following the H1N1 (swine flu) pandemic, antenatal influenza vaccination offers protection for both pregnant women and babies, and is recommended by the World Health Organization.

Antenatal immunisation rates are too low and are inequitable (Figures 1 and 2). The College has

therefore engaged in sustained advocacy for the government to prioritise antenatal immunisation for pertussis and influenza. With a representative on the National Immunisation Taskforce, the College identified a lack of national governance and systematic approach to prioritising antenatal immunisation. We recommended that a National Immunisation Technical Advisory Group (NITAG) and a national antenatal immunisation working group be established to take a strategic focus on increasing immunisation coverage in pregnancy. The College has also advocated for maternity facilities (particularly rural) to be enabled for vaccine provision, including cold chain maintenance; the establishment of a funding mechanism for midwives who self-identify as having capacity and capability to be able to offer antenatal immunisations; and access to the Aotearoa Immunisation Register (AIR), including both active (for vaccinating midwives) and view-only access. Positive and ongoing working relationships have been established with Health NZ I Te Whatu Ora National Public Health Service, the National Immunisation Programme team, the Immunisation Advisory Centre and regional public health leaders.

Progress is now being made on these initiatives, which will enable more midwives to be funded to meet the needs of their communities (see Funding and development on next page).

TAKING VACCINATION TO THE COMMUNITY

Auckland-based research, led by midwife Ady Priday (2023), made the point that, “Given intersections of inequity, there is a strong social justice argument for the development of strategies which seek to actively facilitate equitable access to antenatal vaccines.”

CLAIRE MACDONALD MIDWIFERY ADVISOR

The researchers identified the need to take “vaccination to the community”, rather than requiring women to go “to the vaccine” and found that “Participants appreciated the convenience and familiarity of being vaccinated in localities and centres with which they were familiar and that they frequented for other reasons.” Vaccination provision by midwives or co-located with midwives is therefore an equity adjuster.

There are some excellent models already underway to learn from and scale up, as many midwives around the motu have recognised the need in their communities

FUNDING AND DEVELOPMENT

• Funding has recently been budgeted for by government to increase antenatal immunisation coverage.

• An expert working group has been established to inform the work programme, including College representation.

• The resourcing is expected to include a funding mechanism for LMC midwives and supporting primary maternity units to be key facilities in antenatal immunisation service provision.

• Primary maternity units in regions that have the lowest rates of antenatal immunisation uptake will be prioritised.

and have been proactive in their efforts to establish accessible and acceptable antenatal immunisation services, despite the barriers they encountered.

MIDWIFERY PROVISION OF ANTENATAL IMMUNISATIONS

The Midwifery Resource Centre (MRC) in Ōtautahi Christchurch is a hub with two LMC midwife antenatal clinic rooms and a drop-in service where women can access free pregnancy tests and help with finding a midwife. Recognising their capacity to further serve the community, the MRC team has worked hard to establish an antenatal immunisation service, and has recently added anti-D prophylaxis to its offerings. Antenatal immunisations are available from midwives who are directly contracted by the MRC, and also from the LMC midwives who hold clinics there and have opted into to providing immunisations. The MRC worked through several requirements (see Table 1), including negotiating for funding from Te Whatu Ora region, to break ground as the first community midwifery immunisation service in the area.

CO-LOCATED ANTENATAL IMMUNISATION SERVICE

The importance of antenatal immunisation availability at the time of women’s other appointments is clearly highlighted by Linda Burke from Niu Life Midwives, a Pasifika practice in Tāmaki Makaurau. In 2022,

Linda and the team added immunisation to the other co-located, wraparound services their practice offers. Counties Manukau provided unspent funds from the Covid-19 response and a vaccinator for four full days a week to provide antenatal and infant immunisations. The midwives discuss maternal immunisation with all whānau during antenatal appointments, and vaccinations can be accessed alongside midwifery care. Niu Life Midwives is a busy practice providing multiple additional services, so do not have the capacity to vaccinate themselves. They recognise that whānau are also busy and simply do not have time to add another appointment for immunisation at a different time and place. Furthermore, as Linda explains, women's trusting relationship with their midwives and the vaccinator increases the likelihood of vaccine uptake – an approach backed up by Aotearoa research (Young et al., 2023). The easy access to vaccination and the whānau-friendly atmosphere at the practice contributed to Niu Life having the highest maternal immunisation rates in the country under this contract. Women report that they prefer being immunised in the midwifery practice than going to a pharmacy where they don’t know the clinician and often have to be in a small side room without enough space for their other tamariki.

When the Covid funding ended in June 2024, the immunisation service at Niu Life was reduced to two days a week with shorter hours, so women who have their antenatal visits when the service is not running have to return on another day. This has resulted in a decrease in immunisation numbers, which further illustrates the importance of being able to access immunisation as a one-stopservice alongside midwifery care.

FACILITY-BASED CORE MIDWIFERY ANTENATAL IMMUNISATION SERVICES

Several maternity facilities and employed community teams are providing antenatal immunisation services, including Papakura Birthing Unit, Te Nīkau Hospital in Greymouth, Nelson community midwives and (imminently) Motueka birthing unit. Some facilities offer drop-in or by-referral immunisation services. Women often access these services when they have their midwifery antenatal appointment on site, or when they have their anatomy scan (the radiology department in Greymouth is on the same campus).

FIGURE

TABLE 1. REQUIREMENTS TO BECOME AN ANTENATAL IMMUNISATION SERVICE

Requirement Actions for midwives who wish to offer immunisation

Generating health system support

Education

Access to Aotearoa Immunisation Register (AIR)

Midwifery practices who wish to establish vaccination capability on their premises are encouraged to engage with regional College and district midwifery leadership. Infrastructural support is best approached at a regional level so it can be applied across multiple community midwifery sites and services.

