Abstract:
This Professional Doctorate in Midwifery explores the development of maternity services in New Zealand subsequent to legislative changes in 1990 enabling midwives to provide the same services as doctors and access the same funding for the provision of care for childbearing women. The papers in this portfolio describe and analyse challenges faced by New Zealand midwives in achieving their full potential as autonomous health professionals and the strategies they developed to survive within a healthcare environment that despite changes, remained medicalised.
Throughout this portfolio, a theoretical framework based on complexity theory provides a lens for critique of the varying challenges to midwifery development and strategies to progress the profession. The seven papers that make up this portfolio were developed and written over a five-year period from 1999 to 2003. During this time I was involved in various activities supporting midwifery in New Zealand, including the establishment of a postgraduate midwifery programme and participation in the refocusing of both the New Zealand College of Midwives and the Midwifery and Maternity Provider Organisation. These activities took me to various parts of the country, enabling me to maintain contact with midwives from a variety of settings.
The first paper sets the scene for the portfolio by exploring the socio-political context of contemporary midwifery in New Zealand. The second paper tracks the emergence of a theoretical framework out of Complexity theory and presents a set of principles, which guide the critique of midwifery services and professional development, explored in the subsequent papers. Part Three documents the development of a contextual scanning tool, used to analyse the organisation of maternity care by midwives in rural settings. Part Four presents the findings of the scan and strategies for consolidating the role of midwives as key providers of maternity services in rural localities. Part Five documents the development of a programme for optimising midwifery leadership within the health sector, while Part Six explores the risks and opportunities for midwives with the development of clinical governance strategies by District Health Boards. Part seven focuses on strategies to increase the potential for midwives to consolidate, maintain and further develop community-based maternity services throughout the country.
This portfolio provides an organisational analysis of contemporary maternity services in New Zealand and presents a multifaceted approach to securing midwifery as a key health profession and midwives as the main provider of maternity services to women in this country. The findings of this collection of works, identified midwifery in New Zealand as precariously positioned within a rapidly changing health service environment. While appearing most vulnerable, midwifery within the rural and primary settings appeared to offer the most potential for innovative development in order to secure the place of midwives as the prime providers of health care for women in childbirth.
