scholarly journals First Birth at Home or in Hospital in Aotearoa/New Zealand: Intrapartum Midwifery Care and Related Outcomes

2021 ◽  
Author(s):  
◽  
Suzanne Claire Miller
Keyword(s):  
New Zealand ◽  
Focus Group ◽  
Emotional Health ◽  
Care Provision ◽  
First Birth ◽  
Aotearoa New Zealand ◽  
Foetal Monitoring ◽  
First Time Mothers ◽  
First Time ◽  
At Home

<p>A woman's first birth experience can be a powerfully transformative event in her life, or can be so traumatic it affects her sense of 'self' for years. It can influence her maternity future, her physical and emotional health, and her ability to mother her baby. It matters greatly how her first birth unfolds. Women in Aotearoa/New Zealand enjoy a range of options for provision of maternity care, including, for most, their choice of birth setting. Midwives who practice in a range of settings perceive that birth outcomes for first-time mothers appear to be 'better' at home. An exploration of this perception seems warranted in light of the mainstream view that hospital is the optimal birth setting. The research question was: "Do midwives offer the same intrapartum care at home and in hospital, and if differences exist, how might they be made manifest in the labour and birth events of first-time mothers?" This mixed-methods study compared labour and birth events for two groups of first-time mothers who were cared for by the same midwives in a continuity of care context. One group of mothers planned to give birth at home and the other group planned to give birth in a hospital where anaesthetic and surgical services were available. Labour and birth event data were collected by a survey which was generated following a focus group discussion with a small group of midwives. This discussion centred around whether these midwives believed their practice differed in each setting, and what influenced care provision in each place. Content analysis of the focus group data saw the emergence of four themes relating to differences in practice: midwives' use of space, their use of time, the 'being' and 'doing' of midwifery and aspects relating to safety. Survey data were analysed using SPSS. Despite being cared for by the same midwives, women in the hospital-birth group were more likely to use pharmacological methods of pain management, experienced more interventions (ARM, vaginal examinations, IV hydration, active third stage management and electronic foetal monitoring) and achieved spontaneous vaginal birth less often than the women in the homebirth group. These findings strengthen the evidence that for low risk first-time mothers a choice to give birth at home can result in a greater likelihood of achieving a normal birth. The study offers some insights into how the woman's choice of birth place affects the care provided by midwives, and how differences in care provision can relate to differences in labour and birth event outcomes.</p>

scholarly journals First Birth at Home or in Hospital in Aotearoa/New Zealand: Intrapartum Midwifery Care and Related Outcomes

2021 ◽  
Author(s):  
◽  
Suzanne Claire Miller
Keyword(s):  
New Zealand ◽  
Focus Group ◽  
Emotional Health ◽  
Care Provision ◽  
First Birth ◽  
Aotearoa New Zealand ◽  
Foetal Monitoring ◽  
First Time Mothers ◽  
First Time ◽  
At Home

<p>A woman's first birth experience can be a powerfully transformative event in her life, or can be so traumatic it affects her sense of 'self' for years. It can influence her maternity future, her physical and emotional health, and her ability to mother her baby. It matters greatly how her first birth unfolds. Women in Aotearoa/New Zealand enjoy a range of options for provision of maternity care, including, for most, their choice of birth setting. Midwives who practice in a range of settings perceive that birth outcomes for first-time mothers appear to be 'better' at home. An exploration of this perception seems warranted in light of the mainstream view that hospital is the optimal birth setting. The research question was: "Do midwives offer the same intrapartum care at home and in hospital, and if differences exist, how might they be made manifest in the labour and birth events of first-time mothers?" This mixed-methods study compared labour and birth events for two groups of first-time mothers who were cared for by the same midwives in a continuity of care context. One group of mothers planned to give birth at home and the other group planned to give birth in a hospital where anaesthetic and surgical services were available. Labour and birth event data were collected by a survey which was generated following a focus group discussion with a small group of midwives. This discussion centred around whether these midwives believed their practice differed in each setting, and what influenced care provision in each place. Content analysis of the focus group data saw the emergence of four themes relating to differences in practice: midwives' use of space, their use of time, the 'being' and 'doing' of midwifery and aspects relating to safety. Survey data were analysed using SPSS. Despite being cared for by the same midwives, women in the hospital-birth group were more likely to use pharmacological methods of pain management, experienced more interventions (ARM, vaginal examinations, IV hydration, active third stage management and electronic foetal monitoring) and achieved spontaneous vaginal birth less often than the women in the homebirth group. These findings strengthen the evidence that for low risk first-time mothers a choice to give birth at home can result in a greater likelihood of achieving a normal birth. The study offers some insights into how the woman's choice of birth place affects the care provided by midwives, and how differences in care provision can relate to differences in labour and birth event outcomes.</p>

The novice birthing: theorising first-time mothers’ experiences of birth at home and in hospital in Australia

