Morgan Weathington, Jean Patterson and Rae Hickey
The association between maternal age and stillbirth increases beyond age 40. So how do we best care for these women? Otago Polytechnic graduate midwife, Morgan Weathington, and lecturers Jean Patterson and Rae Hickey sought to investigate.
“I observed a trend in my midwifery practice that women were delaying childbirth until later in life,” says Morgan. “I often work with women over the age of 40, most of whom are in good health and physical fitness. These women ask me about the risks of childbearing at their age and I realised I needed more knowledge to facilitate these discussions.”
Currently there is no New Zealand-based research on the risk of advanced maternal age and stillbirth. As it is a rare occurrence, affecting a small group of women, New Zealand does not have a population large enough to easily draw conclusions from. Therefore, District Health Board guidelines on how to care for advanced maternal age women are based on research from countries with different models of care, which do not include mitigating factors such as parity and good health.
“What I found out was that the current District Health Board guidelines recommend induction of labour after 39 weeks to address this increased risk of stillbirth, regardless of complications. However, many New Zealand midwives address this risk differently by using expectant management,” says Morgan.
Despite this disparity, stillbirth rates are not vastly different between midwifery-led care and GP or obstetric care. This prompted Morgan to consider the possibilities of a collaborative approach with obstetric colleagues, to hopefully uncover an effective model of care that addresses the increased risk but that also allows individualised care. This paper is currently under review by the New Zealand Midwifery Journal.
Weathington, M., Patterson, J. & Hickey, R. (2015) What are the risks of advanced maternal age in the New Zealand maternity setting? A literature review of the evidence to inform midwifery practice. 7th Biennial Joan Donley Midwifery Research Forum, Napier, 24–25 September 2015.
The importance of good nutrition during pregnancy and lactation is emphasised by midwives in their role when working with women and whanau.
Midwifery lecturer, Jade Wratten, co-authored a chapter on micronutrients, their effects and the foods that contain them, in the book Nutrition in Pregnancy and Childbirth: Food for Thought.
“A pregnant woman requires various micronutrients for her own nourishment and to facilitate critical life processes within her body such as cell division and DNA synthesis,” Wratten explains. “We wanted to create a comprehensive and accessible source of information on micronutrients for midwives and health professionals.” But she points out that people consume food – not micronutrients - in isolation.
Wratten says food is much better to consume than supplements.
“Women often rush out to buy pregnancy multi-vitamins which can be expensive, but with the exception of folic acid and iodine, these supplements are usually unnecessary.”
As a midwife of 14 years, Wratten has a keen interest in nutrition in pregnant women. She coordinates a paper on nutrition for childbearing women and a postgraduate course for registered midwives.
“Midwives are charged with providing holistic information encouraging women to adopt and maintain a well-balanced diet,” she says. “Midwives may be more likely to share nutritional information to women if they feel confident in their understanding of micronutrients and their contribution to health and well-being.”
Wratten, J., Martin, C. & Mullen, A. (2013) Examining Micronutrients in Pregnancy and Lactation. Chapter 3 in Davies, L. & Derry, R. Nutrition in Pregnancy and Childbirth: Food for Thought, Routledge. ISBN-10: 0415536065, Kindle Edition 2013.
“Even though the SIDS rate in New Zealand has reduced significantly since the 1990s – from 200 to 50 deaths per year – our rate is still higher than other developed countries,” Baddock, Co-Head of the School of Midwifery at Otago Polytechnic, explains. “Our SIDS rate is one death per 1000 live births, whereas the USA, UK and Australia are half that.”
The factors that appear to influence SIDS are: sleep position; a smoke-free environment; breastfeeding; and a safe sleep environment. “There are a number of risk factors for SIDS that have been identified, but sleeping babies on their back has had the biggest impact on reducing the rate.”
This study is in collaboration with the Māori community and researchers from the University of Otago. The idea for the Wahakura came from Dr David Tipene Leach and the Māori SIDS group, and Baddock was approached to join the research team. The Wahakura, a woven flax basket, can be placed on or near the parents’ bed. The infant stays close to the mother; with the advantages of bed-sharing while having a separate sleep space. The protocol for investigating its safety grew from Baddock’s PhD study investigating bed-sharing versus cot-sleeping – using the same overnight videoing and physiological monitoring of the infant.
