A demographic profile of independent (self employed) midwives in New Zealand Aotearoa

Abstract

The years from 1990 to date have seen major changes to the way in which maternity services in New Zealand are structured and provided. The impact of the Nurses Amendment Act in 1990 and the economically based health reforms initiated in 1993 have had profound effects on the midwifery profession and consequently on the maternity service. Midwives' ability to practice autonomously, define their educational needs and to be self employed are the key elements which have affected the development of the New Zealand midwifery profession and the maternity services workforce. These elements enabled an independence on many levels previously denied midwives. This thesis reviews and identifies key elements in the last decade which have shaped and influenced the development of the midwifery workforce. These key components include population demographics, midwife and medical maternity service provider demographics, education factors and outcome statistics to monitor quality of care. The primary focus was a descriptive study of 413 self employed or independent midwives representing 83% of all self employed midwives practising in 1995/96. This information provides the first dataset and demographic profile of self employed midwives in New Zealand. The secondary focus of the thesis was the development of a national midwifery practice dataset and computerised database. The database was piloted to establish its feasibility and usefulness to midwives when recording their practice outcomes. The study was designed to provide a starting point for addressing the need for more reliable information on the midwifery workforce as the existing data collection mechanisms were demonstrated to be inaccurate. The study found that the self employed midwifery workforce is mature (mean age 43), has a mean of ten years midwifery experience and is well educated. They are committed to ongoing education and access a wide range of educational sources. They are younger than the total midwifery population and more likely to have been initially registered in New Zealand. They are over represented in towns and rural areas as are their clients. Their predominant service is as Lead Maternity Caregiver but they offer a comprehensive range of service options to women. Their client group is wide ranging and not restricted to "low risk" clients and includes Maori women in greater proportions than the total population. The study's findings confirmed the magnitude of the restructuring in the provision of maternity services. It identifies several factors which make the midwifery workforce and the maternity service vulnerable. The midwifery workforce is aging, particularly the hospital employed midwifery service. It is educationally demanding and one which relies heavily on overseas trained midwives to provide the majority of the midwifery workforce. The exodus of experienced midwives into self employment requires strategies to support the waged workforce. The reliance of rural and town women on midwives to provide their maternity service following the political withdrawal of general practitioners in those areas after July 1996 is largely unrecognised. This requires the Ministry of Health and the Health Funding Authority to recognise and plan for strategies to support those midwives. The expansion of midwifery practice identified in the study's birth outcome survey is a result of many factors. Continuity of care, changing consultation and transfer patterns within CHEs and between private and public obstetricians and new contractual arrangements by the Health Funding Agency have had a major impact on the midwifery (and maternity) workforce. It is recommended these issues are urgently addressed by all stakeholders in order to provide a stable and effective maternity service.