Midwives are authorised prescribers under their scope of practice, including for vaccines and do not need to be credentialled separately as vaccinators. Midwives are encouraged to access education on immunisation to refresh their knowledge, specifically on vaccine pharmacology, and to understand the cold chain system. IMAC’s e-learning course titled Maternal immunisation essentials for midwives is fully funded for midwives to access, and provides 4–5 hours of elective education.

Midwives have been enabled to onboard to AIR, both for active use as vaccinators and for view-only access (this can help in conversations about immunisations if women are not sure which vaccinations they have had).

See www.tewhatuora.govt.nz

Cold chain Contact the local or regional immunisation for provision of onsite training and support. A vaccine fridge is required and clinicians are responsible for their part in cold chain maintenance (e.g. regular fridge temperature recording).

Ability to order vaccine stock Regional immunisation co-ordinators can support midwifery services to set up accounts for ordering TDaP and influenza vaccines.

Resuscitation equipment and supplies

Funding for vaccine administration

Standard midwifery adult resuscitation equipment is required at the immunisation service, along with adrenaline.

A national funding mechanism for LMC midwives is in development. The College will keep members updated on progress.

In conclusion, while some midwives will be well-placed, willing and able to offer antenatal immunisations themselves, this is not feasible or expected of all midwives. It is important, however, that all midwives share high quality, nationally consistent information with all whānau, who can only make a decision about antenatal immunisation if they know it exists. As midwives, we all have a role to play in this.

KEY MESSAGES:

• Midwives who wish to provide antenatal immunisation services will be enabled to do so if feasible

• Immunisation protection for pēpi starts during pregnancy

• All midwives have a responsibility to discuss antenatal immunisation with wāhine hapū and whānau:

- Whooping cough and influenza are serious infections

- Antenatal immunisation is safe and recommended and offers effective protection for newborns and women

- How maternal immunisation works to protect babies

- Vaccines are free-of-charge

- Where to get immunised – midwives, pharmacies, GPs

• TDaP vaccination during pregnancy is safe and a recommendation from a health care professional is an important part of whānau decision making.

• On-time infant immunisation is crucial at 6 weeks, 3 months, 5 months and onwards as per the National Immunisation Schedule. Square

FIGURE 2. MAP OF TDaP PREGNANCY COVERAGE (DISTRICT LEVEL DATA) FOR INDIVIDUALS WHO GAVE BIRTH BETWEEN JULY AND SEPTEMBER 2024

VAPING IS PERCEIVED AS SAFER, BUT IS IT?

TE PAEA MIDWIFERY ADVISOR

Vaping has taken the world by storm over the last decade. By 2017 it became a $10 billion industry (McCubbin et al., 2017). It has been reported that, “in the USA 25% of 8-yearolds are now vaping daily” (Mitchell, 2024). In Aotearoa daily vaping among adults has increased from 3.5% in 2019/20 to 11.1% in 2023/24 (Figure 1).

This represents an estimated 480,000 people vaping daily (Nip et al., 2024). The decline in cigarette smoking prevalence over the same period could suggest some people who smoked now use vapes as a substitute nicotine product. But, whilst it may reduce harm for those on a smoking cessation pathway, research is emphasising it is not harmless – especially in pregnancy as vaping is associated with adverse birth outcomes.

In Aotearoa health inequities are of grave concern and vaping is another example of inequity. Vaping is more prevalent among 18–24 year olds, Māori and Pacific peoples (Figure 2), and people living in more deprived neighbourhoods.

Vaping refers to the use of an electronic device (also known as an e-cigarette) that heats a liquid turning it into an aerosol (vapour) which the user inhales. The contents commonly include nicotine, propylene glycol, vegetable glycerol, nickel, lead and flavouring (Ministry of Health, 2023).

Although vaping is now regulated (Health NZ, 2024), a New Zealand study in 2022 found that harmful products are not always disclosed on the packaging but were evident when analysed. Furthermore, higher levels of nicotine were discovered than what was stated on the packaging (Unu, 2022). It is understood the “amount of nicotine in e-cigarettes has nearly tripled since they first hit the market, a single pod from one vape manufacturer contains 0.7mls of nicotine which is about the same as 20 regular cigarettes” (Mitchell, 2024). It is not surprising that vapes are highly addictive.

Nicotine is known to have a negative effect on the function of the placenta and smoking is a major concern in Sudden Unexpected Death Infant (SUDI) prevention (Mitchell, 2024). Similarly, a study by Regan et al. (2021)

found daily e-cigarette use during pregnancy increases the prevalence of low birthweight: 10.6% for users versus 6.1% for non-users. In addition, preterm birth prevalence increased from 7.6% for non-users to 12.4%. for users. These findings were supported by a large very recent systematic review that found vaping to be associated with low birth weight, preterm birth and small for gestational age; it also reported 53% higher odds of decreased breastfeeding (Deprato et al., 2025).

The list of risks continues, with Mescolo, Ferrante and La Grutta (2021) stating there is evidence that using e-cigarettes can cause both short- and long-term respiratory problems in the paediatric population. A retrospective cohort study using the United States national longitudinal data from 20132018 has also (shockingly) correlated a higher risk of infant death with the usage of mint/ menthol flavouring.

Although there is a plethora of research emerging on the effects of vaping in pregnancy, there is little about the effects on breastfeeding. Health NZ recommends vaping and other nicotine replacement therapy as part of a smoking cessation pathway for pregnant women but strongly discourages any nonsmoker starting in pregnancy. The message is clear; vaping is less harmful than smoking but it is not harmless (Health NZ, 2022).

