We advocate for, promote, and support a sustainable rural midwifery and primary maternity workforce that is committed to providing culturally safe and appropriate maternity care to rural communities. We promote and contribute to research and initiatives that enhance our knowledge and understanding of rural midwifery and maternity care needs, and work with Hauora Taiwhenua Council, Chapters, and members to positively influence birthing and health outcomes of rural communities. Our work will also help to identify Government strategic and policy issues impacting on rural midwifery and maternity services to be considered by the Hauora Taiwhenua Council.
Below you can learn more about rural midwifery from Kendra, one of our Chapter Co-Chairs.
Rural midwifery is facing workforce shortages that are threatening the sustainability of rural midwifery practice and access to quality primary maternity services for rural communities. We are currently focussing on creating a database of midwifery service delivery models from around the motu. The goal of this project is to identify commonalities for success that can contribute to a healthy and sustainable rural midwifery workforce that could be adopted nationally. You can learn more about two case studies below.
Initially, the practice was unsustainable with the LMCs completely burnt out and close to quitting, which would have left no midwifery service in the area. The midwives were doing full continuity in terms of birthing locally and following their women and whānau to base hospitals in Invercargill and Dunedin.
From 1 April 2023, there has been funding from Te Whatu Ora for an employed case loading midwifery team. Central Otago now has two teams of two midwives, and Wanaka has three teams of two midwives. There is also one self-employed midwife in the area. The teams of midwives have on-call arrangements where they are on call for 14 out of 28 days. There are always two midwives on call so they can continue to offer home birth services and they have shared records that are accessible by all midwifery team members. Their case load is also significantly reduced. Last year one of the midwives had approximately 65 cases by herself, this year she has 36 cases and shares them with the other midwife on her team – she feels like she is working part-time and is loving it! She has taken a bit of a cut financially; however, she isn’t working anywhere near the 60 to 70 hours a week she was working previously, or driving the 80,000kms she was driving! They no longer follow their women through to base hospitals which is freeing up their time and resources to be with the women locally. They have gone from being short on midwives to having more midwives; they have attracted new midwives to the area! The midwives are provided with cars, laptops, and other resources, and they have one coordinator in Alexandra and one in Wanaka who help set up the teams, structure the time off, and handle other administrative tasks.
This model works well due to the personal commitment of the team members, the consultative approach to setting up the teams and flexibility in how they work, the local leadership and coordination, the retained autonomy in working with women and whānau, and the shared records that are accessible by all team members. The midwives acknowledge that this won’t work in every area, but it works for them, and they are all happier with the arrangement!
The Midwives Chapter will be presenting this case study, and others, at the National Rural Health Conference in April 2024, so please come along to learn more! In the meantime, the Midwives Chapter will continue to build the service delivery model database and invite more midwives to share their stories.
Kendra lives in rural South Canterbury and has been working as a community midwife in the area for the last 5 years. Kendra is passionate about equitable access to health care services for rural communities.
