Having Babies Out of Context Pasifika Midwifery Workforce in Aotearoa: Having Babies Out of Context ‘ Eseta Finau, ONZM ([email protected]) Tongan

Pasifika Midwifery Workforce in Aotearoa:

Having Babies Out of Context‘Eseta Finau, ONZM

([email protected])Tongan Nurses Association of NZ,

P.O.Box 13252, Onehunga; &Sitaleki A. Finau, MNZM([email protected]) CEO Masilamea Press; &

Manager, Research, Information, & Innovation, Tongan Community Development Society

Auckland, NZ

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mailto:[email protected]

Content of Presentation

The Pasifika Midwives Group in NZ Definition of a Midwife; Pasifikans of NZ; Locations of Pregnant Pasifikans; Pasifika Women’s Health; Pasifika Health Workforce & Midwives; NZ Maternity System Concluding remarksFinau, E & S.A. SPNF Conf. Melbourne

(Nov. 2012) 2

Pasifika Midwives Group

Finau, E & S.A. SPNF Conf. Melbourne (Nov. 2012) 3

Relationship, Relationship, Relationship! Culture is the ability to: understand & apply cultural

values, & practices underpinning Pasifikans’ worldview and perspectives on health: including: the ability to use Pasifika values, principles, structures, attitudes, & practices in the care and delivery of services to Pasifikans, their families and communities.

(ADHB Pacific best practice guidelines 2010). Using Pasifika best practice guidelines within

one’s professional vernacular and collaborating with Pasifika providers will engage Pasifikans with midwives.

What are we all about?

“A midwife is: “recognised as a responsible and accountable professional

who works in partnership with women to give the necessary support, care and advice during pregnancy, labour and the postpartum period, and

to conduct births on the midwife’s own responsibility and provide care for the newborn and the infant. This care includes preventative measures; the promotion of normal birth, the detection of complications in mother and child, the accessing of medical care or other appropriate assistance and the carrying out of emergency measures.”

Source: International Confederation of Midwives, 2005

Definition of a Midwife


Pasifikans of Aotearoa


Pasifikans in the 2006 census

6.9% total NZ population. About 67% of the Pasifikans reside the greater Auckland region. We are a diverse population.

Fastest growing population in NZ; an expected 15% more by 2050.

Youthful population; median age 21 years c.f 35 years for the total NZ; 39.2% of Pasifikans are under 15yrs of age c.f. 23% of the total population).

83% religious c.f. 61% for NZ population.


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Pasifikans are many

Not 1

Finau, E & S.A. SPNF Conf. Melbourne (Nov. 2012)


0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Māori Pacific peoples Asian European

Maternal ethnicity

No LMC

Postnatal

Trimester three

Trimester two

Trimester one

Percentage of women giving birth

Pregnant Pasifikans: % Giving Birth

This 2010 data indicates more Pacific women registered with an LMC in the second trimester of pregnancy than the first.

In comparison, 65.4% of European women registered with an LMC during the first trimester of pregnancy.

38.9% Pasifikans DNA an LMC


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Pregnant Pasifikans: Rates of Babies/100 Women :


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HIGH RISK INDICATORS Pasifikans Others: General population

Deprivation Index>48% live in the most deprived (decile 10) areas..*Evidently <3% live in the least deprived areas.

19.7%

Diabetes Pacific women are 3x > likely to have with Type II diabetes c.f. others

DNA (Non-attendees) 8.3% booked before 10wks gestation.

28.6% booked before 10wks gestation.

42.3% booked after 20wks gestation.

16.7% booked after 20wks gestation.

Obesity > 50% had BMI > 30 16% had BMI > 30.

Perinatal mortality/1000 births 21.1 19.8Post-partum haemorrhage (≥1000mls)

13.4% Pasifikans c.f. 9% for others.

Smoking 16% disclosed at booking (27% Cooks & 3% Tongan)

8% disclosed at booking

Pasifika women (15- 24yrs) 5x more had 1st baby by 21 years > others & Maori.