Midwifery messaging should be congruent with this. The best thing women can do for their and their baby’s health is to quit smoking. It can be difficult to quit smoking but there are different tools and services that can help. These include many pregnancyspecific smoking cessation services around the motu, as well as the national Quitline service ph. 0800 778 778, and the use of nicotine replacement therapy (NRT). Although our focus has been on smokefree pregnancies, and vaping has been used as a safer alternative, it is not without risks which women and whānau need to be informed about.

FIGURE 1. TRENDS IN VAPING AMONG NEW ZEALAND ADULTS (≥15 YEARS OLD)

USEFUL LINKS

Health NZ | Te Whatu Ora (2024) vaping information: healthpromotion.govt.nz/mentalhealth/alcohol-and-drug-addiction/vaping

Protect your breath – about young people and vaping: protectyourbreath.co.nz

The rise and rise of specialist vape stores: Time for the Government to act: phcc.org.nz/ briefing/rise-and-rise-specialist-vape-storestime-government-act

Asthma and Respiratory Foundation NZ: asthmafoundation.org.nz/your-health/ecigarettes-and-vaping/vaping-some-more-facts

Te Whatu Ora Health Promotion posted a video in 2024 on NRT therapy in pregnancy: youtube.com/watch?v=CFcHi9mZFH0. Square

References available on request.

FIGURE 2. TRENDS IN DAILY VAPING BY ETHINICITY IN NEW ZEALAND ADULTS (≥15 YEARS OLD)

‘IT CAME WITHOUT WARNING’

VANUATU MIDWIVES’ TIRELESS EFFORTS FOLLOWING MAJOR EARTHQUAKE

ZAHRA SHAHTAHMASEBI JOURNALIST

When the magnitude 7.3 earthquake struck Vanuatu in December, Harriet Obed was at the ANZ bank in Port Vila. She ran outside along with everyone else to stand on the road amongst the capital city’s tall buildings, until someone shouted “move to higher ground”, and the crowd made for a nearby hill.

Harriet is a midwife, president of the Vanuatu Midwifery Society and acting national coordinator for Vanuatu’s Reproductive, Maternal, Neonatal, Child and Adolescent Health (RMNCAH) programme. She says the earthquake came without warning and was a very different experience from cyclones, for which there are warnings and people can prepare.

The earthquake destruction has had a major impact on Harriet and her midwifery colleagues, who work across the hospital and community settings. Her colleagues are “trying to fix their homes and be at work because their family depends on them too,” she says.

While a lot of pregnant women were due to give birth, fortunately none of them were injured or experienced pregnancy complications as a result of the earthquake, says Harriet.

However, Port Vila Central Hospital’s neonatal care unit was impacted by the four-day power cut and also when part of the ceiling fell off and hit an incubator. Harriet is unsure whether the baby survived.

The Vanuatu Midwifery Society, made up of volunteers, tried to stay in touch post-earthquake, but communication lines were down for nearly two weeks and damage to roads and bridges meant they couldn’t travel to meet each other either.

Harriet describes how most maternal and child services were decentralised immediately without much information or instruction, which left many confused and scared. Although this model of care is a goal that Vanuatu had been working towards, she says health clinics in the suburbs were unable to be upgraded before the earthquake hit.

“We were not prepared, we did not upgrade the facilities to be ready to receive women and so everyone comes running to the main hospital. You can just imagine the workload with only two midwives per shift.”

The two midwives rostered at the hospital look after admission, labour, birth and postnatal, as well as caring for patients pre- and postcaesarean section; Meanwhile, midwives in the community provide maternity and child health services, general outpatient care and are on call 24/7.

In the aftermath of the earthquake, midwifery shifts at Vila Central Hospital were extended to 12 hours to cope with demand, but this quickly became too much and they soon returned to eight hours.

Harriet says the Vanuatu Midwifery Society made a request for support to the Ministry of Health, which was able to obtain the valuable services of four Fijian midwives, sponsored by the United Nations Population Fund.

While Harriet speaks to the passion she and her midwifery colleagues have for their work, she also notes the challenges that they face on a daily basis, including

Members of the Vanuatu Midwives Society outside the Women’s Health Clinic at Vila Central Hospital, Port Vila.

staff and resource shortages, which have worsened post-earthquake. Despite these difficult circumstances however, Vanuatu midwives continue with their tireless efforts.

Harriet highlights her gratitude for the New Zealand College of Midwives for taking note of Vanuatu’s plight.

“We are so honoured and grateful for the opportunity that we can be heard somewhere,” she says.

FACTS

• The Vanuatu archipelago can receive two to three cyclones a year. Earthquakes are not entirely unknown in the region but have very rarely caused death.

• The major earthquake on December 17 resulted in at least 18 deaths, 265 people injured, 85,000 people affected and nearly 1,500 displaced from their homes.

• Buildings and roads have been damaged significantly by the earthquake and the resulting landslides; water supply has been affected and supermarkets closed.

• Aftershocks have been occurring regularly, up to magnitude 6.3. Square

EMERGENCY DISASTER RELIEF FUND –SUPPORTING MIDWIVES FOLLOWING NATURAL DISASTERS

In 2023, the College established an Emergency Disaster Relief Fund (EDRF) as a means to support midwives who were significantly affected by the severe weather events in New Zealand in January 2023. Donations from College regions and individual members into this fund enabled support to be provided to a number of midwife members who had suffered significant loss to property and livelihoods as a result of these events.

Following the recent earthquake in Vanuatu, the College has been in contact with the Vanuatu Midwifery Society and understands that midwives there have been suffering with disruption to communications and damage to homes, property and hospital facilities.

