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NZ Midwife 2-Year Training/Childbirth Trends

This post is for childbirth nerds who have a fascination with childbirth histories.

We are where we are because we’ve done what we’ve done.

Childbirth trends are very new because modernity is very new. Our modern world is very different from our many thousands of diverse traditional societies. Humans have lived in many more thousands of distinct societies for the hundreds of thousands of years we’ve existed around the globe.

Each society has it’s own childbirth beliefs and health systems that engage in pregnancy, birth, newborn and children.

After WW2, we began to move more toward the Global modern world. Childbirth trends have moved from society-specific to country-specific to the globally homogenized. You may already have researched into cultural pregnancy/childbirth diversity. You are also aware of WHO reach and the global standardization of maternity care.

Below is a very simplistic understanding of childbirth trends and how we got here. Where is here? Here … in New Zealand and our very unique maternity system compared to the global standardization. Many of us hope our Midwifery Partnership can lead the way to a new global maternity model.

When push comes to shove

  • Our dedicated 24/7 care midwives are exhausted
  • Statistics don’t look good
  • Midwives/NZCOM are turning more to DHB/MOH to sort out some of the real issues with the hope the Co-Design Funding will solve some of the problems.
  • The Strategic Plan 2017 to 2020 has been put forward.
  • A review of the Partnership has not yet happened. This training suggests a possible more balanced and stronger Partnership definition.

Everything in the Now comes from the Past so let’s stroll down memory lane. You may know all of this. It might be new. You might agree or firmly disagree.

Wintergreen has been involved in the childbirth conversation since the early 1970s. She has focused on the local, regional, Statewide (USA) and International conversation. She has always looked at childbirth from the view of birthing families.

Recent childbirth trends

  • Before the 1950s … Globally and this trend is based on a global Truth that still exists around the world even within the following trends. ‘There’s no way to know what your birth will be like’.
  • 1950s-1970s … Limited Skills-based Trend … based on a belief that Women seeking natural birth, pain-free births with no interventions.
  • 1970s-1990s … Choice-based Trend … based on saying ‘no’ to medical interventions
  • 1990s-present … Midwifery Partnership Trend … based on ‘a relationship of ‘sharing’ between the woman and the midwife involving trust, shared control and responsibility and shared meaning through mutual understanding’ p. 95  Women’s Business

 

A trend is a ‘system’

Every system has 5 elements:

  • Ideas lead
  • Language follows
  • Actions are taken
  • Policies are formed
  • Goals are either achieved or not

When a system is formed and implemented there are three ‘goal’ results:

  • Success
    • Goals are achieved
    • The societal message aligns with the 5 elements
    • Society can see the goals achieved
    • EX: Kiwis have become safer drivers since the late 1980s because Government has constantly put out the ‘safe driving’ messages.
      • The government could have focused on improving roads, more police and not selling millions of cars.
        • That would not have achieved the goal to reduce auto deaths.
      • The government focused on the ‘driver’.
        • This has achieved reasonable success
  • Partial Success
    • Goals (and there can be a number of them) partly achieved
    • Societal message sort of aligns with 5 elements
    • Society has mixed experience or feelings about the goals
    • EX: NCEA came from an idea, a language developed, actions and policies were put in place with very mixed results.
  • Questionable Success
    • Important goals not achieved
    • The societal message doesn’t align with 5 elements
    • Society is confused
    • EX: Our Midwifery Model of Care. Women LOVE their midwives and love Continuity of Care. The primary goal for midwifery continuity of care has not been achieved … a decrease in medical births.

Sometimes it takes a generation or more for systems/trend to change. Our precious Midwifery Model has now been in effect for a generation.

Please add or subtract to the below from what you know and believe.

Before the 1950s

This trend has always existed globally because it’s based on a Truth and not determined by society or belief. It still exists today around the world even in New Zealand under our Partnership Model. This is what the trend looks like.

  • Ideas
    • Everything that can happen might happen at birth and is normal and natural … the good and challenging.
  • Language
    • ‘There’s no way to know what your birth will be like’
    • ‘There’s really nothing you can do to prepare for it’
  • Actions
    • Every culture has its own birth practices
  • Policies and Societal Messages
    • Each culture has its own policies and societal messages
  • Goals 
    • Safe birth for mother and baby
    • Acceptance of all births … the good, sad, wonderful, tragic
    • Becoming a mother

What happened under this system? 

