1. Regulation of Midwives –ensuring public safety along with confidence and trust in Midwifery
South Pacific Nursing and Midwifery Forum
Honiara 3 November 2016
Judith McAra-Couper Chair
Sharron Cole CEO/Registrar
Midwifery Council of New Zealand

2. Background
Midwives in New Zealand have been able to practice autonomously since 1990 and as a result a unique maternity model of care has developed.
Women are able to choose care from a Lead Maternity Carer (LMC) 92% of whom are midwives, the rest being obstetricians or general practitioners.
The Midwifery Council of New Zealand was established as the regulatory authority for midwives in 2004.

3. Background cont…
Despite a maternity system with excellent outcomes and high levels of satisfaction in the service, there appears to be a ‘perception problem’ about midwifery that could impact on public confidence.

4. 03 01 02 Why do we think there is a perception problem ?
Not professional 03 01 02
Sisterhood
Bad media
We assume mothers see their Plunket nurse or GP as more ‘qualified’ than their midwife
The bad stories define midwifery
We think there is a perception amongst the public that midwives put their own values ahead of the safety of mothers and babies
“Mum & baby deaths; Coroner slams midwife”
‘Public trusts nurses more than midwifes’
Some midwives don’t want to be seen as ‘medical professionals’
Research from the University of Otago implies that midwives without nursing degrees are less qualified and therefore less professional than and not as safe as midwives with nursing degrees.
Plunket has a high profile and is a ‘beloved’ and trusted brand amongst the New Zealand public, therefore we assume they are seen as more professional.

5. Research
Qualitative research was carried out using focus groups in different parts of New Zealand.
Focus groups took place in Auckland, Dunedin and in a rural area outside of Dunedin.
Participants were sourced from a range of socio-economic backgrounds, with a wide mix of experiences from high risk, high anxiety births to low risk, low anxiety.

6. Findings from from the Research
No Trust Problem
The midwife is highly trusted. She knows what to do at every step. Mothers trust her to ‘hit the red button’ and refer to hospital care in a crisis. She is reassuring because she ‘actively observes’ and ‘constantly monitors’ mothers.

7. Findings from the Research
No crisis of public confidence
Even mothers who had high risk births, miscarriages or negative experiences with their first midwife don’t see these experiences as evidence of a crisis in the profession. The problem was either the individual midwife (not the profession) or they were just ‘unlucky’ – ‘bad things can happen’.

8. Findings from from the Research
Professionalism not undermined
The intimate, informal relationship between a midwife and a mother (‘She’s like my second mum’) does not appear to be undermining the image of the midwife as a medical professional. Both perceptions sit easily alongside each other.

9. Findings from from the Research
Negative media not a problem
Mothers are aware of negative stories but these are not undermining confidence in midwifery. The levels of trust in individual midwifes are too strong. There is empathy and concern, but this is not directed at midwives or the profession.

10. Findings from from the Research
Midwives seen as experts
Midwives are seen as the ‘experts’ in birthing. Mothers assume they’re highly qualified (just as they assume a GP is qualified, otherwise ‘they can’t call themselves a doctor’). There is general awareness that midwifery is a four year degree.

11. Findings from from the Research
Midwives seen as experts Ahead of Plunket & GPs
The midwife is seen as more expert and better qualified in the areas of pregnancy, birth, and post birth than the Plunket nurse (or even the GP), and more trusted than the Plunket nurse, who is seen negatively as an extension of government bureaucracy, ticking boxes on a clip board and wearing a uniform.

12. The ideal midwife is like the farmer’s wife
She always knows what to do in a crisis. She can fix the quad bike if it breaks down, birth a calf in a storm, and get you back home safely. She knows what to do when things go wrong.
She’s empathetic, but won’t stand for any nonsense. She knows when she’s hit her limits, and brings others on board if necessary.
She is the expert who tells me what I need to do.

13. Findings from the Research Areas for improvement
Weak awareness of regulation among the research participants
Proof needed that regulation exists
Council needs a higher profile
Midwives too busy
Funding Model problematic
First meeting with a midwife is critical

14. Promote the Council as the guardians of professional standards
Build on high levels of trust
Stop small problems becoming big 1 4
The midwife has the highest levels of trust. That makes her the best vehicle for communicating messages to the public (even more effective than media). What gets communicated to mothers at the first meeting about the role of the Council and the professional standards expected is key.
It’s your job to stop small problems becoming big. That gives you a mandate to work more closely with professional partners; to support them to do their job well; reducing the need for regulation by intervening early on. This is an opportunity to demonstrate to your peers that you are the guardians of professionalism in midwifery.
Go to where mothers are 2
Biggest challenge, your peers
Mothers are checking up on midwives on sites like ‘Oh Baby’/Huggies & chat rooms. Rather than trying to drive them to the Council web site, we need to go to where they are and embed our messages on these sites. 5
Not the public. Levels of trust are high amongst the public. Although untested, we can assume levels of trust are not as high amongst your peers (Health & Disability Commission, Coroners, Ministers, Midwifery College etc.) A greater focus needs to go on changing their perceptions.
Promoting professionalism 3
As a regulator you have a key role in promoting professionalism (rather than ‘policing’ midwifery). Making sure midwives are registered, fit to practice and of a professional standard is your primary role (positive). Managing complaints (negative) is secondary. 21

15. Three things we have done #1

16. Three things we have done #2

17. Three things we have done # 3

18. Design.
Josie Pagani
The most popular image to signify professionalism in midwifery is the tape measure.

20. As regulators it is important we take the time to listen to the voices of women and their families.
Only in this way can we understand what is important to them in relation to public safety, and so inspire confidence and trust in the Maternity Service.