Why Care Matters: Discover the Power of Midwifery Care

A Paradigm Shift in Prenatal and Postnatal Wellbeing

Expecting in New Zealand with our third son

Prepping for Pēpi and Embracing Midwifery Care in New Zealand

When I first heard of the midwifery model of care, it seemed rife with risk. No MD behind their name? Not allowed in the hospital? Coming to my home to do all of the check-ups and tests?  Um, no thank you. What if there were complications? Somehow I had equated sterile rooms reeking of bleach and ammonia and white gowned males snapping blue latex gloves onto their large (and often hairy) hands with safe and unerring prenatal care. The thought of a plain clothed woman in my home using a doppler from her purse-like bag was unnerving and didn’t seem right. I needed the high-tech machinery whirring in the background as I sat on that crunchy white papered bench (put so high it always made me feel like toddler trying to climb up onto the kitchen counter) that could produce a perfectly detailed picture of what was going on inside my belly within arm’s reach for every visit. Just in case.

And while I correlated Obstetricians with gold standard health care, I was rushed through every visit, my concerns or questions squashed the second they exited my lips and often felt like I was a little girl and my dad scolding me for even thinking about these silly worries. In hospital, it was the nurses on shift who I met for the first time in that moment that were the primary carers during my birth and I was left on the delivery bed with my baby’s head out (“you can reach down and feel his hair,” I was told) so the doctor could drive from his home to the hospital “only five minutes away” because as the nurses (who were fully competent to deliver my baby) said “he doesn’t like to miss the birth.” It wasn’t until later I realized that they meant, he doesn’t get paid as much if he doesn’t catch the baby.  

So imagine my surprise when an obstetrician wasn’t really an option in New Zealand, unless I was high risk or wanted to pay out of pocket as a low risk pregnancy. Still paying off my first and second hospital births from the States totalling over $5000, it wasn’t really an option for us as young parents of two with another on the way. So that was settled - my provider for this third birth was going to be a midwife.

When I pictured midwifery care, I conjured up Widow Tweed from Disney’s The Fox and The Hound, an elderly, big bosomed woman with a kind, motherly disposition, appearing at my door with floppy hat set upon her head of short, silver hair and a Mary Poppins-like bag in her hands. But this was wrong on so many levels. First off, midwives are healthcare professionals that spend 4,800 hours in education and training before becoming certified, not necessarily older women that use motherly dispositions as their credentials, and secondly midwives have been proven to provide better outcomes than their MD-qualified peers. Midwives and OB-GYNs are both experts in women’s health and pregnancy care who have extensive specialty training and experience in their field. At 25 weeks pregnant in Auckland, I booked my first appointment, which would be completely free of cost, with a midwife. This was prenatal care, Kiwi-style.   

My cousins and family friends didn’t seem to be phased by the absent obstetricians from their pregnancy journey. Midwifery care is the standard pre-and postnatal healthcare here in New Zealand, and as I would find later on, in many other countries around the world.   

Women choose their lead maternity carer (LMC), most often a hospital based or independent midwife. The LMC-integrated model of primary maternity care is the cornerstone of the New Zealand maternity service. All other services, such as obstetric or paediatric services, fit in around this model so that the woman experiences a seamless maternity service that meets her individual needs. The Ministry of Health in Zealand says that this model is unique in the world and has been highly successful, with women expressing considerable satisfaction with their maternity services. The outcomes for women having continuity of midwifery care are very good and the perinatal mortality rate has never been lower. Women choose their own LMC, with the vast majority choosing a midwife and the remainder choosing an obstetrician or a general practitioner who has a diploma in obstetrics. Maternity care is free to eligible women, unless they choose a private obstetrician. Women can choose to give birth at home, in a primary maternity facility or birthing centre, or in a secondary/tertiary maternity hospital. In New Zealand, it’s not about medicalizing birth to control as much as possible, while leaving most decisions up to the doctors; it’s about normalizing birth as a natural process and putting women at the forefront of thought. The whole notion is predicated on midwives being the experts in low risk births. 

