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Pasifika Midwifery Workforce in Aotearoa:
Having Babies Out of Context
‘Eseta Finau, ONZM
([email protected])
Tongan Nurses Association of NZ,
P.O.Box 13252, Onehunga; &
Sitaleki A. Finau, MNZM
([email protected])
CEO Masilamea Press; &
Manager, Research, Information, & Innovation,
Tongan Community Development Society
Auckland, NZ
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Content of Presentation
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The Pasifika Midwives Group in NZ
Definition of a Midwife;
Pasifikans of NZ;
Locations of Pregnant Pasifikans;
Pasifika Women’s Health;
Pasifika Health Workforce & Midwives;
NZ Maternity System
Concluding remarks
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Pasifika Midwives
Group
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What are we
all about?
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Relationship, Relationship, Relationship!
Culture is the ability to: understand & apply cultural values, &
practices underpinning Pasifikans’ worldview and perspectives
on health: including: the ability to use Pasifika values, principles,
structures, attitudes, & practices in the care and delivery of
services to Pasifikans, their families and communities.
(ADHB Pacific best practice guidelines 2010).
Using Pasifika best practice guidelines within one’s
professional vernacular and collaborating with
Pasifika providers will engage Pasifikans with
midwives.
Definition of a
Midwife
“A midwife is:
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“recognised as a responsible and accountable professional
who works in partnership with women to give the necessary
support, care and advice during pregnancy, labour and the
postpartum period, and
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to conduct births on the midwife’s own responsibility
and provide care for the newborn and the infant. This
care includes preventative measures; the promotion of
normal birth, the detection of complications in mother
and child, the accessing of medical care or other
appropriate assistance and the carrying out of
emergency measures.”
Source: International Confederation of Midwives, 2005
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Pasifikans of Aotearoa
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Pasifikans in the
2006 census
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6.9% total NZ population. About 67% of the
Pasifikans reside the greater Auckland region. We
are a diverse population.
Fastest growing population in NZ; an expected 15%
more by 2050.
Youthful population; median age 21 years c.f 35
years for the total NZ; 39.2% of Pasifikans are
under 15yrs of age c.f. 23% of the total population).
83% religious c.f. 61% for NZ population.
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Pasifikans are many
Not 1
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Pregnant Pasifikans:
% Giving Birth
 This 2010 data indicates more Pacific women registered with an LMC
in the second trimester of pregnancy than the first.
 In comparison, 65.4% of European women registered
with an LMC during the first trimester of pregnancy.
 38.9% Pasifikans DNA an LMC
Percentage of women giving birth
100%
90%
No LMC
80%
Postnatal
70%
Trimester three
Trimester two
60%
Trimester one
50%
40%
30%
20%
10%
0%
Māori
Pacific peoples
Asian
Maternal ethnicity
European
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Pregnant Pasifikans: Rates
of Babies/100 Women :
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Pasifika Women’s
Health
(2010 ADHB)
HIGH RISK INDICATORS
Pasifikans
Others: General population
Deprivation Index
>48% live in the most deprived
19.7%
(decile 10) areas..*Evidently <3% live
in the least deprived areas.
Diabetes
Pacific women are 3x > likely to have with Type II
diabetes c.f. others
DNA (Non-attendees)
8.3% booked before 10wks
gestation.
42.3% booked after 20wks
gestation.
> 50% had BMI > 30
Obesity
Perinatal mortality/1000 births 21.1
28.6% booked before 10wks
gestation.
16.7% booked after 20wks
gestation.
16% had BMI > 30.
19.8
Post-partum
haemorrhage
(≥1000mls)
Smoking
13.4% Pasifikans c.f. 9% for others.
Pasifika women (15- 24yrs)
5x more had 1st baby by 21 years > others & Maori.
