Midwifery in New Zealand
The Challenges of Being a Midwife in a Maori Community
Sarah McGhee, a senior midwife and mentor at the East Coast midwife centre Te Hauora O Paikea Midwives, described the challenges of being a midwife in the predominantly Maori community of Kaiti as part of evidence she gave in the 2006 inquest into the death of a one month old baby girl (later ruled to have been from SIDS).
Mrs McGhee told the court she had been a New Zealand registered general and obstetric nurse since 1957 and a registered midwife with a diploma in midwifery since 1996. She was a founding member of Nga Maia, a national body formed more than 10 years ago to support Maori midwives and aligned to the New Zealand College of Midwives.
Mrs McGhee said her comments about the situations challenging staff at the Te Hauora O Paikea midwife centre were general and not necessarily a reference to the lifestyle of the family of the baby for whom that particular inquest was being held.
Being a Midwife in a Low Decile Maori Community
The suburb of Kaiti, where Te Hauora O Paikea midwife centre had an office, had the lowest possible decile ranking for health, Mrs McGhee said. That low decile ranking was characterized by specific needs and challenges. She said recruiting and retaining midwifery staff was difficult.
Being a midwife in such a low decile area meant having to possess the ability to deal with unexpected and risky situations. She personally had been verbally abused and had attended mothers in volatile family situations where they and their children were at risk. She once had to hide under a bed with a baby when a gang incident evolved at a home she was visiting.
Midwives could be threatened or feel very unsafe in such environments, particularly if they were alone, Mrs McGhee said.
The mothers under Te Hauora O Paikea midwife centre's care were often under stress, had inadequate support, no transport, no phones, and lacked good accommodation, Mrs McGhee said. Some were transient, missed appointments or presented late to the service, she said.
"All our midwives have a challenging job," Mrs McGhee said.
The number of clients being dealt with by the Paikea midwife centre's four staff at that time, averaged 55 a month. Of those, an average of 16 would be teenagers. Clients experiencing domestic violence problems averaged 13 a month, those with drug and alcohol issues averaged 19 a month and as many as 50 percent had gang affiliations, Mrs McGhee said.
Midwifery in New Zealand Needed to Include a Unique Midwife Centre for Maori Community
Mrs McGhee said Te Hauora O Paikea midwife centre was initially a marae-based kaupapa Maori clinic supporting whakawhanau antenatal classes in Gisborne. It arose out of a specific need to support teenage Maori mothers at a time when there was no Maori midwife in the East Coast region (Tairawhiti) but 605 Maori women on birthing lists.
Due to the area's specific problems, the midwife centre had to devise special processes and supports for their clients and for their own safety, Mrs McGhee said. Some of those processes were only possible after extensive discussion with other agencies and health professionals. Some were expensive, such as the provision of a free calling telephone number.
The Paikea midwife centre provided a neutral space and appointments were carefully scheduled, where necessary, to avoid conflict between clients with differing gang affiliations.
Screening for alcohol and drugs and domestic violence occurred at the start of each clients schedule of antenatal health checks, Mrs McGhee said.
Midwifery in New Zealand
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