We follow midwives and midwifery students.

By L Kelly, L Pansino, A Towle & C Grace-Beck
Jun 2014

Lian Pansino – 3rd year midwifery student

With Women

The following reflection was written during 3rd year of midwifery elective placement in Te Marae Ora hospital in Rarotonga, Cook Islands. I spent six weeks working in the hospital and remaining on call for births. This reflection was written around my fourth week of placement. In total I attended 19 births; 17 normal vaginal births and two emergency caesarean sections.

Since beginning this placement I have struggled with myself at times about why I am here. The midwifery in this country is not autonomous. Much of my experience with women has been to bear witness to their care being dictated entirely through a one way conversation: the doctor telling the woman and midwives the plan of care. At times I have wanted to negotiate for an episiotomy not to be cut, an artificial rupture of membranes (ARM) not to be performed, or for syntocinon, a synthetic form of oxytocin used to increase uterine contractions, to be delayed just one hour longer. I rarely protest against these procedures as it is clear the decision is not up for discussion and am left asking myself ‘what am I gaining from this placement.’

Yesterday however I was reminded of why I love midwifery when I attended the labour and birth of three women. Regardless of the ARM’s, syntocinon, and pethidine* I saw used, I also saw women walking, rocking, and breathing through their labour. I saw the mothers, sisters, and aunties of these women come to their side to rub their low backs, wipe the sweat from their brow, and be present to meet the newest member of their families. I saw a woman’s vulnerability as she looked at me for guidance when her contractions grew ever stronger, and I reassured her, reminding her to breathe and that she is strong. As I witnessed these women labour, I answered for myself what I am gaining from this placement. I am taking from this place just the simple act of being with women in labour. The most essential part of midwifery! For me, being ‘with women’ is probably one of the most challenging aspects of learning to be a midwife; how do you navigate through a woman’s birthing space. What to do? What not to do? What to Say? Where to touch? Where to stand? The more I am with women the more easily the answers to these questions come to me. I am finally beginning to feel some comfort being in this special place and for that I am grateful to this placement.

*Pethedine is a synthetic opioid used in labour for pain management. Women often describe it as ineffective in reducing pain while leaving them feeling sleepy, distant, unable to articulate needs.

Lian in Rarotonga with (pictured left to right) Judith Couch, Tungane Kani, Moe, Maryann, Mo, Tahi, Sala, Lycee, and Louisa. In the centre, Lian with Tungane’s son, Connor.

Christie Grace-Beck – Midwifery Student.

Where to start!? Half way through the 2nd year of midwifery studies and it’s been an absolute blur. The year kicked off with very minimal sleep and constant rearranging of plans. Everything kicked it up to the next level, and all of a sudden I’m in situations which challenge me and make me thoroughly question my knowledge base because I quickly need to be in action and make real-life decisions. My first few shifts in Queen Mary I walked around like I own the place, but have quickly had a reality check and feel a bit humbled. There are lots more skills to learn and lots of practice to do on skills I already know. There have been many incredible women who have allowed me to follow their pregnancy, labour and postpartum periods and I am indebted to them. I have marvelled throughout these experiences at the generosity of our gender, somehow despite all their own commitments these women allow a student to absorb every bit of their experience also. I feel like a human sponge constantly taking in information and trying to take as much away from practical situations as possible! Each second year student is paired with a midwife or two and I have been fortunate to work with a midwife that has challenged me, given me experiences and allowed room for me to grow. I keep coming around to the concept that we as students, midwives, women, mothers and daughters are part of a cycle and rely on one another for support, love and encouragement. So far, I feel like I have been given so much from those who have facilitated my learning and have let me share their pregnancy journeys. Focusing on this generosity motivates me even more to graduate so that I too can contribute to the cycle and pay forward the support I have received. I’m semi-dreading the second half of the year, as assignments seem to be building up and while I have finished following women for now, the learning is crucial. Reading about midwifery is almost a leisurely activity for me so I’m sure I’ll survive!

Lisa Kelly – Midwife

Kia ora! I am Lisa Kelly, a Māori midwife from Torere on the East Coast. I have been married to my husband Geoff for 20 years and have four tamariki – three teenage girls and an eight-year-old boy.  I have been practising as a midwife since 2002 and moved home to the coast to look after my own iwi nine years ago, a job that I absolutely love.

Birth of our tamariki

My three girls were born at home in Raglan, where we lived for 10 years in three different houses.  My son was born at my mother’s home in Torere.  He had broken the homebirth drought in Torere, as there had not been a home birth there for manyyears.   My first labour was 15 hours, and our daughter was 9lb 7oz.  My next three births were all very quick, with my midwives only just making it in time. Our 3rd daughter was two weeks overdue and weighed 10lb 7oz.

