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55 Chapter 2 The New Zealand Maternity System A Midwifery Renaissance Chris Hendry INTRODUCTION New Zealand is a small country with a population of just over 4 million people. We live in relative geographic isolation on two main islands (with a combined land mass greater than the United Kingdom) in the Southern Pacific Ocean, three hours flight time from Australia, which is our nearest neighbor. As a nation, we see ourselves as fiercely independent, yet we have a critical dependence on the vagaries of international markets for income from the sale of our products, mainly consumables, manufacturing, and increasingly, tourism. Politically, we tend toward the center left and pride ourselves on our anti-nuclear stance and our affinity with nature and ecology . We have a long history of government-funded social services such as the provision of health care and education, including that of health professionals such as doctors and midwives. Over the years, these combined features have supported the development of many social and political innovations that have been viewed as revolutionary by other nations. Our maternity service is no exception. The main objective of this chapter is to present the development of the New Zealand model of maternity care, which has been predominantly midwifery led. This model of care has evolved over the past eighteen years and continues to evolve. Had it not been for initial legislation in 1990 enabling midwives to access government funding independently from the medical profession for the provision of maternity care, it is unlikely that such a model would have developed and been sustained. In the 1970s and 1980s, a group of consumers and activist midwives, dissatisfied with the increasing medicalization of maternity care, were the catalysts for change. Many of the midwives and a number of the consumers have remained active in 56 c. hendry political and professional leadership of women’s health and midwifery since that time. Midwifery in this country has continued to “push the boundaries” of women-centered maternity care, mainly, I believe, because of the homeand community-based nature of the services and because women have increasingly chosen midwives over medical practitioners as the preferred providers of primary (uncomplicated) maternity care. Over time, almost all general medical practitioners other than obstetric medical specialists have opted out of the direct provision of maternity care, and midwives have enthusiastically taken over the service. At this point, it would be useful to introduce myself and declare my ongoing interest in the provision of maternity services by midwives. I have lived in the South Island of New Zealand all my life. In my thirty-year midwifery career, I have had many experiences in this country’s maternity services, from consumer through to practitioner and midwife manager. In 1994 I worked with midwifery colleagues in the New Zealand College of Midwives (NZCOM) to set up one of the first hospital-funded continuity of midwifery care teams. This small unit within a general hospital in Christchurch has maintained its delivery of midwife-led services to the present day. I have also been involved in midwifery education over the years, and combined my practice with my own study, ultimately completing a doctorate in 2003 with a thesis on the provision of maternity services by midwives in New Zealand. I am currently involved in the midwifery profession in a number of leadership roles centered on the logistics of maternity service provision, including as part-time Executive Director of the national Midwifery and Maternity Providers Organization (MMPO), which provides practice management support to about 80% of New Zealand’s caseload midwives. In case others are thinking of replicating the New Zealand model, it is important to understand the context of maternity service provision in this country. It is unique. Our maternity service is not provided in isolation from other health services, nor without a history that has had a profound impact on service development and relationships with other professions. Understanding the drivers of change that produced the various aspects of this model may be more important than obtaining a recipe for transplanting this model to “foreign” soil. Crucial factors in the development and success of the New Zealand midwifery model include (1) the groundwork of legislative and/or regulative change; (2) the political astuteness and determination of midwife leaders and home birth consumers presenting a united front; (3) the desire and ability of midwives to embrace change and work differently. [Editors’ note: These factors [3.17.128.129] Project MUSE (2024-04-25 05...

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