We know from our experience here in Aotearoa that recovery from significant natural disasters is a long and slow process, which can take years or even decades. The impacts are far reaching and they are felt in our homes, our families, our communities and, as midwives, in our professional lives.

The Vanuatu Midwifery Society is a fledgling association, which is working hard to strengthen midwifery in Vanuatu. The College is opening its EDRF to enable New Zealand midwives to make donations which we will provide to the Vanuatu Midwifery Society so midwives there can experience support from the international midwifery community at a time of stress and crisis. Every bit counts.

Donations can be made to: The New Zealand College of Midwives 12-3191-0008921-53 please ensure that donations are coded (i.e. Vanuatu)

APPLY NOW TO BECOME A CALMBIRTH® EDUCATOR IN AOTEAROA NEW ZEALAND; calmbirth.nz

Changing Birth Culture

One Birth At A Time

Changing Birth Culture

One Birth At A Time

Dates for the training are on consecutive Thursday’s 18th September, 25th September, 2nd October, 9th October & concluding on the 16th Oct 2025

Photo by Angela Scott Photography

WOVEN INTENTIONS

HAYLEY MCMURTRIE COMMUNICATIONS MANAGER

Ka whānau mai te pēpi, ka takaia ki te harakeke. Ka noho te harakeke, hei kākahu, hei rongoā, hei mea tākaro, hei oranga mōna, a mate noa ia. | When a child is born, the child will be wrapped in the muka of the flax plant. The flax shall provide a means for living, for flourishing, for health and wellbeing throughout their life journey.

Te ao Māori places significant emphasis on the relationships between people and nature, offering a holistic perspective with focus on interconnectedness, and rooted in tikanga (customary values), lore, and mātauranga (knowledge). Practices, values, and principles derived from te ao Māori unite ancestors and communities, fostering deep connections with whenua (land) and taiao (environment). The wahakura (woven harakeke bassinet) is a powerful representation of the whakapapa (ancestry) and tikanga (customs) of te ao Māori.

Across Aotearoa, whānau are coming together at wahakura wānanga (workshops) to connect, learn and create. These wānanga, where hapū māmā and their whānau gather, have a profound impact.

Though introduced relatively recently, primarily as a safe shared sleeping space for pēpi in their parents' beds, the wahakura has been widely adopted and can contribute to a reduction of Sudden Unexpected Death in Infancy (SUDI). For Māori, however, the process of creating a wahakura holds deep cultural and spiritual significance, reflecting tikanga and strengthening whānau bonds.

Across Aotearoa, whānau are coming together at wahakura wānanga (workshops) to connect, learn and create. These wānanga, where hapū māmā and their whānau gather, have a profound impact. They embody the Māori principle of bringing together ancestral knowledge, connection, and whānau, creating something beautiful that not only keeps newborns safe but also nurtures and nourishes them, fostering a cycle of wellbeing that transcends generations.

Hayley McMurtrie speaks with some of the kaikaranga, (weavers) holding these wānanga about the process of creating the wahakura and the nourishment it brings to the entire whānau, forming a safe sleeping environment while also creating a connected, extended family unit where pēpi can thrive.

Jenny Firman, a skilled kaikaranga, describes

the process of making a wahakura as a pathway to wellbeing. “Most people think they are just coming to weave a wahakura, but when they leave after the weekend, they have produced a beautiful moenga (sleeping place) and what they have taken away with them is so much more.”

Whaea Jenny adds that “through the wānanga there are many lessons, many layers. On day one we get the weavers and the health professionals together (midwives, child health practitioners, anyone who is connected to the wellbeing of our babies and whānau). We introduce them to the harakeke bush, how to cut, where to cut and some of the tikanga that will apply to them for the day. We get them to reflect on their work practices, their own bias, an opportunity to think about best practices, we look at our purpose and our intentions. It makes us stop and think and gives us permission to reset.”

“Then the whānau come in, each whānau has an experienced weaver and a health professional that we try and fit with the whānau needs. The whānau can be anyone who is connected to that baby, usually the hapū māmā and she drags along the pāpā,” Jenny laughs, “often there are grandparents and aunties and uncles too.”

“We talk about intentions, what is your intention as a māmā, as a pāpā, as an uncle, as a nanny. Sometimes the intention from the māmā and the pāpā is to change something from their childhood. ‘I want to be a better father’ and I will say – that’s awesome, what does that mean for you? 72 times they are thinking about this, with each piece of harakeke. This can often be a healing process for those new parents as they consider their own upbringing and what they would like to do differently.”

“It makes the parents think about their partnership, what does that look like? If they are on the same page this can only benefit the pēpi.”

Jenny talks passionately about the way pāpā go from being closed and not necessarily wanting to be here to ‘get out of the way, I’m doing this’. She says, “We talk about the male’s role, what he can do to support the hapū māmā. How does she like to be miri miri – pampered”.

“At each stage we reflect. The process is empowering, one of the questions we ask is ‘how do you want to be communicated with?’. We have women realising that maybe they don’t like the way their tāne is talking, they have permission to decide what is working for them.”

Through the creation of their own wahakura, participants gain a deeper understanding of their role as a parent and as a partner, which strengthens all of the relationships that support the hapū māmā and ultimately the pēpi. “They all learn to weave and they all learn how to safely sleep their mokopuna, the additional intrinsic messages woven into the wahakura is the icing on the top.”

Shelley Bell, a kairaranga living in Tāmaki Makaurau, reflects on the process for many whānau who have attended her wānanga. “The wahakura strengthens bonds and allows us to practice te ao Māori. As we weave we are linking and binding whakapapa, whānau and whenua and it links us to our atua, our higher being”.

