Day of the midwives

Press, 15 June 1985, Page 19

Day of the midwives

By

CINDY BAXTER

Fears for their future as changes demanded

Midwives fear that they are fieing phased out of the health system; and that mothers and their newborn babies could suffer from the consequences. For the first time, midwives in the New Zealand Nurses’ Association (N.Z.N.A.) organised a National Midwives Day, yesterday, which they are using to highlight their concerns at what they view as threats to their profession.

• They want the midwifery training course changed from its present form as one of the specialist .options in the year-long Advanced of Nursing (A.D.N.) course Available at polytechnics in Wellington, Christchurch, Auckland, and Waikato.

• They also see existing legislation, in the Nurses’ Amendment Act, 1983, as inadequate and are seeking further amendments.

They say the midwifery course at polytechnics should be treated as a separate, more specialised course, with more emphasis on clinical experience, to give the

students better preparation for their registration as midwives with •the New Zealand Nursing Council. One prerequisite for acceptance • to the A.D.N. midwifery option is registration as a comprehensive nurse or general and obstetric nurse, which takes three years of . training and one year as a staff nurse.

j Also, applicants must have had a minimum of two years post-basic ‘ training clinical experience, which

must include six to 12 months of "nursing in a maternity unit. This, along with the one-year course at the polytechnic, means that it takes seven years of trainring to become a registered mid.wife.

The A.D.N. midwifery student .can either pay her or his way for the year, or be sponsored by a hospital board. This means a further, bonded, two consecutive years working for that board after graduation, making midwifery a nine-year commitment. The chairman of the Canterbury Westland division of the Midwives Section, Miss Sandra Balloch, says that the nine-year commitment is putting many nurses off becoming midwives. “It just takes too long,” she adds. If the midwifery course was :_more specialised, with more clini,cal hours, the two years of posthaste training would not be neces- ,■ sary, and would cut the seven-year •training down to five years. Miss Balloch stresses that the •Advanced Diploma of Nursing .-.studies are an important part of -the midwifery training, and should be left out. This is N.Z.N.A.

policy, and should be adhered to. However, if a separate midwifery course was set up, the A.D.N. studies could be included, but with a greater emphasis on midwifery. The stress on midwifery students in the A.D.N. course is far greater than on the other students, because of the need to sit state finals at the end of the year to gain registration as a midwife, she says. The emphasis in studies in the course is on the diploma studies, which are internally assessed, yet the emphasis on exams is the opposite. “We don’t want to do away with the exam, because we feel that everybody should sit it, but we want to change the emphasis."

Another midwife, a former tutor at Burwood Hospital’s hospitalbased midwifery training course in the 19705, Mrs Daphne Lowe, says she has heard registered midwives, after graduation from the course, say they feel inadequately prepared for their work. The curricula guidelines for the A.D.N. course are set down by the Nursing Council, and are carried out by the Education Department, in consultation with the Health Department. The four polytechnics have “a high degree of flexibility along those guidelines,” says the acting director of continuing education with the Education Department, Mr Errol Jaquiery.

He did not go into detail on the courses, preferring to wait for the

Ms Lewis confirmed that concern, saying that the quality of the clinical experience did vary, depending on what sort of a team the student was working with. “Sometimes they can be made very welcome, learn a lot, and enjoy the experience. In other cases they can feel extremely unwelcome, and just want to get out as soon as possible. They can end up learning very little here.” There is also a tendency to concentrate the clinical experience in the labour ward, says Mrs Lowe, as required under the Nursing Council’s regulations. This leads to registered midwives not having

enough experience in the primary health care area — the counselling of the mother before and after the birth, and teaching. “The breakdown of the family unit, with so many solo mothers, has led to families not supporting their young enough,” she adds. “There are a tremendous number of solo mothers who are getting inadequate parenting and breastfeeding counselling. This, along with the trend for shorter stays in the maternity unit, means that some children are ending up in public hospitals as a result of inadequate care.”

results of the research study, now in progress. The study is looking at the way in which all advanced diploma courses in polytechnics are shaping, and how they should suit the needs of the professions. It will be completed later this year. The acting head of department at Christchurch Polytechnic’s School of Nursing Studies, Ms Helen Lewis, says that midwifery students have to do 500 hours of clinical work during their first year’s training. < They have to “follow through” five mothers, from ante-natal to final checks after the baby is bom, carry out 20 normal births, and assist with abnormal births. Miss Balloch and Mrs Lowe both expressed concern at the clinical experience, saying in some cases the student could end up doing normal nursing duties.

