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Cecile's Comment
								
						
						
								
										HELPING HANDS FOR MIDWIVES
								
						
				
				
						By now all midwives will have received the Midwifery
						Council’s consultation document inviting feedback about the regulation, training and scope of practice of the midwifery assistant in NZ. This document has had wide coverage, including consumers, DHBs and other maternity facilityproviders. I know from experience that midwives are notalways very good at responding to questionnaires, but I hope they do so inthis case, since it affects midwives more than anyone else.
				
						There is little doubt that midwifery shortages will continue to be a problem
						in this country for the foreseeable future. We also know that hospitals are 
						already employing maternity health care assistants (MHCAs), many of
						whom are doing a sterling job at supporting overworked midwives. But
						their training has been rather ad hoc, varying in different areas, and their
						tasks dictated by the changing needs of the work area.
				
				
						It appears that we have come full circle: when I started working in the
						neonatal unit at National Womens Hospital in 1978, we had hospital aides,
						Karitane nurses, enrolled and obstetric nurses in our department. The
						aides were expert at feeding the premature babies, who were quite a
						challenge to feed and wind. The Karitane nurses and enrolled/obstetric
						nurses also did a lot of hands‐on care, theoretically working under the
						supervision of the registered nurses and midwives, but in actual fact, often
						teaching them if they were new to the ward. They were valuable members
						of the team. In the delivery units, hospital aides assisted at births,
						facilitated breastfeeding, showered women after delivery and bathed
						babies. Enrolled and obstetric nurses were excellent theatre nurses at
						caesarean sections.
				
				
						Gradually, the demand for more highly trained staff led to registered
						nurses and midwives taking over most of the tasks previously undertaken 
		
		by auxiliary staff. When I worked at St Helens, even the distribution of meal
		trays was considered to be a midwifery task!
		 
		And now we have HCAs who support the midwives, assist with
		mothercrafting, take over some administrative duties ‐ and even give out
		meal trays. How times change!
		
				In Holland, MHCAs complete a 3‐year course, must pass an exam, and work 
				under midwife or GP supervision. Their scope of practice includes
				necessary household chores, help with breastfeeding, care of older
				children, instruction and teaching, providing comfort and confidence with
				baby cares, and assisting at deliveries. They are essential to the continuity
				of the high rate of home births in Holland, since they provide much of the
				postnatal care, and thus free the midwives to attend more deliveries. Most
				midwives attend 150 births per annum, working in groups in order to be
				able to take time off.
		
		
				The Dutch midwifery programme was increased from 3 to 4 years in 1994,
				and recruitment is very competitive. In 1979, the title of
				“idwife”(vroedvrouw) was replaced by “erloskundige”–expert in
				obstetrics ‐ while obstetricians were called gynaecologists. Midwives have
				more obstetric training than GPs, and can “ssist birth with patience”–still
				the most important condition for normal obstetrics. In Holland, the
				existence of the MHCA has elevated the midwife’ status.
		
		
				I would like to see a formalized, comprehensive MHCA training
				programme, and a paid trainee intern year for midwives after their 3‐year
				degree course, which would ease the midwifery shortage and increase new
				midwives’expertise and confidence.
		
		
				Virtually every country has experienced increased medicalisation of
				childbirth since the 1970s. In Holland the LSCS rate is around 8%. It would
				be nice to think we could increase the home birth rate in this country,
				particularly since it would reduce our rising LSCS rate. If we had trained
				MHCAs who could provide the home care & support that Dutch women
				receive, more people might choose home birth as an option.
		
		
				Cecile O’Driscoll