NZ Midwife 2-Year Training/Andrea's Practice-based Research

Working with skilled families made sense right away to Andrea. We know this 2-year training will clearly show similar benefits. We have no doubt.

The Brant Study just confirms, way back in New Zealand’s history, that birth skills have a huge positive impact on childbirth no matter the maternity system.

Andrea’s relationship to Common Knowledge Trust

The Concept 1970s-1995

The idea for this Concept began to grow in the early 1970s as Wintergreen and families developed Birthing Better Childbirth Preparation (previously known as The Pink Kit).
Wintergreen presented at conferences around the world advocating for a skilled birthing population for all births whether in a maternity system that respects ‘choices’ or not.
- Skills work when there are no choices or when they change unexpectedly.
- Skills work when Women want, need or are pressured to have interventions.
Wintergreen was accepted into New Zealand as a resident in 1995 based on both The Concept and Birthing Better skills

Common Knowledge efforts 1995-2002:

Wintergreen gave a presentation in 1996 at an NZCOM conference
Presented various ‘training’ courses to midwives throughout New Zealand
Andrea met Wintergreen in 1998 and approached Common Knowledge Trust in 2000 when Edition #1 launched.
Andrea purchased 20 ‘Pink Kit’ in 2000 and gave one to every client.
Edition #1 of The Pink Kit/Birthing Better launched with only half the skills.
- The first 5 years of Andrea’s statistics were using Edition #1 … half the skills and no linear learning.

Common Knowledge efforts 2002-2008:

Wintergreen taught 6-week classes in Nelson for 3 years for ‘referred’ families by midwives. Each family was given edition #1 and expected to self-learn the skills. The second half of skills were taught.
Continued efforts were made to get a regional trial of 5-10 midwives in Nelson
Andrea worked closely with Wintergreen as she shifted her public health partnership message

Common Knowledge efforts 2008-20013:

Wintergreen left New Zealand to continue the Trust’s work internationally.
Andrea and Wintergreen continued to work together to flesh out a potential extended training.
Andrea asked Wintergreen to return in 2013 with the belief that her much loved midwifery profession was more open to The Concept.
Edition #3 and #4 became available.

Common Knowledge efforts 2013-2015:

Andrea and Wintergreen ran Strengthening The Partnership workshops to midwives across New Zealand.
Edition #5 became available

Common Knowledge efforts 2015-present:

Wintergreen and Andrea worked together to create a simple, effective nation-wide NZ midwife 2-year participation study.
Edition #6 … online courses became available. Finally, the content is organized into simple lessons.

Andrea’s presentations from 2002-2015

Nelson DHB presentation – 2002

This presentation was given when Andrea was 2 years into her practice-based research. Her presentation is raw. All the emotions that led her to begin her journey to strengthen her partnership are heightened 2 years into her adventure … as they will for you.

Go back and read 1961 NZ Brant childbirth study. Imagine what New Zealand society would look like today had that research led to a childbirth trend that encouraged every pregnant/birthing mother and father/other to become skilled. The ‘trained’ assistant in Brant’s study exists only due to lack of fathers/others naturally being present.
Imagine the history of our Midwifery Model of Care from 1990 had Kiwi families been using skills since the 1960s for all births?

Editor notes: At the very end of Andrea’s talk, she suggests that CKT teach ante-natal classes. This is where you might be confused between The Concept and Birthing Better Childbirth Preparation.

Wintergreen/Common Knowledge Trust has dual roles in this NZ midwife 2-year training

Role #1 … Primary

To give participating midwives 24/7 Continuity of Care so each can enjoy their participation in this training.

Role #2 … Secondary

CKT/Wintergreen will offer three separate 3-hour workshops directly to clients of participating midwives on request.

Common Knowledge Trust believes families should have a ‘choice’ which skills to learn. Becoming skilled to give birth should be the norm. Birthing Better is one of a number of skills-methods.

Common Knowledge classes: Inspire pregnant birthing families to become skilled thus more consciously supporting their midwives and achieving a more satisfying birth in all circumstances.

The Concept Workshop focus …
1. Clearly explain The Concept
2. How your clients can effectively participate in this 2-year training
3. Emphasize the importance of becoming skilled for both mothers/fathers/others
4. How becoming skilled supports midwives.
5. COST: $20/person or $30/couple. Minimum of 20 people. ALL midwives are welcome whether or participating in this NZ midwife 2-year training.
Birthing Better Workshop Introduction Focus …
1. For expectant families who want to know more about Birthing Better Childbirth Preparation skills and those who have chosen Birthing Better skills. ALL midwives are welcome whether or not participating in this NZ midwife 2-year training.
2. COST: $20/person or $30/couple. Minimum of 20 people.
Birthing Better Workshops with Specific Focus …
1. First-time mothers and fathers
2. VBAC or experienced traumatic births
3. Families ‘choosing’ , needing or pressured to have more medical care such as elective Cesareans.
4. COST: $20/person or $30/couple. Minimum of 20 people. ALL midwives are welcome whether or not participating in this NZ midwife 2-year evaluation.

NZCOM presentation -2008

Andrea has now used her new Partnership explanation for 8 years.

For the first few years, Andrea did struggle to require her clients to become skilled and not just leave that decision to their ‘choice’ which is the core foundation of the Midwifery Partnership.

She was sick and tired:

Of working with women who didn’t cope well
Long labours
- high babies
- increase in Cesareans
Dads who were useless
More interventions than necessary had the woman been skilled

Andrea had 10 years working in hospital and 10 years working independently under Section 88 prior to putting in place the protocol. After 10 years as an LMC, she despaired at her statistics.

