Pasifika Midwifery Workforce in Aotearoa: Having Babies Out of Context ‘Eseta Finau, ONZM (eseta@pacifichealth.org.nz) Tongan Nurses Association of NZ, P.O.Box 13252, Onehunga; & Sitaleki A. Finau, MNZM (finauclan@xtra.co.nz) CEO Masilamea Press; & Manager, Research, Information, & Innovation, Tongan Community Development Society Auckland, NZ 1 Content of Presentation The Pasifika Midwives Group in NZ Definition of a Midwife; Pasifikans of NZ; Locations of Pregnant Pasifikans; Pasifika Women’s Health; Pasifika Health Workforce & Midwives; NZ Maternity System Concluding remarks Finau, E & S.A. SPNF Conf. Melbourne (Nov. 2012) 2 Pasifika Midwives Group Finau, E & S.A. SPNF Conf. Melbourne (Nov. 2012) 3 What are we all about? Relationship, Relationship, Relationship! Culture is the ability to: understand & apply cultural values, & practices underpinning Pasifikans’ worldview and perspectives on health: including: the ability to use Pasifika values, principles, structures, attitudes, & practices in the care and delivery of services to Pasifikans, their families and communities. (ADHB Pacific best practice guidelines 2010). Using Pasifika best practice guidelines within one’s professional vernacular and collaborating with Pasifika providers will engage Pasifikans with midwives. Definition of a Midwife “A midwife is: “recognised as a responsible and accountable professional who works in partnership with women to give the necessary support, care and advice during pregnancy, labour and the postpartum period, and to conduct births on the midwife’s own responsibility and provide care for the newborn and the infant. This care includes preventative measures; the promotion of normal birth, the detection of complications in mother and child, the accessing of medical care or other appropriate assistance and the carrying out of emergency measures.” Source: International Confederation of Midwives, 2005 Finau, E & S.A. SPNF Conf. Melbourne (Nov. 2012) 5 Pasifikans of Aotearoa Finau, E & S.A. SPNF Conf. Melbourne (Nov. 2012) 6 Pasifikans in the 2006 census 6.9% total NZ population. About 67% of the Pasifikans reside the greater Auckland region. We are a diverse population. Fastest growing population in NZ; an expected 15% more by 2050. Youthful population; median age 21 years c.f 35 years for the total NZ; 39.2% of Pasifikans are under 15yrs of age c.f. 23% of the total population). 83% religious c.f. 61% for NZ population. Finau, E & S.A. SPNF Conf. Melbourne (Nov. 2012) 7 Pasifikans are many Not 1 Finau, E & S.A. SPNF Conf. Melbourne (Nov. 2012) Finau, E & S.A. SPNF Conf. Melbourne (Nov. 2012) 8 Pregnant Pasifikans: % Giving Birth This 2010 data indicates more Pacific women registered with an LMC in the second trimester of pregnancy than the first. In comparison, 65.4% of European women registered with an LMC during the first trimester of pregnancy. 38.9% Pasifikans DNA an LMC Percentage of women giving birth 100% 90% No LMC 80% Postnatal 70% Trimester three Trimester two 60% Trimester one 50% 40% 30% 20% 10% 0% Māori Pacific peoples Asian Maternal ethnicity European Finau, E & S.A. SPNF Conf. Melbourne (Nov. 2012) 9 Pregnant Pasifikans: Rates of Babies/100 Women : Finau, E & S.A. SPNF Conf. Melbourne (Nov. 2012) 10 Pasifika Women’s Health (2010 ADHB) HIGH RISK INDICATORS Pasifikans Others: General population Deprivation Index >48% live in the most deprived 19.7% (decile 10) areas..*Evidently <3% live in the least deprived areas. Diabetes Pacific women are 3x > likely to have with Type II diabetes c.f. others DNA (Non-attendees) 8.3% booked before 10wks gestation. 42.3% booked after 20wks gestation. > 50% had BMI > 30 Obesity Perinatal mortality/1000 births 21.1 28.6% booked before 10wks gestation. 16.7% booked after 20wks gestation. 16% had BMI > 30. 19.8 Post-partum haemorrhage (≥1000mls) Smoking 13.4% Pasifikans c.f. 9% for others. Pasifika women (15- 24yrs) 5x more had 1st baby by 21 years > others & Maori. 