Shelley creates many wahakura herself, and these are presented to māmā Māori at Middlemore Hospital and primary maternity facilities in Counties Manukau.

“Whilst it is important that these māmā have access to the wahakura, it is not the same as parents creating their own. Through the creation they learn about safe sleep practices, the benefits of being smoke free and about nutrition, but the most beautiful

part of the journey is when they gain a deeper understanding of what it is to be Māori and the strength they take from that. Especially the pāpā, they take away a deeper sense of responsibility for the pēpi.”

Describing the time when māmā from both the hapū māmā side and the pāpā side come together, Shelley says, “It’s the connection that creates the really special moments, that’s when the magic happens. Sometimes they’ve never met before. It starts a really special relationship, which we call whanaungatanga, creating a wider protective unit for our tamariki.”

Keita and Lamon share their enthusiasm for attending a wahakura wānanga prior to having their third pēpi: “It was way better than I imagined, I just thought I was there to make a wahakura but it was so much more, it’s not just about the weaving it’s the korero, the guidance that comes with it,” says Keita.

Lamon adds, “For me it was the opportunity to sit and think about your

intentions as parents, about what you want for your baby. The space that is provided for you to do that is a beautiful thing. We are third time parents and we learned so much.”

Keita and Lamon were gifted a wahakura for their first baby and, whilst they received the safe sleep messaging along with the moenga, they both agree that the wānanga provided the opportunity to instil mauri –life force and energies – into every strand. “Every strand held our intentions”.

The creation embodies the essence of te ao Māori - strengthening relationships, nurturing wellbeing and weaving ancestral knowledge into everyday practices.

The challenge is quantifying the investment and, much like parenting, the benefits of this investment will unfold over years and generations, leaving a legacy of connection and care. Square

With thanks to Hāpai te Hauora | Māori Public Health

MOTHER AND BABY UNITS IN PRISONS

The Corrections (Mothers with Babies) Amendment Act 2008 made it possible for mothers who meet certain criteria to keep their babies with them in prison until the child is two years old (NZ Government, 2008). This is to provide for the best interests of the child by enabling bonding, feeding and maintaining continuity of care. Legislation requires prisons to have facilities that provide a healthy and supportive environment for the child.

Mothers with Babies Units (MBUs) opened in New Zealand women’s prisons in 2011. Day units, described as “feeding and bonding” facilities, also became available to enable babies and children under 24 months of age, who are being cared for in the community, to visit their mothers (Department of Corrections, undated A). MBUs were developed to enable the mother-baby relationship to develop, to facilitate responsible parenting, to provide for infant health and to provide intervention in breaking the cycle of intergenerational abuse and incarceration (Carlson, 1998).

The chance to develop an early close relationship between a mother and newborn baby sets the stage for bonding and attachment, breastfeeding, health benefits for the baby and the mother, and a more secure involvement of the mother in parenting. There is also research which indicates a reduction in reoffending when

mothers keep their babies with them in prison (Blanchard et al., 2018; Carlson, 2018; Tuxhorne, 2021; Walker et al., 2021). This supports a key principle of our prison system – reintegration, which means that prisoners are prepared for release into the community and helped to reduce the likelihood of reoffending (Office of the Inspectorate, 2023).

PREGNANT WOMEN AND MOTHERS IN PRISON

Aotearoa has three women’s prisons, the Auckland Region Women's Corrections Facility, Arohata Women's Prison in Wellington and Christchurch Women's Prison. All have MBUs, although the unit in Wellington was unused from 2014 to 2022 (Hatton, 2022).

Pregnant women in prison should have access to midwifery continuity of care but finding a midwife is difficult due to restricted internet access. If a pregnant woman has

already booked with a midwife prior to incarceration, ideally, she should be able to continue to receive care from this midwife, although in some circumstances this is not possible. The Auckland region corrections system works well and the article in this issue of Midwife Aotearoa (p.24) about midwife Kelly McConville provides more detail about this initiative. Understanding women’s prisons, the Corrections system and what pregnant women and mothers face when incarcerated is essential to care and advocacy provision. The Mothers Project, a New Zealand initiative of independent volunteer female lawyers, was set up to help imprisoned mothers connect with their children and they estimate that 85% of imprisoned women in Aotearoa are mothers. The number of incarcerated mothers who are separated from their young babies is unknown.

The Chief Inspector of Corrections, Janis Adair, commissioned a thematic inspection to review the operating environments of the MBUs. The aim was to focus on and strengthen efforts in managing pregnant women in prison, mothers with babies in prison, or mothers with children in the community (Office of the Inspectorate, 2023). The report described how mothers arriving in prison were not informed about the availability of MBUs or the feeding and bonding rooms, and that there was limited support for drug and alcohol issues. Other issues for consideration were reviewing options for transporting breastmilk from women in prison for their babies in the community, privacy for breastfeeding in prison if required, and access to maternity/ breastfeeding clothing.

BREASTFEEDING

AND BEING A MOTHER IN PRISON

“For a baby the environment is the mother”. Gallagher (1992) Because successful breastfeeding in any context requires regular removal of milk from the breasts (preferably via breastfeeding), barriers remain for breastfeeding mothers within the prison environment.