Many times during the 10 years prior to starting her informal practice-based research, she had begun to feel her ‘partner’ … Women … were, in fact, tyrannical and needy beyond belief. Choice and 24/7 care had given Women the license to constantly be in touch at all hours of the day and night with often tiny issues.

Eight years into her stronger, more balanced Partnership, Andrea was feeling a bit reborn. Enough of her clients had come on board. She was using her professional status to inspire her clients to become skilled as well as the Birth Stories she was collecting. At this point, 70-85% of her clients were on board. She was working on that last 20%!

Homebirth Hui 2011

Since the 1970s, the home birth movement … natural birth/homebirth advocates and home birth midwives … have sought to legitimize, legalize, make available and increase home births attended by midwives (preferably with non-nurse midwives) a normal part of New Zealand childbirth.

The pathway to their goal was achieved in 1990!

The home birth rate in New Zealand has either stayed the same regionally or decreased. I believe Hawkes Bay is presently (2018) the only area where home births are increasing. report-on-maternity-2015-updated

Editor notes: Can New Zealand society actually increase interest in and achieve more home births? Yes, WHEN … more families are skilled. Here’s the reality … most modern women do not want to birth at home for a number of reasons. Pregnancy and birth are SO infrequent coupled with ‘You never know what your birth will be like’.

Anxiety and fear of birth, of course, leads more women to more assessments, monitoring, and procedures. Birth skills bring increased confidence. Is fear of birth normal and natural or unnecessary?

SideBar … The Gift of Fear

If you have anxious or frightened clients, this is a skill you can share with them.

Fear of birth is actually hard-wired into our human cellular intelligence. Without modern medical care, societies around the world throughout Time have only their own cultural health system to rely on and all traditional societies ‘fear’ pregnancy, birth and the newborn to about 5 years.

Until antibiotics and immunizations, all societies expected to lose 20%+ of childbirth before the age of 5. New Zealand’s statistics from The Trouble with Women:

‘From 1894-1903 15,767 children under 1 died and 732 mothers or possibly double that’. p.10
‘In 1920 New Zealand had the 2^nd highest deaths of mothers from sepsis 6.8 out of 1000 women.’ p.10

From Wintergreen’s extensive experience living in a number of traditional communities (not working directly with birth), she learned that when traditional people become afraid, they become more observant. Here is a skill learned.

The steps in the below skill teach observation and actions in relation to fears … whether during pregnancy, in birth, raising kids or throughout Life.

Acknowledge the anxiety and fears. Don’t try to suppress the fears. Fear is a Gift.
Ask yourself this question: ‘Do I feel that what I fear is going to cause death or serious injury in 5 minutes?
If the answer is YES then seek immediate help.
If the answer is NO the ask this question: ‘Do I feel that what I fear is going to cause death or serious injury in 12 hours?
If the answer is YES then seek immediate help.
If the answer is NO the ask this question. ‘Do I feel that what I fear is going to cause death or serious injury in the next 24-72 hours?
During this 24-72 hours, just observe. Either the situation will get worse (seek help) or resolve itself and you feel better.

The Gift of Fear in pregnancy serves two purposes:

For Women/others to act immediately in pregnancy and birth to try to prevent an ‘issue’ from becoming a ‘problem’
When this observational skill is grown in pregnancy and birth, it matures and is used when listening to and observing newborns in the years before a child can explain what’s bothering them.

These steps should be taught to all expectant parents and encouraged to be used. Individual men and women who use this simple skill tend to seek appropriate help and feel more confident to make decisions.

Andrea’s 2012 NZCOM

Andrea and Common Knowlege Trust recognized the Partnership was the framework for change within this trial. The hiccups in the Midwifery Model of Care had become well known by 2012 when Andrea gave this presentation … after 20+ years.

Growing Birth Skills – year unknown

Andrea always hoped more of her colleagues in Nelson would come on board. She could see the benefits of a group of local midwives implementing The Concept. Doing so would require less effort on her part because the idea of becoming skilled would be known by more families in the area and they won’t require as much convincing.

Andrea realized that many women would seek out a midwife who did not require skills to be learned giving any number of ‘reasonable reasons why not’ such as: “I’m too busy’ or “I have other kids at home’ or ‘I’m going to hospital and they’ll take care of me’ or ‘I’m choosing a home birth and birth is natural, I just trust all will be right’ or ‘I can’t be bothered’.

Do NOT expect 100% of your clients to jump at the chance to become skilled. There are many ‘reasonable reasons why not’ that both midwives and clients give.

Birth Skills 2015 Auckland

Andrea was now completing her second term on the Midwifery Council.

By 2015, Andrea has become more discouraged about birth in New Zealand.

More and more midwives are leaving practice.
Changes have been occurring in DHBs.
Childbirth education classes have lost funding.
The Cesarian rate continues to rise.

By 2015, Andrea felt The Concept for a skilled birthing population and getting more midwives engaged in strengthening the partnership seemed to move further and further away and unachievable.

She realized an autonomous practice has its bonuses and drawbacks.

On the one hand, every midwife feels she is working well with her clients and has good statistics.
On the other hand, midwives feel unsupported (as pointed out on the Dear David March)

The midwifery profession seems to be turning more toward the DHBs and MOH for solutions rather than turning to their defined Partner.

The Concept for this training is based exclusively on growing a more empowered Partnership between Women/Men/Others and Midwives.

Editor notes: If you want Andrea to be a mentor in this 2-year training you must reach out to her. Wintergreen and Common Knowledge Trust believe her participation would be a huge benefit because she shares ‘Midwifery Speak’ whereas Wintergreen is the ‘Client Whisperer’. She and Wintergreen have always worked well together.

Further reading:

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NZ Midwife 2-Year Training/Andrea’s Practice-based Research