Midwifery ◽  
2010 ◽  
Vol 26 (1) ◽  
pp. 53-63 ◽  
Author(s):  
Hannah G. Dahlen ◽  
Lesley M. Barclay ◽  
Caroline S.E. Homer
Keyword(s):  
First Time Mothers ◽  
First Time ◽  
Mothers Experiences ◽  
At Home

scholarly journals The Maternity Experience of New Zealand Samoan First-time Mothers

2021 ◽  
Author(s):  
◽  
Marianna Churchward
Keyword(s):  
New Zealand ◽  
Interpersonal Relationships ◽  
Intergenerational Relationships ◽  
Embodied Experience ◽  
Theoretical Frameworks ◽  
Pregnancy And Childbirth ◽  
Early Motherhood ◽  
First Time Mothers ◽  
Before And After ◽  
First Time

<p>Motherhood is a life-changing event. It is a significant milestone for a woman. This thesis explores the concept of motherhood from the perspectives of Samoan first-time mothers living in New Zealand. The thesis traces their experiences from conception, pregnancy and childbirth through to early motherhood. Their narratives are the focus of the research and are complemented by the viewpoints from some of their own mothers, and maternity health professionals.  The overarching question, ‘What are the experiences of a group of first-time New Zealand-born Samoan mothers before and after birth?’ was framed from a strengths-based approach and draws on work which defines a strength-based approach to resilience as research that changed traditional deficit perspectives. Rather than focusing on how individuals or families have failed or struggled, emphasis is directed to how they can succeed or how they can manage (Walsh, 2006).  Interviews were conducted in Wellington and Auckland with 11 first-time Samoan mothers prior to childbirth and follow-up interviews with nine of these women within 12 months of the birth of their child. Five Samoan grandmothers, i.e. mothers of these first-time mothers, five midwives and five Plunket nurses were also interviewed.  Four sites of analysis were examined – the embodied experience of conception and pregnancy; the process of labour and childbirth; the new norm of early motherhood, and interpersonal relationships and encounters. Analysis was conducted through the overarching lens of the Samoan concept of the vā (Wendt, 1999), the theoretical frameworks of ‘negotiated spaces’ (Mila-Schaaf and Hudson, 2009) and sophisticated mediation (Churchward, 2011).  It was found that the first-time New Zealand-born Samoan mothers engaged in a complex and, at times, contradictory process of seeking support during their transition to motherhood. They demonstrated resilience and their skill as sophisticated mediators. The women depended on relationships, some biological and some not, that were reliable and sustainable and the interaction and care that the relationship offered. Intergenerational relationships were important to these first-time New Zealand-born Samoan mothers, particularly ones they had with their own mother, or someone close to them, as it was pivotal in the way in which they constructed their maternity experience.</p>

scholarly journals "Moving things forward": Birthing Suite culture and labour augmentation for healthy first-time mothers.

2021 ◽  
Author(s):  
◽  
Suzanne Miller
Keyword(s):  
Continuity Of Care ◽  
Tertiary Hospital ◽  
First Birth ◽  
Good Doctor ◽  
Normal Birth ◽  
Healthy Women ◽  
First Time Mothers ◽  
Generative Mechanisms ◽  
The Impact ◽  
First Time

<p>In Aotearoa New Zealand, healthy women giving birth for the first time may plan to give birth in range of settings - from home to a tertiary hospital where surgical and anaesthetic services are available. Each birth location has its own culture, and the extent to which this culture influences the birth experience lies at the heart of this research. Just twenty-three percent of first-time mothers experience a normal birth with no obstetric interventions, and the chosen place of birth is implicated in this statistical outcome. Tertiary maternity settings report the highest rates of birth interventions, even for healthy women who can anticipate straightforward labour experiences. Among the most frequently used birth interventions are labour augmentation procedures - artificial rupture of membranes and administration of synthetic oxytocin infusions.   My critical realist ethnography aims to explore the cultural landscape within one tertiary birthing suite and in doing so to identify the generative mechanisms that influence the likelihood of labour augmentation for well first-time mothers. I begin with a retrospective chart review to uncover the magnitude of the use of augmentation procedures for a sample of healthy women presenting in labour to the birthing suite over one calendar year. Interviews with women who experienced long labours yield insights about their decision-making with respect to augmentation. Focus groups and interviews with midwives and obstetric doctors contribute an understanding of factors associated with their use of augmentation, and a period of non-participant observation in the birthing suite illuminates the nuanced ways the unit culture contributes to the permissive use of augmentation procedures in this birthing environment.  Findings reveal that sixty percent of women experienced labour augmentation procedures and for one third of them, the augmentation was not indicated according to the clinical guideline in use at the time. Pressure to be “moving things forward” characterises the birthing suite culture. The identified generative mechanisms that combine to influence the likelihood of augmentation include a lack of belief in birth, not valuing midwives, the education and socialisation of midwives and doctors, and the industrialisation of birth - all underpinned by available social discourses about being a good mother, a good midwife or a good doctor.  Ironically, the very attributes that make the tertiary hospital the ideal place to be when birth is complex or the unexpected happens (‘poised-ness’ for action, being a ‘well-oiled machine’ for emergency care, surveillance and control) are the same attributes that create a dis-abling environment for physiological first birth to unfold at its own pace. The ‘perfect system’ is in place; a well-embedded midwifery-led continuity of care model incorporating seamless and integrated secondary referral processes. But despite this potentially enabling model of maternity care, once ‘nested’ within the tertiary hospital setting the impact of social, professional and industrial discourses overwhelms the salutogenic factors that should protect normal birth.  A re-focussed commitment to providing continuity of care across the labour continuum, home visiting in early labour, enhancing physiological birth support in both the relational and environmental realms, averting the obstetric gaze and prioritising women’s needs over institutional needs represent the best way forward as strategies to resist the inexorable rise of obstetric intervention. Midwives are well-positioned to respond to this call. Reclaiming their expertise in support of physiological first birth by driving the practice and research agenda presents the optimal way to “move things forward” for women.</p>

