What to ask a midwife

This article explains the role of the midwife in New Zealand, how to find a midwife and what they will do during pregnancy, birth and afterwards.

What is a Midwife?

The meaning of midwife is ‘with woman’. The term applies to a health professional who supports another woman through pregnancy, childbirth and the postnatal period. The origins of midwifery go back to time immemorial – women have always supported other women through childbirth and continue to do so today in various forms around the world. The French word for midwife ‘la sage femme’ translates to ‘the wise woman’, which is still how midwives are perceived in many cultures around the world.

In New Zealand midwives have been independent practitioners since 1990, enabling them to work as Lead Maternity Carers (LMCs) and take a proactive role in normal pregnancy and childbirth.

Midwives are educated through tertiary institutions in Auckland, Hamilton, Wellington, Christchurch and Dunedin. They undertake a 3 year programme incorporating academic study with clinical placements in the hospital and community setting. Some midwives are nurses also and may have done shortened courses in midwifery, and some midwives in New Zealand trained overseas, but all qualifications and Annual Practising Certificates are monitored by the Midwifery Council of New Zealand.

In order to maintain an Annual Practising Certificate (APC) a midwife must attend compulsory annual and triennial updates and continuing education, as well as carrying out professional activities, such as teaching and mentoring.

Midwifery care is free to all women who are residents of New Zealand. LMCs are paid per module of care that they provide for women: pregnancy is divided into 3 modules; there is also a birth module and a post natal module. The majority of women have midwives as LMCs, but some do choose an obstetrician or GP if this available to them.

When should I see a Midwife?

Midwives can work in different ways and in different settings in New Zealand:

  • As independent midwives working as LMCs
  • As hospital midwives, employed by District Health Boards (DHBs)
  • As childbirth educators
  • As midwifery managers in institutions
  • As midwifery educators/ lecturers in education institutions or DHBs
  • As special care baby nurses

How do I find a Midwife?

It’s common for women to find a midwife by talking to friends, whanau and acquaintances.  After all, midwives usually work in a relatively small geographic area, so other mums who live close by should be able to give you some good advice.

If you don’t have anyone who can give you a recommendation, look around to see if you have a midwife clinic in your area which will be able to provide you with a list of local midwives.

Another really good place to start is with the New Zealand College of Midwives (see their website address details below).  They have a contact list for midwives in each area of New Zealand.

What will my midwife do?

A midwife can provide all of your maternity care if your pregnancy, childbirth and post natal period are normal.

In pregnancy your midwife will see you regularly to monitor your health and the baby’s wellbeing. Often this will be done at a midwife clinic, but occasionally she may visit you in your home. She will support and advise you throughout the pregnancy – ensuring that you and your baby remain in optimal health. Your midwife is a great source of information and this will be backed up by childbirth education classes, information from other health professionals and family/ whanau.

If your LMC is a midwife then she will usually care for you during childbirth. You may also receive care from hospital/DHB midwives who provide a supportive role for LMCs and families in the birthing rooms.

Midwives provide postnatal care for up to 6 weeks following the birth of your baby. Initially this will be in a hospital or birth centre, unless you have birthed at home, and then the midwife will visit you at home as often as you both feel is necessary.

If the midwife is concerned for the wellbeing of you or your baby at any time, she will refer you to an obstetrician for advice or medical care. There are national guidelines regarding conditions that require referral to obstetricians, for example:

  • In pregnancy – multiple births, previous caesarean section, pre-eclampsia, breech position.
  • During birth – fetal distress, abnormally slow progress in labour.
  • After the birth –  abnormal blood loss, postnatal depression, abnormality with baby.

If your condition warrants your care being transferred from your LMC midwife to an obstetrician, a three way agreement should be made between yourself, the midwife and the obstetrician. The LMC midwife can continue to support you, but decisions regarding your maternity care would become the responsibility of the obstetrician (this is called secondary care), until such a time as the care was transferred back to the midwife – through joint agreement once again.

Sometimes the LMC midwife or GP may refer you to an obstetrician for advice, without transferring your care to secondary care; for example if your baby seemed large or small for the number of weeks pregnant. You would not pay for this consultation, as it was requested by your LMC, not yourself, and you would continue to receive care from your LMC.

What can I do?

As soon as you are pregnant, book your midwife as they are very busy in some areas of New Zealand.

Ask your chosen midwife about her qualifications and experience – particularly if you have any risk factors (such as high blood pressure or previous complicated births).

If you have chosen a home birth, then ask your midwife about her experience at home births, her systems for dealing with complications at home, equipment she carries and her back-up system for obtaining help in the community.

Access information about pregnancy and birth from various sources – childbirth education classes, midwife appointments, books, the Internet and friends and family.

Ask about her arrangements to cover time off and holidays (you may wish to meet her locum or back-up midwife too).

Of course, the best thing you can do is take great care of yourself and your baby!

Useful websites & articles on midwives

For more information on the role of the Lead Maternity Carer, see our article Choosing a LMC

To read more about the role of the Obstetrician or Family Doctors (GP) click here.

www.midwiferycouncil.org.nz

The Midwifery Council for New Zealand is responsible for ensuring that all midwives who hold current Annual Practising Certificate are fit to practise midwifery.

www.midwife.org.nz

The New Zealand College of Midwives is a recognised professional body and is a voice for midwifery in New Zealand. This excellent website has a section for both midwives and women – with information on the role of the midwife, the services they offer and help on finding a midwife.

http://www.health.govt.nz/our-work/life-stages/maternity-and-breastfeeding

The Ministry of Health maintains an active section on maternity care and current changes in New Zealand.

Paula Skelton

Paula Skelton is a qualified NZ nurse and midwife, a midwifery & childbirth educator and the mum of three lovely girls.

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