16% disclosed at 8% disclosed at booking (27% Cooks booking & 3% Tongan) Pasifika Health Workforce Medical Practitioners 1.0 % (MCNZ 2002) Nurses and Midwives 3.0 % (NCNZ 2003) Dentists 0.6% (APC 2003) Pharmacists 0.2% Registration 2003 Finau, E & S.A. SPNF Conf. Melbourne (Nov. 2012) 12 Pasifika midwives 55 MW’s per 3075 Pasifika Women 2.1% total MW’s in NZ Ref: Midwifery workforce Survey 2011 Finau, E & S.A. SPNF Conf. Melbourne (Nov. 2012) 13 Pasifika Midwives: Key Drivers Establish a Pasifika advisory body in midwifery; Develop & deliver a Pasifika midwifery for Pasifikans indicative of ‘cultural competency’; Rationale Finau, E & S.A. SPNF Conf. of Melbourne (Nov. 2012) 14 Locations of Pasifika Nurses Location Cooks Fijian Samoan Tokelau 265 35 Tonga Niue Other PI SubTotal 74 809 Auckland Manukau, 62 170 North Shore 145 58 Finau, E & S.A. SPNF Conf. Melbourne (Nov. 2012) Papakura Waitakere Porirua 12 26 108 23 17 4 17 207 4 10 3 16 100 Lower & Upper Hutt Christchurch 8 Dunedin 12 47 Source: Raw Data from Nursing Council of New Zealand, 2002 Nelson Council mail out 45 72 TOTAL 127 280 91 511 18 20 80 192 10 75 57 164 313 1,429 15 Retaining Skilled Pasifika Nurses Appropriate basic training: skill and job fit; Postgraduate training: specialized skill with conceptual and managerial development; Continuing education: leading to qualifications, improved status and remuneration; Parity, incentives, acculturation, and citizenship training Experiential placement in Pacific countries; Worker friendly administration: Consistent management, accountability, transparency, good governance; and Staff appraisal: identify personal demands and match with service needs Finau, E & S.A. SPNF Conf. Melbourne (Nov. 2012) 16 Frameworks for Midwifery y Legislative: Midwifery Council; Professional: New Zealand College of Midwives; Contractual: Section 88, maternity facility service specifications; The Health Practitioners Competency Act (2004): ‘Health professions are to set standards of clinical, cultural competence & ethical conduct to be observed by practitioners’ 17 NZ’s Maternity System NZ has: a free, integrated maternity service; home to hospital & home; primary, secondary care from pregnancy test to 6 weeks post partum Community-based, continuous care by a lead maternity caregiver (LMCs) mostly midwives national funding for primary health & midwifery as it’s philosophy universal right of access for midwives & clients to hospital obstetric care as required Finau, E & S.A. SPNF Conf. Melbourne (Nov. 2012) 18 The Regulation and Provision of NZ Midwifery Services Framework Professional framework Regulatory Framework MIDWIFERY COUNCIL Code of practice Standards NZ COLLEGE OF MIDWIVES Philosophy Registers midwives Ethics Defines scope of practice Standards Registered Midwife Sets Competencies Education Approves education Professional support Midwives Union (MERAS) Sets Standards of conduct, disciplinary role, Public safety, and monitors competency/Standards Competencies Midwifery Standards Review Finau, E & S.A. SPNF Conf. Melbourne (Nov. 2012) 19 Competencies & standards The Competencies and Standards apply to all midwives who hold an Annual Practicing Certificate. Mason Durie wrote: ‘The degree of comfort individuals feel with seeking health services impacts on their use of services and in turn health outcomes. The delivery of care in a culturally appropriate manner is an important element in determining both the willingness of people to access services and the success of any treatment or care then delivered.’ Finau, E & S.A. SPNF Conf. Melbourne (Nov. 2012) 20 International Midwifery and Obstetric Position ‘ICM and FIGO uphold the human right of childbearing women to have access to a midwife’s care for herself and her newborn. There is strong evidence that out of hospital birth supported by a registered midwife is safe, and a preferred experience for many mothers’ Ref: ICM/FIGO Media release 8 March 2012 Finau, E & S.A. SPNF Conf. Melbourne (Nov. 2012) 21 NZ Women’s Rights right to a fully government funded maternity service,including home birth; right to choose who provides her maternity care and where; may choose a midwife, a family doctor with obstetric training, or an obstetrician; free access to other opinions and advice from obstetricians, paediatricians; and Can choose who supports her: partner, family, friends, or other children Finau, E & S.A. SPNF Conf. Melbourne (Nov. 2012) 22 Maternity Resources NZ maternity standards Primary maternity service 2007 Find a Midwife website 2012 Referral Guidelines 2012 DHB consumer quality plan 2012 Section 88 2007 2011 Finau, E & S.A. SPNF Conf. Melbourne (Nov. 2012) 23 Challenges to Midwifery Services The PIF study (2001) identified many factors affecting how Pasifikans engage with antenatal services. These include; cultural implications, educational status, language barrier; child-care accessibility; lack of transport; whether pregnancy was planned; & what social support was available to the mother. Many Pasifikans felt antenatal classes were aimed at ‘Papalagi’ mothers and had little reference to them. Novak(2006) wrote: Service users may choose not to access services for fear of being misunderstood or disrespected. Providers may fail to take into account differing responses