CAROL BARTLE POLICY ANALYST

The effective expression of breastmilk may assist in maintaining lactation for some women but breastfeeding is optimal for both breastfeeding exclusivity and duration, and for mother-baby bonding/attachment. The logistical constraints of correctional settings can make both breastfeeding and breastmilk expression challenging – the key barrier being any mother-baby separation. There is a significant difference between lactation and breastfeeding, and the effective expression of breastmilk requires:

• regular access to an effective breast pump or skilled regular hand expression

• hygienic conditions

• adequate and appropriate storage containers

• facilities for storage and freezing

• reliable safe transportation of expressed breastmilk into the community

The Office of the Children’s Commission report on Arohata Prison in Wellington contained narratives from women who described being hungry while pregnant or breastfeeding and not receiving extra food when they requested this (Hatton, 2022). Women also reported being restrained with handcuffs, some while in hospital prior to the birth of their babies, and again after the birth. Breastfeeding needs to get off to a good start after birth with uninterrupted motherbaby skin to skin contact, and handcuffs interfere with contact and breastfeeding initiation. Although Corrections reported

in 2022 that there is now a policy stating that mothers over 30 weeks, giving birth or immediately post-birth are not to be handcuffed, handcuffs at any time while breastfeeding and while mothers are getting to know their babies is inappropriate. Continuing the advocacy to improve care for

pregnant women and mothers with babies in prison is an ongoing project in many countries, including New Zealand.

Women in prison have described the personal significance of breastfeeding. Narratives in one study referred to the importance of bonding, optimal feeding choice and part of achieving a new start through motherhood (Huang et al., 2012). Conflicts described included fears of separation, concerns about a potential lack of support and how a poor health status could prevent breastfeeding. This included beliefs that breastmilk could be tainted, worries about unhealthy diets and feelings of guilt about previous substance abuse and smoking. Most issues described by women were not evidence-based contraindications to breastfeeding, which highlights the importance of providing accurate information in pregnancy.

BFHI RECOMMENDATIONS

All women using maternity facilities in Aotearoa are entitled to receive the same standard of healthcare regardless of their legal status. The Ten Steps to Successful

Breastfeeding (BFHI) assert that all mothers should be offered uninterrupted skin-to-skin contact with their babies after birth for a period of at least one hour and assisted as necessary with the first breastfeed. Individual breastfeeding assessment and care may include advocacy for the creation of some private time for a mother and baby without prison officers in the room, if this is acceptable to the custodial agency and if there are no security issues or other adverse circumstances.

Support for breastfeeding should be available 24/7. This includes the management of common early difficulties with lactation or breastfeeding, and information about how the use of bottles, teats and pacifiers can interfere with the establishment of milk supply and breastfeeding. Helping women with the key skills of recognising infant cues for feeding, and how to handexpress breastmilk are also part of clinical practice. Information about the expression of breastmilk needs to be tailored to the individual needs of the mother and dependent on her situation. This may include

managing overfull breasts using hand expression if mother and baby are staying together, or the maintenance of lactation if mother and baby will be separated after discharge from the maternity facility. Discussion about what mechanisms will be available to support the transport of expressed breastmilk to babies in the community may be needed. Breast-care advice and possibly information about suppression of lactation may be necessary in some situations. In terms of support for breastfeeding after a mother and baby are discharged to a prison MBU, LMC postnatal care will continue for up to six weeks as usually expected.

WHY LACTATION OR BREASTFEED MIGHT NOT BE INITIATED

Women’s decisions about infant feeding should be respected, and coercion in terms of MBU eligibility is inappropriate. There may be situations when a woman returning to prison may not plan to breastfeed. Women who are going to be separated from their babies may feel there is no point in even establishing lactation. Fears of breastfeeding creating a further baby bond when separation is inevitable was described by one woman as causing greater pain (Abbot & Scott, 2017). Barriers to breastfeeding include geographical difficulties, often related to prison location and where the baby is being cared for (Rush, 2000). Unwillingness of caregivers to transport babies to visit their mothers has also been identified, along with inabilities to afford transport costs (Baldwin, 2022). Prisoners meeting visitors in meeting rooms may also have to wear overalls which makes breastfeeding impossible (Dept of Corrections, undated B). Some mothers may be reluctant for any contact with their babies or children due to unease about the baby being exposed to a space of punishment (which for some women feels inappropriate or shameful), or to the pain of separation when the baby or child has to leave. Mothers have described prison visits from their children as a source of both joy and pain, a mixed blessing and bittersweet (Baldwin, 2022).

CONCLUSION

Midwives are aware of the importance of breastfeeding, BFHI policies and the support breastfeeding women need. When a pregnant or postnatal woman is in prison there are barriers and challenges to overcome and specific individualised information will be needed about breastfeeding, maintaining lactation and the logistics of storing and transporting expressed breast milk when there is mother-baby separation. Pregnant women may need information about applying for compassionate release after childbirth. They may need support to make an application for a place in an MBU or an application for time in the feeding and bonding rooms. The UN Convention on the Rights of the Child is focused on the “best interests” of the child (UNCROC, 1989). As described by Gribble and Smith (2019) there are ways to support mothers and babies to stay together and to facilitate breastfeeding. If there are no options for home detention or compassionate release, mother and baby units are the next best option. Breaking the cycle of disadvantage can start with helping incarcerated mothers to provide care to their babies and to breastfeed if they plan to do so. Alternatives to prison wherever possible for pregnant women and mothers deserves more consideration in the best interests of the child – and the mother. Square

References available on request.

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TAKU WĀHI MAHI MY MIDWIFERY PLACE

Rosemary (Rosie) Sharman is the Clinical Midwife Manager at Bay of Islands Hospital Maternity Unit in Northland. Her love of the region and the integrated team she leads shines through, as she shares what she’s most proud of.

After training in Queenstown, Rosie relocated to Auckland to complete her new graduate year at Middlemore Hospital but found herself spending most weekends diving and spearfishing in Northland. She decided to move to the fisherwoman’s paradise permanently in 2020, settling on Bay of Islands Hospital Maternity Unit after first working across the region’s maternity facilities to gain an overview.