“We are not privileged enough to have that foundation of language”: Pasifika young adults share their deep concerns about the decline of their ancestral/heritage languages in Aotearoa New Zealand

2019 ◽  
Vol 15 (2) ◽  
pp. 131-139
Author(s):  
Lina-Jodi Vaine Samu ◽  
Helen Moewaka Barnes ◽  
Lanuola Asiasiga ◽  
Tim McCreanor
Keyword(s):  
Young Adults ◽  
New Zealand ◽  
Focus Group ◽  
Language Policy ◽  
National Language ◽  
Minority Languages ◽  
Focus Group Interviews ◽  
Heritage Languages ◽  
Aotearoa New Zealand ◽  
Group Interviews

Focus group interviews conducted with Aotearoa New Zealand–born Pasifika young adults aged 18–25 years highlighted their intense apprehension about the diminishing abilities of New Zealand–born Pasifika people to speak their ancestral/heritage Pasifika languages in Aotearoa. Some Pasifika languages are also declining at their homeland wellsprings. There has been no comprehensive strategic national language policy developed in New Zealand where Pasifika heritage and other community languages can flourish. New Zealand appears to default to a monocultural given where English prevails without critique. Minority languages are battling it out with each other for legitimacy of existence. Resulting from New Zealand’s failure to create a comprehensive languages strategy for all, younger generations of Pasifika neither have fluency in their ancestral languages which impact negatively on their identity security and their ability to attain critical fluency in English to thrive as their migrant parents and grandparents envisioned they would in Aotearoa New Zealand.

Shifting Identities: Uncovering Complexities of Psychosocial Aspects of Care for an Adolescent Child Dying at Home in Rural Aotearoa/New Zealand

2015 ◽  
Vol 19 (4) ◽  
pp. 73-76
Author(s):  
Francie Dulieu,
Keyword(s):  
New Zealand ◽  
Sick Child ◽  
Human Relationships ◽  
Adolescent Child ◽  
Aotearoa New Zealand ◽  
Technical Competencies ◽  
Psychosocial Difficulties ◽  
Dying At Home ◽  
Shifting Identities ◽  
At Home

This narrative integrates ontological and technical competencies, along with perceptions, thoughts, and emotions, thus illuminating the fragility of human-to-human relationships. It uncovers many psychosocial difficulties encountered when caring for an adolescent child at home in rural Aotearoa/New Zealand. Revealing Sophie’s “shifting identities” as she transitioned from well child, to sick child, to terminally ill child, I quietly observed Sophie’s parents and her brother, as they joined the difficult dance, stepping skillfully around her, witnessing turning points and transformations as they unfolded, along with the hard and often silent work of dying, as explored by Coyle (2006).

New Views on a ‘Stuck’ Issue: Communicating about Childhood Immunisation in Aotearoa New Zealand

2014 ◽  
Vol 152 (1) ◽  
pp. 40-56 ◽  
Author(s):  
Elspeth Tilley ◽  
Niki Murray ◽  
Bronwyn Watson ◽  
Margie Comrie
Keyword(s):  
Decision Making ◽  
New Zealand ◽  
Focus Group ◽  
Research Process ◽  
Decision Makers ◽  
Communication Process ◽  
Qualitative Investigation ◽  
Childhood Immunisation ◽  
Aotearoa New Zealand ◽  
Depth Interviews

This article explores attitudes towards immunisation and immunisation communication materials among parents and caregivers currently facing immunisation decisions in Aotearoa New Zealand. The research aimed to discover, from an open-ended qualitative investigation, new ways to conceptualise and explain immunisation decision-making, and identify participants' own views on approaches worth trialling as ways to increase immunisation rates. The research used communication artefacts as talking points, and an action research process to modify these to reflect participants' design suggestions, but was primarily exploratory. It started a broad conversation with participants about their decision-making influences rather than being designed to test any particular attributes of the immunisation communication process. From a qualitative analysis of transcripts of focus-group and in-depth interviews with 107 immunisation decision-makers, themes were drawn. Applying an emic process enabled identification of participants' own ideas that have now broadened the range of possible approaches currently being considered for immunisation communication in Aotearoa New Zealand. Given that immunisation decline is a problem internationally, these participant-driven ideas may also be worth testing in other contexts.

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