to medication, treatment or care options. Service users may not adhere to medical advice because they do not understand or do not trust the provider. Finau, E & S.A. SPNF Conf. Melbourne (Nov. 2012 Chronology of Development November 2011:1st Pasifika Fono; February 2012:Present at NZCOM National Committee; March 2012: 1st meeting of Pasifika midwives and consumers (National fono). June 2012: 1st Pasifika Midwifery Focus Group. August: Ratification Pasifika Arm of NZCOM at AGM. September:1st Fono with Pasifika midwifery students Finau, E & S.A. SPNF Conf. Melbourne (Nov. 2012) 25 Roles of a Pasifika Advisory Section Contribute to midwifery strategies planning for the recruitment, training, retention and nurturing of the Pasifika workforce: Special commitment to improving the health and wellbeing of the diverse pregnant Pasifikans; Remove barriers: to training for; access & utilisation of maternity services of Pasifika communities, & providers; improve functional (health) literacy; Pacific midwives have a voice in contributing to solutions that are measurable and tangible in effecting optimum outcomes for our Pasifika women, babies & their families: Promote midwifery as a viable career option for Pasifika communities and students; Work with agencies on midwifery scholarships. Finau, E & S.A. SPNF Conf. Melbourne (Nov. 2012) 26 Pasifika Model of Practice: There many Pasifika models of health and research E.g., Fono Fale Model: The foundation (floor of the fale): represents the family which is the foundation for all Pasifika cultures; The Roof: represents cultural values and beliefs that shelter the family for life; culture is dynamic and constantly evolving; Finau, E & S.A. SPNF Conf. Melbourne (Nov. 2012) The Four Posts: connects culture & family, & are continuous & interactive with each other. The Pou are representative of four areas: spiritual, physical, mental and other influences impacting on family wellbeing. The Fono Fale is encapsulated in a cocoon that has dimensions with direct or indirect influences on one another. These are: Environment, Time and Context. RECOMMENDATIONS: Review current maternity model Grow Pasifika midwives & community-based services Pasifikan pregnancies to have Pasifika competent or supported LMC Return to Midwifery Program Skilled Overseas Registered Nurses Review current midwifery training to include General nursing training Complimentary roles of doctors and widwifes Non Pacific midwives to go though Pacific cultural competency training Finau, E & S.A. SPNF Conf. Melbourne (Nov. 2012) REFERENCES: Arendas, K., Q. Qiu, et al. (2008). Obesity in pregnancy: preconceptional to postpartum consequences. Journal of Obstetrics and Gynaecology Canada: JOGC 30(6):477-88. Cundy, T., et al (2001) Perinatal mortality in Type 2 diabetes mellitus. Diabetic medicine, 17(1):p.33-9. Erick-Peleti S, Paterson J, Williams M (2007) Pacific Islands Families Study: Maternal factors associated with cigarette smoking amongst a cohort of Pacific mothers with infants. NZ Med J.120(1256). Cited from http://www.nzma.org.nz/journal/120-1256/2588. Low. P,J. Paterson, T.Wouldes, S. Carter, M. Williams (2005) Factors affecting antenatal care attendance by mothers of Pacific infants living in New Zealand, The NZMJ 118:1216. Minister of Health and Minister of Pacific Island Affairs.(2010)’Ala Mo’ui – Pathways to Pacific Health and Wellbeing 2010-2014. Ministry of Health. (2008). Maternity services consumer satisfaction survey 2007. Wellington: Ministry of Health. Pacific Best Practice Guidelines, (2010). Auckland District Health Board Mainstream Pacific Responsiveness Plan, 2008. Sundborn, G., et al., (2006) Differences in Health-Related Socioeconomic Characteristic Among Pacific Populations Living in New Zealand. The New Zealand Medical Journal, 110(1228). Violani Wills: in Ministry of Health Pregnancy Book, also PHD Journal Finau, E & S.A. SPNF Conf. Melbourne (Nov. 2012) 29 Pasifika Midwives are Rare as Birds’ Teeth ‘Alu a koē mo ke fiemalie!’ Finau, E & S.A. SPNF Conf. Melbourne (Nov. 2012) 30 Tui Atua Tupua Tamasese Ta’isi Efi (Head of State, Samoa, 2009) “I am not an individual; I am an integral part of the cosmos. I share divinity with my ancestors, the land, the seas and the skies. I am not an individual, because I share my tofi (an inheritance) with my family, my village and my nation. I belong to my family and my family belongs to me. I belong to my nation and my nation belongs to me. This is the essence of my belonging.” E & SA Finau SPNF Melbourne 2012 31 Mālō! Haere Ra! Questions ? & Answers ? Finau, E & S.A. SPNF Conf. Melbourne (Nov. 2012) 32