Our first New Zealand-born baby

For my prenatal visits, I was to meet at my midwife’s office which was a cottage-core style space shared with a certified pre- and postnatal massage therapist, osteopath, and acupuncturist. To say it didn’t feel like a healthcare setting would be an understatement. I sat in the waiting room that felt more like a living room with a cozy sofa and packages of lactation cookies, belly binders, pregnancy and breastfeeding teas, and herb and supplement jars lining the shelves along the wall. The woman behind the desk offered me a cup of tea as I waited and while I’d never been much of a tea drinker, when in Rome…I accepted. I relaxed deeper into the sofa and cradled my teacup, taking small sips of the raspberry leaf tea as the liquid seemed to warm and relax my entire body, feeling very far removed from the OBGYN’s office in San Diego where I sat on hard, plastic chairs constantly rearranging my bottom to avoid pain and discomfort. Here, the sofa seemed to swallow me and for a moment I forgot that I was at a prenatal appointment. It felt like I was meeting a friend or an aunt or far-removed family member (which potentially could be true since in New Zealand it often seems that everyone knows everyone). Then a bright and friendly face popped around the corner and I scuttled into her office with my ever expanding belly to begin a journey that would expand my understanding of prenatal care and its impacts on wellbeing after birth. 

Revolutionizing Maternity Care in New Zealand: A Triumph of Women's Rights and Holistic Approach

Like most Western countries, New Zealand’s maternity care had historically been provided by midwives at home until the early 1900s. Birth then became a medical event, managed by doctors in hospital when in the 1970s, midwives were not allowed to attend births without a doctor present. However, social movements challenged the control the medical profession had over birth, and over time, they successfully lobbied for New Zealand women’s rights in birth. In the late 1980s, midwives regained their autonomy, and were able to attend childbirth without a doctor in the room. Not long after this, the Lead Maternity Care (LMC) model of care was introduced to New Zealand. Today, continuity of care is accessible and home birth is widely accepted as a normal choice for women if they are not at risk of complications. An increase in midwifery-led models of care reduces the rate of interventions, while keeping mothers and babies safe. Ultimately, research shows that New Zealand women are satisfied with their care, their birth experience and have support in the postpartum period that enables them to access services as needed. In the postpartum, the LMC provider will visit at least 7 times (at least 5 times in the family’s home) to ensure all is going well. This support is invaluable in terms of helping new parents to adjust to having a newborn, supporting new mothers in breastfeeding, and identifying what support is needed as early as possible. 

“At the end of the 18th century, most people assumed that midwives had no formal training, even though some did, and common existing beliefs held that women were emotionally and intellectually incapable of learning and applying the new obstetric methods. Well-to-do families soon came to believe that physicians could provide better care than female midwives could and thus offered the best hope for a successful birth.” — Midwifery Today (1)

While close to 90 percent of New Zealand women choose to give birth in hospital, Kiwi women have three options when it comes to where they can give birth that the New Zealand health system categorizes into primary, secondary and tertiary facilities. The primary are birth units and centers, the secondary are the regional hospitals, and the tertiary are the larger hospitals.

Both Bali and New Zealand are similar with the choices of care — you can choose natural or you can choose a more medical approach. That choice is important, it really is up to each mother (and of course what happens on the day beyond our control). - Lara Laban

The birth centers are homey where partners can stay overnight and regardless of where you give birth, mothers can check in for free for three days following birth. But even the hospitals were more like what I would consider a birth center than the hospitals I remembered when I gave birth in America. The hospital delivery suites were not the clinical, bleak environment with only a bed and beeping medical equipment surrounding you. Most have warmer decors, and some, like the one I was in, had equipment for active labour and a large bath for pain relief and a water birth.  

The Transformative Power of Midwifery Care: Empowering Women and Improving Maternal Outcomes

The benefits of midwifery care can be seen throughout the world and over time. A comprehensive review of a number of studies on this subject conclusively affirmed that "the bond between the expectant mother and midwife is pivotal, leading to additional benefits such as trust, personalized care, and empowerment."