“Around 60% of SIDS deaths in New Zealand are in Māori families. There’s an ethnic disparity and this is quite a concern. We are now looking at the Wahakura as a possible solution for safe bed-sharing in Māori families and so far we’ve had a positive response.”
The research targets 200 babies in the Hawkes Bay area, recruiting from midwives who work with mainly Māori families. Babies are randomised to receive a bassinet or a Wahakura, and then they are videoed overnight at one-month. “We video what is ‘normal behaviour’ for the family,” Baddock explains, “and while we encourage them to use the bassinet or the Wahakura, the choice is up to the parents.”
Baddock is keen to expand the research to include another sleep device, the Pēpi-pod, a plastic container of similar size to the Wahakura but cheaper and easier to produce. “This is a possible solution for wider dissemination, but we need to evaluate these devices and make sure there aren’t any unexpected risks.”
Associate Professor Sally Baddock and Professor Sally Pairman
The environments women choose to give birth in have a significant impact on the rates of intervention in labour and the type of births they will have.
These are the findings of a recent study conducted by a multi-disciplinary team of researchers that included Otago Polytechnic School of Midwifery Co-Head, Associate Professor Sally Baddock, and Director of Learning and Teaching and Head of Midwifery,
Baddock’s and Pairman’s exploration of New Zealand’s model of midwifery care, published in the prestigious Birth journal in June 2011, provided a unique opportunity to investigate the impact of the place of birth for women and their babies.
The research showed that women at low risk of complications, who give birth in a tertiary hospital rather than a primary birthing unit, are four and a half times more likely to have an emergency caesarean section. Those in secondary hospitals were more than three times more likely to have a Caesarean section.
“It is important that maternity caregivers explore factors that may assist them to better support women and encourage physiological birth where appropriate, including making more use of primary birthing units.”
Davis, D. Baddock, S. Pairman, S. Hunter, M, Benn, C, Wilson, D, Dixon, L & Herbison, P. (2011) Planned Place of Birth in New Zealand: Does it Affect Mode of Birth and Intervention Rates among Low-Risk Women? Birth, 38:2, June 2011, 111–119.
In 2010, Anna Seiuli was a student advisor working with Pasifika students to improve outcomes. At the time there was no clear model on how to approach the challenges facing her in her role.
“Finding a solution was complex. More than 15 island nations are represented under the umbrella of ‘Pasifika’ and they’re all quite different,” says Anna.
“Some consider themselves French or American not Pasifika. And most of the models that exist are of Samoan origin. So to help find the way forward that will help me with my job, I conducted my own research to find a commonality that is equally shared by all Pasifika in New Zealand.”
Anna’s discoveries led to the development of a tool called Spacifichology. As the name implies, the tool is specifically for Pasifika and is underpinned by psychology, which is fitting since Anna’s other role is as a counsellor.
Since developing Spacifichology, Anna now interviews Pasifika students prior to them commencing their study to pinpoint their strengths, learning needs and the support they required. These profiles can then be sent to lecturers of their classes.
“Asking lecturers to build strong relationships with every Pasifika student is unrealistic because of the teaching time constraints and many other students in the class. Yet we know that the key to working with Pasifika students is to build relationships and staff are one-half of that equation,” explains Anna.
“My model assists teachers to get to know their Pasifika students before they even knock on their door.”
Otago Polytechnic’s School of Midwifery has been particularly interested in, and involved with, Anna’s research. Like Anna, they also share a desire to help their Pasifika students achieve. Dr. Jean Patterson, Deb Beatson, Chris Griffiths and Kerry Wilson, together with Anna, looked at a method called Talanoa, which means “conversation” or “discussion” in Fijian, Samoan or Tongan. The concept of Talanoa, which can be formal or informal, is used to teach, share stories and bring people together.
“As part of our research, we were privileged to hear the amazing narratives of Pasifika student experience including the struggles they face, their determination to succeed and their desire to be role models for their children.”
The team’s research was presented at an international nursing conference (NETNEP) in Brisbane. “Deb and I co-presented at the conference and it was the most profound thing. The research talks about finding a place to belong and these students have found their place. At the end of the presentation, there was silence in the room, followed closely by a standing ovation.”
Since the inception of Spacifichology, the School of Midwifery has had their first Pasifika midwifery graduates since the blended programme model began. In addition, two Pasifika students are in year two of the degree and are doing brilliantly.
“This research adds another strength to their School and shows that their practice is research informed.”