  • Women felt totally powerless
  • Women lack control because of the Truth … ‘There’s no way to know what your birth will be like’
  • Birth just happens
  • Women hoped for a safe birth for themselves and baby
  • Women lived with the consequences of having no control at all
  • The first birth advocates came together in modern countries to try to give Women control over their births.

Societal view 

  • Birth is out of Women’s control
  • Some women have easy births, some hard, some result in healthy mother and/or baby, others don’t.

1950s-1970s

During this period, childbirth was mostly a country-to-country issue but becoming increasingly international.

  • WHO was founded in 1948
  • International Confederation of Midwives loosely formed in the 1950s
  • Parent’s Centre (birth from the viewpoint of expectant parents)  was formed in 1952.
  • From the history of Parent’s Centre, The Trouble With Women, the impetus initially focused on parent access to children in pediatric wards closely followed by childbirth education.

In the US there was nothing like Parent’s Centre. Every State is quite different. By 1957 there were no midwives in the US. They were outlawed. Staff was obstetrical nurses.

However, in the US, Lamaze classes began to be taught in every hospital. The Bradley Method was considered more up-market with privately taught classes. From the 1950s-70s there was a high societal expectation that expectant parents take either a Lamaze or Bradley class in the US. Birth professionals saw many millions of skilled birthing women and skilled birth-coaches. From this, the ‘evidence-based practice’ of the post WW2 era dramatically and positively changed.

In New Zealand, a woman had to get a prescription from her doctor as ‘treatment’ to attend a Parent’s Centre childbirth class that taught Grantly Dick-Reid’s method from the 1950s onwards. The first obstetrical chair was appointed in 1931.

By this time in the United States and New Zealand, modern, post WW2 women seemed to have forgotten childbirth’s past just as immunization and antibiotics wiped out the memories of the devastation caused by infections and communicable diseases.

  • Ideas
    • The medical profession was taking over birth
    • Brilliant link to the history of obstetrics
    • All birthing women were treated the same
    • Birth was now treated as a disease
    • Birth was taking place in a hospital
    • Women seeking natural birth learned skills with the hopes to achieve:
    • Natural birth
    • Pain-free labor
    • Less medical care
  • Language
    • Women want to reclaim birth
    • Follow your doctor’s orders
  • Actions
    • Teach skills to those women who want a natural birth
    • Parent Centre Grantly Dick-Read then Lamaze classes were taught in NZ
    • Lamaze/Bradley Method classes were taught the in US
  • Policies and Societal Messages
    • In NZ, midwives being brought into the medical profession and obscured as a separate specialty and outlawed in the US
    • No real policies for birthing families
    • No Birth Plans
    • Birth skills for only those women seeking those 3 goals
      • Women not seeking natural birth (those 3 goals) remained in the global Truth … ‘There’s no way to know what your birth will be like’
      • Women seeking a natural birth, learning skills but failed to achieve those three goals remained in the global Truth … ‘There’s no way to know what your birth will be like’
    • Split birth between those seeking natural birth, pain-free labour, and less medical care from those who have medical births
  • Goals
    • Safe birth for mother and baby
    • Follow your doctor’s orders
    • Skills for those seeking natural birth, pain-free labor with less medical care
    • Becoming a mother

What happened under this system? 

  • Most women feel powerless
  • Follow their doctor’s orders
  • Accept ‘There’s no way to know what your birth will be like’
  • Birth just happens
  • Women seeking skills-based classes
  • Put a great deal of faith in skills
  • Thrilled when skills work
    • They feel in control
    • They are admired
  • Terribly disappointed when skills don’t work and revert back to ‘There’s no way to know what your birth will be like and just happens’
    • They feel out of control
    • They don’t feel admired
  • Not enough women achieved the three goals
  • The next generation of birth advocates turned away from skills and looked for another way for Women to have control

Societal view

  • The beginning of the Mummy Wars about birth:
    • Natural vs medical
  • The global Truth still plays a large part
  • Women should have more control but how?
  • Birth has become very medical for all women
    • Safe … a view held by many
    • Disempowering … a view held by some
  • Birth advocates
    • Midwives
    • Consumer groups

1970s-1990s

Ideas

  • Women know what they want for their birth
  • Women should have choices
  • Birth is instinctive
  • Women know how to birth
  • Midwives are the best care providers for low-risk normal pregnancy and birth
  • Birth is essentially safe
  • Women should be left alone to discover birth herself
  • Birth is being more medicalized
  • Home birth is the best place to birth