Pasifika Women’s Health (2010 ADHB)

Pasifika Health Workforce

Medical Practitioners

1.0 % (MCNZ 2002)

Nurses and Midwives

3.0 % (NCNZ 2003)

Dentists 0.6% (APC 2003)

Pharmacists 0.2% Registration 2003


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Pasifika midwives

55 MW’s per 3075 Pasifika Women

2.1% total MW’s in NZ

Ref: Midwifery workforce

Survey 2011


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Pasifika Midwives: Key Drivers

Establish a Pasifika advisory body in midwifery;

Develop & deliver a Pasifika midwifery for Pasifikans indicative of ‘cultural competency’;

Rationale

Finau, E & S.A. SPNF Conf. of Melbourne (Nov. 2012) 14

Locations of Pasifika Nurses

Location Cooks Fijian Samoan Tokelau Tonga Niue Other

PI Sub-Total

Auckland

Manukau, 62 170 265 35 145 58 74 809

North Shore

Papakura

Waitakere

Porirua 12 26 108 23 17 4 17 207

Lower &Upper Hutt

Christchurch 8 12 47 4 10 3 16 100

Dunedin

Nelson

Council mail out 45 72 91 18 20 10 57 313

TOTAL 127 280 511 80 192 75 164 1,429

Source: Raw Data from Nursing Council of New Zealand, 2002


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Retaining Skilled Pasifika Nurses

Appropriate basic training: skill and job fit; Postgraduate training: specialized skill with conceptual and

managerial development; Continuing education: leading to qualifications, improved

status and remuneration; Parity, incentives, acculturation, and citizenship training Experiential placement in Pacific countries; Worker friendly administration: Consistent management,

accountability, transparency, good governance; and Staff appraisal: identify personal demands and

match with service needs


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y Legislative: Midwifery Council; Professional: New Zealand College of

Midwives; Contractual: Section 88, maternity facility

service specifications; The Health Practitioners Competency Act

(2004): ‘Health professions are to set standards of clinical, cultural competence & ethical conduct to be observed by practitioners’

Frameworks for Midwifery

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NZ’s Maternity System

NZ has: a free, integrated maternity service;

home to hospital & home; primary, secondary care from pregnancy test to

6 weeks post partum Community-based, continuous care by

a lead maternity caregiver (LMCs) mostly midwives

national funding for primary health & midwifery as it’s philosophy

universal right of access for midwives & clients to hospital obstetric care as

required


The Regulation and Provision of NZ Midwifery Services Framework

Regulatory Framework

MIDWIFERY COUNCIL

Registers midwivesDefines scope of practice

Sets CompetenciesApproves education

Sets Standards of conduct,disciplinary role, Public safety, and

monitors competency/Standards

Midwives Union(MERAS)

Professional framework

NZ COLLEGE OF MIDWIVES

PhilosophyEthics

Standards Education

Professional support

Midwifery Standards Review

Code of practiceStandards

Competencies

Registered Midwife


The Competencies and Standards apply to all midwives who hold an Annual Practicing Certificate. Mason Durie wrote: ‘The degree of comfort individuals feel with seeking health services impacts on their use of services and in turn health outcomes. The delivery of care in a culturally appropriate manner is an important element in determining both the willingness of people to access services and the success of any treatment or care then delivered.’

Competencies & standards


International Midwifery

and Obstetric Position

‘ICM and FIGO uphold the human right of childbearing women to have access to a midwife’s care for herself and her newborn.

There is strong evidence that out of hospital birth supported by a registered midwife is safe, and a preferred experience for many mothers’Ref: ICM/FIGO Media release 8 March 2012Finau, E & S.A. SPNF Conf. Melbourne (Nov.

2012) 21

NZ Women’s Rights

right to a fully government funded maternity service,including home birth;

right to choose who provides her maternity care and where;

may choose a midwife, a family doctor with obstetric training, or an obstetrician;

free access to other opinions and advice from obstetricians, paediatricians; and

Can choose who supports her: partner, family, friends, or other children


NZ maternity standards 2011 Primary maternity service 2007 Find a Midwife website 2012 Referral Guidelines 2012

DHB consumer quality plan 2012 Section 88 2007

Maternity Resources


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The PIF study (2001) identified many factors affecting how Pasifikans engage with antenatal services.

These include; cultural implications, educational status, language barrier; child-care accessibility; lack of transport; whether pregnancy was planned; & what social support was available to the mother.

Many Pasifikans felt antenatal classes were aimed at ‘Papalagi’ mothers and had little reference to them.

Novak(2006) wrote: Service users may choose not to access services for fear of being

misunderstood or disrespected. Providers may fail to take into account differing responses to

medication, treatment or care options. Service users may not adhere to medical advice because they do not

understand or do not trust the provider.Finau, E & S.A. SPNF Conf. Melbourne (Nov. 2012

Challenges to Midwifery Services

November 2011:1st Pasifika Fono;

February 2012:Present at NZCOM National Committee;

March 2012: 1st meeting of Pasifika midwives and consumers (National fono).