16% disclosed at
8% disclosed at
booking (27% Cooks booking
& 3% Tongan)
Pasifika Health
Workforce
Medical
Practitioners
1.0
%
(MCNZ
2002)
Nurses and
Midwives
3.0
%
(NCNZ
2003)
Dentists
0.6% (APC 2003)
Pharmacists
0.2% Registration
2003
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Pasifika
midwives
55 MW’s per
3075 Pasifika
Women
2.1% total
MW’s in NZ
Ref: Midwifery workforce
Survey 2011
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Pasifika Midwives: Key Drivers
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Establish a Pasifika advisory body in
midwifery;
Develop & deliver a Pasifika
midwifery for Pasifikans indicative of
‘cultural competency’;
Rationale
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Locations of Pasifika Nurses
Location
Cooks
Fijian
Samoan
Tokelau
265
35
Tonga Niue
Other
PI
SubTotal
74
809
Auckland
Manukau,
62
170
North
Shore
145
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Papakura
Waitakere
Porirua
12
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108
23
17
4
17
207
4
10
3
16
100
Lower &
Upper Hutt
Christchurch
8
Dunedin
12
47
Source: Raw Data from Nursing Council of New Zealand, 2002
Nelson
Council
mail out
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72
TOTAL
127
280
91
511
18
20
80
192
10
75
57
164
313
1,429
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Retaining Skilled Pasifika Nurses
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Appropriate basic training: skill and job fit;
Postgraduate training: specialized skill with conceptual and
managerial development;
Continuing education: leading to qualifications, improved
status and remuneration;
Parity, incentives, acculturation, and citizenship training
Experiential placement in Pacific countries;
Worker friendly administration: Consistent management,
accountability, transparency, good governance; and
Staff appraisal: identify personal demands and
match with service needs
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Frameworks for
Midwifery
y
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Legislative: Midwifery Council;
Professional: New Zealand College of
Midwives;
Contractual: Section 88, maternity facility service
specifications;
The Health Practitioners Competency Act (2004):
‘Health professions are to set standards of clinical,
cultural competence & ethical conduct to be observed
by practitioners’
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NZ’s Maternity
System
NZ has:
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a free, integrated maternity service; home
to hospital & home; primary, secondary care
from pregnancy test to 6 weeks post partum
Community-based, continuous care by a lead
maternity caregiver (LMCs) mostly midwives
national funding for primary health &
midwifery as it’s philosophy
 universal right of access for midwives &
clients to hospital obstetric care as required
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The Regulation and Provision of
NZ Midwifery Services Framework
Professional framework
Regulatory Framework
MIDWIFERY
COUNCIL
Code of practice
Standards
NZ COLLEGE OF
MIDWIVES
Philosophy
Registers midwives
Ethics
Defines scope of practice
Standards
Registered
Midwife
Sets Competencies
Education
Approves education
Professional
support
Midwives
Union
(MERAS)
Sets Standards of conduct,
disciplinary role,
Public safety, and
monitors
competency/Standards
Competencies
Midwifery
Standards Review
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Competencies &
standards
 The Competencies and Standards apply
to all midwives who hold an Annual
Practicing Certificate.
Mason Durie wrote: ‘The degree of
comfort individuals feel with seeking
health services impacts on their use of
services and in turn health outcomes.
The delivery of care in a culturally
appropriate manner is an important
element in determining both the
willingness of people to access services
and the success of any treatment or
care then delivered.’
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International Midwifery
and Obstetric Position
 ‘ICM and FIGO uphold the human right of
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childbearing women to have access to a
midwife’s care for herself and her newborn.
There is strong evidence that out of hospital
birth supported by a registered midwife is
safe, and a preferred experience for many
mothers’
Ref: ICM/FIGO Media release 8 March 2012
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NZ Women’s Rights
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right to a fully government funded maternity
service,including home birth;
right to choose who provides her
maternity care and where;
may choose a midwife, a family doctor with
obstetric training, or an obstetrician;
free access to other opinions and advice
from obstetricians, paediatricians; and
Can choose who supports her: partner,
family, friends, or other children
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Maternity
Resources
 NZ maternity standards
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Primary maternity service 2007
Find a Midwife website 2012
Referral Guidelines 2012
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DHB consumer quality plan 2012
Section 88 2007
2011
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Challenges to
Midwifery Services
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The PIF study (2001) identified many factors affecting
how Pasifikans engage with antenatal services.
These include; cultural implications, educational
status, language barrier; child-care accessibility; lack
of transport; whether pregnancy was planned; & what
social support was available to the mother.
Many Pasifikans felt antenatal classes were aimed at
‘Papalagi’ mothers and had little reference to them.
Novak(2006) wrote:
Service users may choose not to access services for
fear of being misunderstood or disrespected.
Providers may fail to take into account differing
responses to medication, treatment or care options.