Language

  • ‘Cats and cows aren’t taught to birth, women don’t need to be taught’
  • ‘Just trust’
  • ‘Don’t be afraid of birth, Women have always birthed’
  • ‘Being a midwife is a calling’
  • ‘Midwives are born with ancient knowledge’
  • ‘Midwives shouldn’t be medically trained’
  • ‘Women should be in partnership with midwives’

Actions

  • A committed group of consumers begins to work with midwives to develop a ‘partnership’ and respecting Women’s choice to have a midwife and home birth
  • Consumer birth advocates and Midwives begin to work together
  • Most Women still follow doctor’s orders
  • Fathers coming into births

Policies

  • Childbirth education classes available
  • Political organizing

Goals 

  • Midwives accepted and if possible the primary birth professional
  • Women’s choices totally respected
  • Natural birth
  • No medical interventions

What happened under this system? 

  • Cesarian rate rises
  • Birth began to change for women and midwives
  • The oppositional relationship became entrenched:
    • doctors vs midwives
    • hospital vs home birth
    • medical vs natural birth

Societal view

  • Confusion
  • Women’s beliefs pitted against each other
  • ‘Choice’ was an anti-medical statement

NZ from 1990s-present … Midwifery Partnership

  • Ideas
  • Midwives and Women in Partnership
  • Choice respected
  • The cesarian rate will come down
  • More home births
  • Fewer interventions
  • Birth is essentially safe
  • Language
    • ‘Pregnancy and childbirth are normal life events that rarely require medical care’
    • ‘ A relationship of trust, shared decision making and responsibility, negotiation and shared understanding. The word midwife means ‘with woman’ and is reflective of the midwife’s role in accompanying the woman on her journey through pregnancy and childbirth into motherhood. The midwife acknowledges the woman’s autonomy in her own life and respects the decisions she makes for her childbearing experience. The midwife has a responsibility to share all the available information with the woman and to respect her values and beliefs. This includes working with her to involve her chosen family members. Midwifery Partnershp
  • Actions
    • Set up NZCOM as an autonomous professional organization
    • NZCOM creates midwifery training
    • Fewer GPs doing births
    • Majority of Women have their own continuity of care midwife
  • Policies 
    • NZ maternity care is midwifery-led
    • No shared care
    • Women’s choices respected
  • Goals 
    • More physiological births
    • More primary birth units
    • Respect Women’s choices
    • More home births
    • Fewer interventions
    • Fewer Cesareans

Societal view

  • Confused
  • Women love their continuity of care midwives
  • Women choosing more elective Cesareans
  • Fewer physiological births
  • A small percent of home births

Next childbirth trend

  • Ideas
    • Birth is an activity every pregnant woman must do to end a pregnancy
    • Every activity is best done with skills
    • Pregnancy and birth share our commonality wrapped around our individuality
  • Language
    • “As a midwife, I’ll respect your choices and you must become skilled to do the activity of birthing your baby no matter the circumstances’
    • ‘Here’s a list of skills-based methods choose one or more and learn them’
    • ‘We’ll mark in your notes both your choices and the skills you’ve learned’
    • ‘I’ll praise you when I see you coping well’
    • ‘I’ll encourage you to use skills when you seem overwhelmed’
    • ‘It’s essential your partner/other share the same set of skills and help you cope, manage and feel in control’
  • Actions
    • Recognize that Women as Partner can strengthen the Partnership Model if midwives give this simple protocol script
    • Women want to be told by trusted professionals what they can do to make birth safe and positive so they don’t end up feeling controlled by the global Truth
    • Midwives turn toward their Partner for change
  • Policies 
    • None yet other than this NZ midwife 2-year effort
  • Goals 
    • Improve the working relationship between Midwife and Women
    • See more mothers and fathers using skills in every birth from home alone to non-labouring Cesarean
    • Enjoy working together as mutually skilled partners
    • Increased positive births
    • Increased birth satisfaction no matter the circumstances
    • Birth is seen of as an activity now linked to skills and overlaid with choices
  • Societal view
    • When a woman falls pregnant, it’s normal and natural to seek out one or more skills-based methods to learn, practice and then use throughout baby’s birth journey
    • Fathers/others consider it normal and natural to:
      • Help woman prepare her body to give birth
      • Learn birth-coaching skills
      • Help the birthing women cope, manage, stay on top of , feel in control, handle, and deal with all the internal sensations and external factors

Further reading:

 

 

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