Because the number of midwives trained each year is decreasing, fewer are available to carry out the follow-up of the mother and child once they are discharged, says Mrs Lowe. “They have the right to be visited every day for 14 days after the birth of their child, just to make sure there are no complications, such as gynaecological disorders.

“Doctors would argue that they are responsible for the care of their patients, but they would see the mothers only if they actually went to them. Doctors rely on the midwives.

“We would see that keeping the midwife as a primary health-care giver would be cost effective to the hospitals, it would relieve the burden on doctors, and would ensure that quality care was available to' the family.” Ms Lewis is a member of the N.Z.N.A. executive which, following a remit at the association’s conference in April, is to set up a committee to investigate the role, scope, and practice of the midwife. Miss Balloch has produced evidence to show the dramatic fall in the number of midwives being trained in New Zealand now, since the move to the polytechnic-based courses.

i In 1975, 162 students graduated as midwives, from hospital-based courses. In 1979, the number was down to 120 as the courses were phased out. After the first year of polytechnic-based training, in 1980, 18 graduated. A total of 99 midwives have registered as midwives through the A.D.N. Midwives are looking overseas for training, she says. Of the 196 midwives who registered with the Nursing Council from March, 1983 to March, 1984, 22 per cent qualified from New Zealand courses and 88 per cent from programmes overseas, with many of these being New Zealand nurses who did their comprehensive training here.

nursing, Miss Elizabeth Wills, says that the only area where some difficulty exists in midwife recruitment is in the rural hospitals. This is because of a small caseload for midwives compared with city hospitals, and they also suffer from “a certain amount of professional isolation,” she says. “Midwives themselves complain that their own competence is being jeopardised.” Miss Wills also refutes the claim that solo mothers are not being adequately prepared for parenting. “There has been no hint of this from the hospitals. The follow-up work is done by a number of people — either the general practitioner’s nurse, a midwife, a plunket nurse, public health nurse, hospital board domiciliary midwives or, in Canterbury’s case, midwives from Nurse Maude.” The other major claim by the midwives is that current legislation threatens the need for the midwife’s presence at childbirth and therefore the lives of the mother and baby could be at risk. Under the 1984 amendment to the Nurses’ Act, obstetric nursing cannot take place in the absence of a doctor, unless there is a person present who “is a registered midwife, registered general and obstetric nurse, or registered comprehensive nurse.”

This means, says Miss Balloch, that a general and obstetric nurse or comprehensive nurse can deliver a child, regardless of whether that nurse has had specialised midwifery training. Although it has been stated by Health Department officials that that is the minimum required training, it also means that often a mother can give birth to a child without the presence of someone who has the knowledge and experience of birth and possible abnormalities, that has been gained by a midwife.

Mrs Lowe also states that this is part of the Health Department’s way of avoiding tfe fact that there is a shortage. I “If they can advertise the job, not for a midwife, but for someone who meets the requirements of the act, then they will not have to admit there is a shortage.” This claim is labelled by Mrs Wills as “incorrect and misleading.” She says the {1984 amendment is an improvement for midwives, and for the safety of patients, because the legislation previously said that an obstetric, or maternity nurse, with only 18 months training, could also carry out the job. “The act was amended last year after considerable discussion, and numerous submissions,” she adds. The midwives present fears were also debated at the time. “We are not aware that the midwives are being phased out jat all.” The midwives want that section of the act amended to read that persons could carry out a delivery if they are “a registered midwife, registered midwife and general and obstetric nurse, or registered midwife and comprehensive nurse.”

The Canterbury Hospital Board chairman, Mr Tom Grigg, has stated over and over for the past few years that there would be a shortage of midwives because of the move towards polytechnic training, says the board’s medical superintendent-in-chief, Dr Ross Fair gray. The claim by midwives that there is a shortage has been denied by the Health Department. The assistant director of the division of