Service users may not adhere to medical advice
because they do not understand or do not trust the
provider.
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Chronology of
Development
 November 2011:1st Pasifika Fono;
 February 2012:Present at NZCOM
National Committee;
 March 2012: 1st meeting of Pasifika
midwives and consumers (National
fono).
 June 2012: 1st Pasifika Midwifery
Focus Group.
 August: Ratification Pasifika Arm of
NZCOM at AGM.
 September:1st Fono with Pasifika
midwifery students
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Roles of a Pasifika
Advisory Section
 Contribute to midwifery strategies planning for the
recruitment, training, retention and nurturing of the Pasifika
workforce:
 Special commitment to improving the health and wellbeing of
the diverse pregnant Pasifikans;
 Remove barriers: to training for; access & utilisation of
maternity services of Pasifika communities, & providers;
improve functional (health) literacy;
 Pacific midwives have a voice in contributing to solutions that
are measurable and tangible in effecting optimum outcomes for
our Pasifika women, babies & their families:
 Promote midwifery as a viable career option for Pasifika
communities and students; Work with agencies on
midwifery scholarships.
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Pasifika Model of
Practice:
 There many Pasifika models
of health and research
 E.g., Fono Fale Model:
 The foundation (floor of the
fale): represents the family
which is the foundation for all
Pasifika cultures;
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The Roof: represents cultural
values and beliefs that shelter the
family for life; culture is dynamic
and constantly evolving;
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The Four Posts: connects culture &
family, & are continuous & interactive
with each other.
 The Pou are representative of four
areas: spiritual, physical, mental
and other influences impacting on
family wellbeing.
 The Fono Fale is encapsulated in a
cocoon that has dimensions with
direct or indirect influences on one
another. These are: Environment,
Time and Context.
RECOMMENDATIONS:
 Review current maternity model
 Grow Pasifika midwives & community-based
services
 Pasifikan pregnancies to have Pasifika competent
or supported LMC
 Return to Midwifery Program
 Skilled Overseas Registered Nurses
 Review current midwifery training to include
General nursing training
 Complimentary roles of doctors and widwifes
 Non Pacific midwives to go though Pacific
cultural competency training
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REFERENCES:
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Arendas, K., Q. Qiu, et al. (2008). Obesity in pregnancy: preconceptional to postpartum
consequences. Journal of Obstetrics and Gynaecology Canada: JOGC 30(6):477-88.
Cundy, T., et al (2001) Perinatal mortality in Type 2 diabetes mellitus. Diabetic medicine,
17(1):p.33-9.
Erick-Peleti S, Paterson J, Williams M (2007) Pacific Islands Families Study: Maternal factors
associated with cigarette smoking amongst a cohort of Pacific mothers with infants. NZ Med
J.120(1256). Cited from http://www.nzma.org.nz/journal/120-1256/2588.
Low. P,J. Paterson, T.Wouldes, S. Carter, M. Williams (2005) Factors affecting antenatal
care attendance by mothers of Pacific infants living in New Zealand, The NZMJ 118:1216.
Minister of Health and Minister of Pacific Island Affairs.(2010)’Ala Mo’ui – Pathways to
Pacific Health and Wellbeing 2010-2014.
Ministry of Health. (2008). Maternity services consumer satisfaction survey 2007.
Wellington: Ministry of Health.
Pacific Best Practice Guidelines, (2010). Auckland District Health Board Mainstream Pacific
Responsiveness Plan, 2008.
Sundborn, G., et al., (2006) Differences in Health-Related Socioeconomic Characteristic
Among Pacific Populations Living in New Zealand. The New Zealand Medical Journal,
110(1228).
Violani Wills: in Ministry of Health Pregnancy Book, also PHD Journal
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Pasifika Midwives are
Rare as Birds’ Teeth
‘Alu a koē
mo ke
fiemalie!’
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Tui Atua Tupua Tamasese
Ta’isi Efi
(Head of State, Samoa, 2009)
“I am not an individual; I am an integral part of the cosmos. I share
divinity with my ancestors, the land, the seas and the skies. I am not
an
individual, because I share my tofi (an inheritance) with my family,
my
village and my nation. I belong to my family and my family belongs to
me.
I belong to my nation and my nation belongs to me.
This is the essence of my belonging.”
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Mālō! Haere Ra!
Questions ?
& Answers ?
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