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

What is a midwife?When should I see a Midwife?How do I find a Midwife?What will my midwife do?What can I do?Professional Organisations for Midwives & Helpful Websites/Articles

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 postnatal period are normal.

In pregnancy your midwife will see you regularly to monitor your health and the baby’s well being. 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 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, you the best thing you can do is take great care of yourself and your baby.

Professional Organisations for Midwives & Helpful Websites/Articles

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

To read more about the role of a Doula, 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/maternity-services

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

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

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KK

Hello,
In the event of a miscarriage, would my midwife be paid differently depending on how far along I am? As in first/second trimester?

Karen

Is it normal for midwives to do home visits.

Rochelle Gribble

Hi Karen, This varies hugely. Unfortunately, the answer is: Some do, and some don’t! If you are talking about post-birth, then yes, it is. If you are talking about before the birth, then it is more variable. Sorry not to be able to be more helpful!

tara

Hi there. Can u please tell me what LMC earn per module? Thank you

Kathy Fray

I’m not sure what you are saying Elise.
Pregnant women can choose to have a self-employed LMC midwife who has Access Agreements to deliver at particular hospitals and birth centres of their choice – and lots of LMCs work out of Middlemore.
Alternatively, women can choose the hospital-based Community Midwives who they see antenataly and postnataly, and then they use the Core shift-working midwives at Middlemore to assist at their labour-birth.
Warm rgds, Kathy Fray, KIWI FAMILIES Resident Midwife

elise

do you have to have a midwife to give birth at the hospital? because i was told that im not allowed to have my baby at middlemoore because of this.

Marquis

Great article, though wanted to point out midwives regained autonomy in 1990, rather than it being newly issued.

s paul

Hi Paula

I was hoping you could help me clarify some queries I’ve got

-Is it essential to have a midwife when pregnant. Would a GP be sufficient
-What if I want to give birth at a hospital under the watchful eye of a medical consultant? Do I need to make special request for this with the midwife?
-Under normal circumstances is it just the midwife who will deliver the baby? Or will she have assistance from a medical consultant if necessary?

Hi Paula It is not law to have a midwife while pregnant – that is the woman’s choice. However the FREE maternity care system is NZ is the government paying for the pregnant woman to have an LMC (Lead Maternity Carer) to look after her with antenatal clinic appointments, during the labour-birth and postnatal home visits. And most LMCs in NZ are Midwives – though a few GPs still provide LMC services. All LMCs (midwives & GPs) have the role of monitoring that the pregnancy and labour stay within the realm of normal. When anything becomes outside this, we have strict legislation… Read more »

mary

How often a midwife visits a newborn at home, cos my midwife only came three times and now my baby is a month now. I want to know becos my baby cries a lot nearly every night.

Kathy Fray

LMC Midwives do at least seven postnatal visits total: Every day or every second day at the postnatal care facility, then a visit within 24 hours of the woman arriving home, and a total of at least five home visits in the first 4-6 weeks.
Rgds, Kathy Fray, Kiwi Families in-house Midwife

Rochelle Gribble

Thanks Kathy! Hope all is well 🙂

Rochelle Gribble
Editor
Kiwi Families
http://www.kiwifamilies.co.nz

adele

Hi does the midwife have to birth the baby to get paid as I want my baby in the hospital due to past two babies but feel she is steering me away from wanting/getting an epidural as she will have to pass care over and not get paid? is this right? it is making me nervous as want the option and am 33 weeks nw.thanks

Rochelle Gribble

Hi Adele, midwives get paid for births in three parts – you can read more about this here: http://www.midwife.org.nz/womens-resources/faqs. There are lots of variables, but your midwife can still be part of your care if you want an epidural. It’s worth talking this over with your midwife, or finding someone at the hospital to chat with if you don’t feel satisfied. Good luck!

Kathy Fray

Your LMC is paid to attend your spontaneous labour as your Primary Care provider. When a woman decides to have an epidural, that is utilising Secondary Care services at the Hospital, and as such her LMC can then opt to handover care to the Core midwives, or continue care. Because epidurals increase the risk of birth complications, many naturally-minded LMCs can try to steer their clients towards using other methods to manage the pain of labour. But regardless of whether you do or don’t utilise an epidural, your LMC still gets paid for your birth. All the best, from Kathy… Read more »

Rochelle Gribble

Hi Mary,

If you are concerned about your baby or want to get some extra help, you can contact Plunket or your local Well Child provider. You can contact Plunket on http://www.plunket.org.nz/ or toll free on 0800 933 922. Good luck!

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