My mum has been at all our births, as have my children. My brother has even been to a few too.

Why I became a homebirth midwife

I was inspired to train as a midwife by my own midwife, Maureen Leong.  I was studying natural therapies at the time, and it seemed like a natural follow through.  Maureen was all about informed choice, and she gave me piles of information to read.  I was happy with my choice to homebirth our first baby and also not to immunise our tamariki, despite all the negative comments. My midwife helped me to become empowered and stand strong about my choices. Thanks Maureen!

Currently I offer homebirth and birthing unit services in our remote rural community.  Sadly, my iwi and hapu are still stuck with the western belief that hospital is safer than home.  At the moment all I can do is give positive reinforcement, heaps of information, and encourage women to talk to their whanau; after all, less than 80 years ago, most Māori were born at home! Home birth is still within us, and the stories are still fresh in the minds of our Tipuna.

My special services

I provide continuity of care throughout the pregnancy, labour, birth, and postnatal period. I do not work in partnership with anyone, but I have several reliable midwives in my area available to back me up whenever I need.  I encourage natural birth and do not provide epidural care.

Encouraging women to use Kaupapa Māori birthing methods is a priority for me. This includes:

    • healthy eating (including fresh kina)
    • regular exercise such as walking, diving, collecting kaimoana and gardening
    • using rongoa māori for any ailments
    • kapahaka, weaving, waterbirth, romi romi and mirimiri.

It is very important that Te Ao Māori is kept alive for our mokopuna.

And of course, our most treasured traditional practice – home birth, spending time with whanau, having a kai, sharing in the care of the mokopuna, he tino ataahua.

Being a good influence

My experience definitely has influenced those around me.  My younger sister is a homebirth mama now, as well as other whanau members.  Also, home birth is more accepted amongst my iwi now as they have seen my own mahi first hand, and it reminds them how normal birth is and that it is not something to be afraid of.

Improving New Zealand’s home birth future?

We need more support from the government and NZCOM to endorse home birth. We also need more positive documentaries, not negative ones, about midwives.

I believe more midwives should be involved in antenatal education through wananga and classes.  I presently teach Te Ha Ora a Kaupapa Māori Childbirth and parenting programme, and it mainly focuses on the normality of birth and home birth as an option.

There’s too much korero on what can go wrong in mainstream classes, and women are becoming afraid of birth.  Midwives also need to stop being afraid.  Nga mihi nui.

Lisa Kelly is part of Te ha Ora, a kaupapa Māori antenatal and parenting education programme for hapu mama and whanau throughout the Eastern Bay.

Amy Towle – Midwife

How do you make a baby?

Making a baby usually (but not always) is done in private.  In the presence of people who love and support each other, often dim lighting, away from public view and ears shot.  In this space people connect, explore and trust each other.  They show things they have never shown anyone else, do things they have never done.  You do this in an environment you create to suit you, whether it be your bedroom, bathroom, lounge room floor or backyard, it makes you comfortable to express yourself.

When a man and woman come together, a great exchange takes place.  They move in sync, exchange glances of love, make an energy connection, touch and most of all release a rush of powerful hormones cementing the connection between them.  For a woman this is oxytocin.  The wondrous hormone of love.  The rush of pleasure runs through her creating a feeling of utter ecstasy.

How do you birth a baby?

During pregnancy the levels of oxytocin increase and come the day of labour a woman is absolutely saturated with oxytocin.  She is literally filled with love.  She needs to express this love and birth her baby.  To allow the release of oxytocin a woman needs to be comfortable, feel safe and secure.  In private, dim lights away from public eyes and ears.  Surrounded by people who love and support her.  In this space she will do things she has never done before, she can connect with her partner.  They will move in sync, exchange glances of love, expand their energy connection, massage, hug, hold and allow the oxytocin to flow.

Could you do this in a bright hospital room, hospital gown, strange smells, people knocking on the door, people talking in the corridor, doors opening and closing, clock watchers?  Could you make love in a hospital birthing room?

Baby’s come out the way they go in.  The best way to have a positive birth experience, is to do it in a space you feel your most comfortable and open, with those who make you feel so.  A fellow midwife once told me she plays two audio tracks to her antenatal class.  One of a couple making love, the other a woman labouring.  No one can tell the difference.

Birthing can be a sacred, empowering experience for a woman.  Holding her, her partner and their baby in arms of love.  When choosing and creating your birth space, don’t forget to ask yourself, could I make love here?

Wahine Toa Midwife

Amy Towle