June 2012: 1st Pasifika Midwifery Focus Group.

August: Ratification Pasifika Arm of NZCOM at AGM.

September:1st Fono with Pasifika midwifery students

Chronology ofDevelopment


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Contribute to midwifery strategies planning for the recruitment, training, retention and nurturing of the Pasifika workforce:

Special commitment to improving the health and wellbeing of the diverse pregnant Pasifikans;

Remove barriers: to training for; access & utilisation of maternity services of Pasifika communities, & providers; improve functional (health) literacy;

Pacific midwives have a voice in contributing to solutions that are measurable and tangible in effecting optimum outcomes for our Pasifika women, babies & their families:

Promote midwifery as a viable career option for Pasifika communities and students; Work with agencies on midwifery scholarships.

Roles of a Pasifika Advisory Section


There many Pasifika models of health and research

E.g., Fono Fale Model: The foundation (floor of

the fale): represents the family which is the foundation for all Pasifika cultures;

The Roof: represents cultural values and beliefs that shelter the family for life; culture is dynamic and constantly evolving;


Pasifika Model of Practice:

The Four Posts: connects culture & family, & are continuous & interactive with each other. The Pou are representative of four

areas: spiritual, physical, mental and other influences impacting on family wellbeing.

The Fono Fale is encapsulated in a cocoon that has dimensions with direct or indirect influences on one another. These are: Environment, Time and Context.

Review current maternity modelGrow Pasifika midwives & community-

based servicesPasifikan pregnancies to have Pasifika

competent or supported LMCReturn to Midwifery ProgramSkilled Overseas Registered NursesReview current midwifery training to

include General nursing trainingComplimentary roles of doctors and

widwifesNon Pacific midwives to go though Pacific

cultural competency training


RECOMMENDATIONS:

REFERENCES: Arendas, K., Q. Qiu, et al. (2008). Obesity in pregnancy: preconceptional to postpartum

consequences. Journal of Obstetrics and Gynaecology Canada: JOGC 30(6):477-88. Cundy, T., et al (2001) Perinatal mortality in Type 2 diabetes mellitus. Diabetic medicine,

17(1):p.33-9. Erick-Peleti S, Paterson J, Williams M (2007) Pacific Islands Families Study: Maternal

factors associated with cigarette smoking amongst a cohort of Pacific mothers with infants. NZ Med J.120(1256). Cited from http://www.nzma.org.nz/journal/120-1256/2588.

Low. P,J. Paterson, T.Wouldes, S. Carter, M. Williams (2005) Factors affecting antenatal care attendance by mothers of Pacific infants living in New Zealand, The NZMJ 118:1216.

Minister of Health and Minister of Pacific Island Affairs.(2010)’Ala Mo’ui – Pathways to Pacific Health and Wellbeing 2010-2014.

Ministry of Health. (2008). Maternity services consumer satisfaction survey 2007. Wellington: Ministry of Health.

Pacific Best Practice Guidelines, (2010). Auckland District Health Board Mainstream Pacific Responsiveness Plan, 2008.

Sundborn, G., et al., (2006) Differences in Health-Related Socioeconomic Characteristic Among Pacific Populations Living in New Zealand. The New Zealand Medical Journal, 110(1228).

Violani Wills: in Ministry of Health Pregnancy Book, also PHD Journal


http://www.nzma.org.nz/journal/120-1256/2588

http://www.nzma.org.nz/journal/120-1256/2588

Pasifika Midwives are Rare as Birds’ Teeth

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‘Alu a koē mo ke

fiemalie!’


“I am not an individual; I am an integral part of the cosmos. I

share

divinity with my ancestors, the land, the seas and the skies. I am notan

individual, because I share my tofi (an inheritance) with my family, my

village and my nation. I belong to my family and my family belongs to

me.I belong to my nation and my nation belongs to me.

This is the essence of my belonging.”

Tui Atua Tupua Tamasese Ta’isi Efi

(Head of State, Samoa, 2009)

E & SA Finau SPNF Melbourne 2012

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Mālō! Haere Ra!

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Questions ?

& Answers ?


Documents

Having Babies Out of Context Pasifika Midwifery Workforce in Aotearoa: Having Babies Out of Context ‘ Eseta Finau, ONZM ([email protected]) Tongan