I spent most of today with a really great group of teaching staff and student midwives exploring the scope of midwifery practice and relating it to their code of ethics, standards of practice and informed decision making. The students started their day by engaging in a debate that required them to argue from either a medical (technocratic) or midwifery (social) philosophical perspective. This was really interesting and entertaining.
Later, the students were tasked with identifying research evidence that they could use to support women to make informed decisions about their maternity care. The New Zealand College of Midwives (NZCOM) have established ‘decision points’ – these provide a guide for midwives to be able to identify those times where there may be an assessment required during pregnancy. These cover pre-conception, six decision points for antenatal care, five decision points in labour, and further decision points in the postnatal period that could be every 24 to 48 hours until the woman feels confident in her home environment and then again at around six weeks.
It’s interesting that NZCOM have developed the Midwives Handbook for Practice which describes midwifery philosophy, the definition of a midwife, the scope of practice for a midwife, their competencies for entry to the register of midwives, their code of ethics, Turanga Kaupapa (a mechanism to give life and meaning to the midwifery profession’s recognition of Maori culture and their obligations under the Treaty of Waitangi), the standards of midwifery practice, decision points for midwifery care, and guidelines for referral to obstetric and related medical services. In the UK, the Nursing and Midwifery Council publish the Midwives Rules and Standards 2012 and The Code but the NZCOM handbook really seems to embody the spirit of a partnership between the woman and the midwife who is coordinating her care.
Later I met with Professor Sally Pairman, one of the architects of the current model of maternity care in NZ who is currently involved in NZCOMs legal efforts to invoke gender discrimination laws to achieve equal pay for work of equal value done by midwives. For anyone interested in finding out more about the history of the New Zealand College of Midwives from 1986 to 2000, you can read Sally’s book Women’s Business.