As clinical midwife manager of the primary unit since 2022, she describes the integration between the LMC workforce and facility team as one of the unit’s greatest strengths.

“Everyone here is invested and that pre-dates me being in this role. It was one of the things that made me want to work here in the first place; it feels different here, there’s no ‘this is my job and that’s your job’ type of thinking – we are here for the community,” she explains.

“The mutual respect between core staff and LMCs is really apparent,” she continues, “possibly because most midwives here have worked both roles, so there’s a solid understanding of how we can best work together. The truth is, we can’t function without each other. It’s fundamental to keeping whānau at the centre of care.”

Extending a helpful hand also goes a long way, as Rosie illustrates. “An LMC might ring us, needing to send a woman in for assessment, but they might be an hour’s drive away.

Wherever possible, we’ll do that assessment because we know LMCs are best placed serving our community, in the community. The support goes both ways; when LMCs are on site they jump in and help if needed, which is crucial in emergency situations.”

Intentionally employing local midwifery students as maternity care assistants (MCAs) in the unit further strengthens the team, bringing the future firmly into the present. “Making students feel as though they’re part of who we are from the beginning is hugely beneficial and it’s growing our local Māori workforce, which is essential.”

Jojo Wehi (Ngatitetarawa, Ngāti Hine), currently a 3rd year midwifery student, is an MCA and loves it. “It feels like a true whānau,” she says. “The team is incredibly supportive, tightknit, and genuinely cares, making you feel valued from the moment you walk in. It’s a place that ignites my passion for midwifery and gives me a deep sense of belonging, deeply rooted in Māori values of whanaungatanga, manaakitanga and aroha.”

As a tauiwi midwife working in a region with a high Māori population, Rosie pays homage to her tangata whenua colleagues and the vital role they play in the success of the unit. “We can’t acknowledge the strength and continuity of our services without acknowledging our local Māori midwifery collective, Te Kahu Wāhine, and in particular, the work Whaea Crete Cherrington and Joyce Croft are constantly doing to advocate for whānau-centred care.” Square

Rosie and team from Bay of Islands Hospital Maternity Unit.

AMELLIA KAPA REGISTERED MIDWIFE

New Zealand College of Midwives I Te Kāreti o Ngā Kaiwhakawhānau Ki Aotearoa Directory

National Office

PO Box 21–106, Christchurch 8140 Ph 03 377 2732

nzcom@nzcom.org.nz www.midwife.org.nz

Auckland Office auckadmin@nzcom.org.nz

College Membership Enquiries

Julie Williams membership@nzcom.org.nz 03 372 9738

Chief Executive

Alison Eddy

Co-Presidents

Beatrice Leatham bea.tangatawhenua.copres@nzcom.org.nz

Debbie Fisher debbieF.tangatatiriti.copres@nzcom.org.nz

National Board Advisors

Kuia: Crete Cherrington

Elder: Sue Bree

Education Advisor: Tania Fleming

Regional Chairpersons

Auckland Jacquelyn Paki, Tania Webb auckchair@nzcom.org.nz

Bay of Plenty/Tairāwhiti

Cara Kellet chairnzcomboptairawhiti@gmail.com

Canterbury West Coast

Becky Bangma chairnzcom.cantwest@gmail.com

Central

Laura McClenaghan centralchair@nzcom.org.nz

Nelson Marlborough

Emma Neal tetauihunzcom@gmail.com

Northland

Ange Yendell tetaitokerauchair@nzcom.org.nz

Otago

Jan Scherp, Ali Barkman otagochair@nzcom.org.nz

Southland

Janelle Carse

sthldnzcom@outlook.co.nz

Waikato Taranaki

Michele Lord chairwaikatonzcom@gmail.com

Wellington Suzi Hume nzcomwellington@gmail.com

Regional Sub-Committees

Hawke's Bay Sub-Committee

Linley Taylor midwife.linley@gmail.com

Horowhenua Sub-Committee

Laura McClenaghan midwife.laura@hotmail.co.nz

Manawatu Sub-Committee

Megan Hooper-Smith megan.scott@live.com

Emma LeLievre emma@LMCmidwife.com

Taranaki Sub-Committee Vacant nzcom.taranaki@gmail.com

Whanganui Sub-Committee

Laura Deane laura.deane@wdhb.org.nz

Consumer Representatives

Home Birth Aotearoa

Bobbie-Jane Cooke

bobbiejane.homebirth@gmail.com

Whānau Awhina Plunket

Zoe Tipa zoe.tipa@plunket.org.nz

Student Representatives

Paytra Buckrell paytra_browne@windowslive.com

Te Rina Apelu tee_apelu@hotmail.com

Ngā Māia Representatives www.ngamaiatrust.org

Jasmine Gray jasmineanamidwife@gmail.com

Te Anna Hema hemawhanua@gmail.com

Pasifika Midwives Representatives

Talei Jackson Ph 021 907 588 taleivejackson@gmail.com

Ngatepaeru Marsters Ph 021 0269 3460 lesngararo@hotmail.com

MERAS

PO Box 21–106, Christchurch 8140 Ph 03 372 9738 meras@meras.co.nz www.meras.co.nz

MMPO

PO Box 21–106, Christchurch 8140 Ph 03 377 2485 mmpo@mmpo.org.nz

Rural Recruitment & Retention Services 0800 Midwife/643 9433 rmrr@mmpo.org.nz

Resources for midwives and women

The College has a range of midwiferyrelated books, leaflets, merchandise and other resources available through our website: www.midwife.org.nz/shop

