YOUR COLLEGE

maternity guideline reviews

Midwifery advisors are representing the College on the steering group for the review of four national maternity guidelines: Guidelines for Consultation with Obstetric and Related Medical Services (Referral Guidelines); Diagnosis and Treatment of Hypertension and Pre-eclampsia in Pregnancy in New Zealand; Screening, Diagnosis and Management of Gestational Diabetes in New Zealand; and the National Consensus Guideline for Treatment of Postpartum Haemorrhage. An initial survey on the Referral Guidelines was circulated to members in April and further opportunities for feedback will be provided once a draft of the new guideline is available. Consultations on the other guidelines will follow in due course.

CONTRACEPTION EDUCATION

Contraception education standards are being developed by the Ministry and the National Contraception Guidelines Steering Group to reflect New Zealand Aotearoa’s Guidance on Contraception and identify the pre-requisites, programme, and ongoing competence requirements for all health professionals who wish to insert long-acting reversible contraception (LARC). Midwives are represented within this group, and aim to ensure that the education programmes developed can be accessed by midwives and fit their scope of practice. Further information will be provided as this work progresses.

SUBMISSION ON LEADERSHIP MIDCENTRAL

The College region and national office has been providing professional support to employed and self-employed midwives in MidCentral DHB at a time of major workforce shortages, including a written submission on the MidCentral leadership change proposal in May.

CLIMATE CHANGE CONSENSUS

Climate change is one of the most pressing issues of our time and requires commitment from individuals, organisations and society as a whole, to address. The College has developed a climate change consensus statement which has been circulated through the College midwives portal for feedback. Following this consultation, we are hoping to have this consensus statement ratified at the AGM in November 2021.

ANTI-D PROPHYLAXIS ADMIN DURING PREGNANCY AND EARLY POSTPARTUM

Following feedback from member consultation, this statement is being finalised in preparation for ratification. The main points relate to the current NZ Blood recommendations and the need for DHBs to enable provision of the service through appropriate pathways, rather than expecting the community midwifery workforce to provide this without the necessary support/ resources.

pulse oximetry submission

The Ministry, along with a multi-disciplinary team which included College representatives, have developed a national guideline for newborn pulse oximetry screening. Pulse oximetry is a simple non-invasive method of measuring hypoxaemia following birth, which may be potentially indicative of critical congenital heart disease, respiratory conditions and other diseases that could have an impact on a baby’s health. Screening has been found to be acceptable to women and their families and reassuring for health professionals.

The College has consulted with members through the College portal and has provided a submission on the discussion document. Feedback was generally supportive, but concerns were raised related to education and the funding of equipment and consumables.

PROFESSIONAL SUPPORT PROPOSALS FOR EMPLOYED MIDWIVES

The College presented two proposals to the Midwifery Leaders Group and the MERAS NRC for professional networking and support of employed midwives: to set up a national, in-person forum for midwives in shift-based clinical leadership roles - Associate Charge Midwife Managers (ACMM)/Clinical Midwife Coordinators/Clinical Midwife Managers - and to establish a virtual network of midwives involved in DHB maternity clinical guideline development. Midwifery clinical leadership roles are pivotal to the functioning and culture of day-to-day birthing and maternity facilities, with a high level of responsibility in a relatively isolated position. Discussions with midwives in these roles and the midwifery leadership groups indicated that there is a pressing need for professional support and networking but that it may be logistically difficult to hold an in-person forum. The College has therefore included a workshop for midwives in clinical shift leadership on the importance of their role and as a space to network, at the conference in November. The College is also working on a proposal for Charge Midwife Managers and will progress conversations on a guidelines network as the implications of the health reforms on regional health system structures are made clear.

rural health alliance meeting

The College is a member of the Rural Health Alliance Aotearoa New Zealand (RHAANZ), an umbrella organisation which advocates for rural health issues. Each year, RHAANZ hosts a RuralFest meeting, where members meet in Wellington to agree on top priorities (day one) which are then presented to key politicians in Parliament (day two).

At the 2019 RuralFest, the College’s midwife representatives were successful in achieving consensus with meeting attendees that rural maternity issues should be among the priorities presented - a key contributor in achieving the revised Section 88 rural payments which were announced in last year’s Budget. This year, rural midwives Tawera Trinder (Taranaki) and Kendra Short (South Canterbury) were the College RHAANZ representatives. Tawera and Kendra reported ongoing strong support for rural midwives and maternity services in this multidisciplinary forum. square

Taranaki midwife Tawera Trinder and her pēpi Kārearea attend RuralFest at Parliament in April 2021.

Covid-19 vaccine update

VACCINE FOR MIDWIVES AND STUDENTS

The College’s work to support members on Covid-19 related matters has moved to the Covid-19 vaccine in 2021. All individuals have the right to make an informed decision about receiving the vaccine, however it is recommended for health professionals (including midwives and student midwives), in order to protect themselves and the whānau they are providing care for, and as an important public health strategy in managing a pandemic. College advisors worked with the Immunisation Advisory Centre (IMAC) and the Ministry to develop resources for midwives, available on the College website:

• Information sheet on the Covid-19 vaccination in pregnancy and lactation • Webinar presentation on the Covid-19 vaccine including information on the vaccine research and development, science and mechanism of action, safety profile, ongoing monitoring and information on vaccination during pregnancy • Information resource with Covid-19 vaccine information for health professionals considering their own vaccination status.

Questions from members have been supplied for expert immunologist responses.

MIDWIVES AS COVID-19 VACCINATORS

The Midwifery Council has confirmed that midwives who have undertaken the required education can work as Covid-19 vaccinators for people who are not pregnant or postpartum. The College confirms that midwives working in this capacity are covered by their professional indemnity policy as part of their membership.

PREGNANT MIDWIVES CONSIDERING VACCINATION

The College refers pregnant midwives considering vaccination to the IMAC information and position: “Women who are pregnant and at risk of exposure to SARS-CoV-2 virus can receive a COVID-19 vaccine at any stage of pregnancy. For those at low risk of exposure, it is recommended to delay vaccination until after birth.”

As a pregnant woman, the individual midwife will need to consider their own risk of exposure to Covid-19 in the course of their work, their health profile and the available information about vaccine safety during pregnancy to make an informed decision. Hygiene measures and distancing practices continue to apply. square