ADVERTISING POLICY AND DISCLAIMER: The New Zealand College of Midwives maintains a schedule of guidelines to exclude advertisements for products or services that are not aligned with its principles and ethics. Every effort is made to ensure that advertising in the magazine falls within those guidelines. Where advertising is accepted, this does not imply endorsement by the College of the product or service being promoted

Midwife Aotearoa New Zealand is published quarterly for the New Zealand College of Midwives. The articles and reports printed in this newsletter are the views of the authors and not necessarily those of the New Zealand College of Midwives, its publishers or printers. This publication is provided on the basis that New Zealand College of Midwives is not responsible for the results of any actions taken on the basis of information in these articles and reports, nor for any error or omission from these articles and reports and that the College is not hereby engaged in rendering advice or services. New Zealand College of Midwives expressly disclaims all and any liability and responsibility to any person in respect of anything and of the consequences of anything done, or omitted to be done, by any such a person in reliance, whether wholly or partially upon the whole or any part of the contents of this publication. The College acknowledges and respects diversity of identities through the language used in this publication. Te reo Māori is prioritised, in commitment to tāngata whenua and te Tiriti o Waitangi. To maintain narrative flow, the editorial style may use a variety of terms. Direct citation of others’ work maintains the original authors’ language, and contributing writers’ language preferences are respected. All advertising content is subject to the Advertising Standards Authority Codes of Practice and is the responsibility of the advertiser. Contents Copyright 2025 by New Zealand College of Midwives. All rights reserved. No article or advertisement may be reproduced without written permission. ISSN: 2703–4546.

Midwife Aotearoa New Zealand

IN A CORRECTIONS FACILITY

Welcome to Issue 116 of Midwife Aotearoa New Zealand

FROM THE CO-PRESIDENTS

A VISIONARY WOMAN AND LEADER

Newborn Metabolic Screening Programme update

screened for in newborn screening

YOUR COLLEGE

ACC births injuries online lodging

Updated consensus statements and format coming soon

Restructuring submissions

The Pae Ora (Healthy Futures) (3-Day Postnatal Stay) Amendment Bill

Call for nominations – Independent Finance Committee member

Whakatāne maternity service transition

FAREWELL LISA, WELCOME JULIE

BULLETIN

Bonding scheme on hold

College representatives meeting with midwives affected by the vaccine mandate

Carosika collaborative update

Practicalities of mentoring in Aotearoa

COLLEGE eLEARNING PROGRAMME

WHAT IS CYTOMEGALOVIRUS?

KEY MESSAGES

HOLLY TEAGLE, AUD UNIVERSITY OF AUCKLAND THE HEARING HOUSE

ANGELA DEKEN, RM NEWBORN HEARING SCREENING PROGRAMME COORDINATOR

SCREENING

HOW TO AVOID INFECTION WHILE PREGNANT

POSTNATAL ANALGESIA

POSTNATAL ANALGESIA

PELVIC FLOOR HEALTH AND ASSESSMENT

ACC MATERNAL BIRTH INJURY COVER

THE IMPACT FOLLOWING BIRTH

CULTURAL SAFETY

INEQUITIES TO ACCESSING SERVICES

SUPPORTING ONGOING PELVIC FLOOR HEALTH

KEY MESSAGES

KEY PRACTICE POINTS FOR MIDWIVES

MIDWIFERY-LED CARE IN A HOSPITAL SETTING

WHAT ARE THE OPPORTUNITIES FOR EMPLOYED MIDWIVES?

THE MERAS COLLECTIVE

IN CONCLUSION

TABLE 1: MIDWIFERY-LED SERVICES

PARENTS CENTRE TRUST CLOSING

TŪRANGA KAUPAPA EDUCATION PROGRAMME: WORTH THE WAIT

LIVE SESSIONS

CONVENIENT SCHEDULING

WE'RE HERE TO HELP

REGISTRATION PROCESS

UNIQUE BENEFITS:

INTERNATIONAL STUDENTS: A THREAD IN AOTEAROA'S CULTURAL FABRIC

WITH WOMEN IN A CORRECTIONS FACILITY

A HOMECOMING FOR MIDWIFERY’S ‘BIG VISIONARY’

DR SALLY PAIRMAN RETURNS TO AOTEAROA

WHAT IS INTERNATIONAL CONFEDERATION OF MIDWIVES (ICM)?

HOW DOES IT SUPPORT MIDWIVES?

WHAT ARE SOME OF ITS KEY RESOURCES?

ANTENATAL IMMUNISATION

GROWING THE MIDWIFERY ROLE

FUNDING AND DEVELOPMENT

MIDWIFERY PROVISION OF ANTENATAL IMMUNISATIONS

CO-LOCATED ANTENATAL IMMUNISATION SERVICE

FACILITY-BASED CORE MIDWIFERY ANTENATAL IMMUNISATION SERVICES

TABLE 1. REQUIREMENTS TO BECOME AN ANTENATAL IMMUNISATION SERVICE

VAPING IS PERCEIVED AS SAFER, BUT IS IT?

USEFUL LINKS

‘IT CAME WITHOUT WARNING’

VANUATU MIDWIVES’ TIRELESS EFFORTS FOLLOWING MAJOR EARTHQUAKE

FACTS

EMERGENCY DISASTER RELIEF FUND –SUPPORTING MIDWIVES FOLLOWING NATURAL DISASTERS

Changing Birth Culture

One Birth At A Time

Changing Birth Culture

One Birth At A Time

WOVEN INTENTIONS

MOTHER AND BABY UNITS IN PRISONS

PREGNANT WOMEN AND MOTHERS IN PRISON

AND BEING A MOTHER IN PRISON

CONCLUSION

TRUSTED • SAFE • UNIQUE

TAKU WĀHI MAHI MY MIDWIFERY PLACE