New Zealand College of Midwives Journal最新文献

{"title":"The lactation and chestfeeding/breastfeeding information, care and support needs of trans and non-binary parents: An integrative literature review","authors":"Sarita Gargiulo-Welch, George Parker, Suzanne Miller","doi":"10.12784/nzcomjnl59.2023.6.47-55","DOIUrl":"https://doi.org/10.12784/nzcomjnl59.2023.6.47-55","url":null,"abstract":"Background: The National Breastfeeding Strategy launched by the Ministry of Health in 2020, commits to the protection, promotion and support for breastfeeding with the aim of increasing exclusive breastfeeding rates in Aotearoa New Zealand. This strategy includes a recommendation that the breastfeeding/chestfeeding information and support needs of trans and non-binary parents and their whānau are identified so that those involved in their care are knowledgeable about these specific needs. Midwives are the primary providers of lactation and breastfeeding/chestfeeding information, care and support for most pregnant people in Aotearoa New Zealand. Aims: An integrative literature review was undertaken: to ascertain the specific lactation and chestfeeding/breastfeeding information and care needs for trans, non-binary, takatāpui and other gender diverse whānau; to consider the implications of this knowledge for contemporary midwifery in Aotearoa New Zealand; and to identify continuing research needs. Method: Literature for this integrative review was primarily sourced through the Ovid Online Database using search terms pertinent to the topic and limited to articles published in peer reviewed journals in English, excluding editorials, commentaries and opinion pieces. Findings: Literature about trans and non-binary parents and chestfeeding/breastfeeding, although increasing since 2010, is limited internationally and absent nationally. From extant literature, connections between healthcare barriers and the negative experiences of trans and non-binary parents are identified and explored in three overarching themes: the foundations of Western perinatal healthcare systems; the invisibility of trans and non-binary people within perinatal healthcare systems; and the lack of perinatal healthcare provider knowledge. Conclusion: Cis-normative, gender binary foundations are omnipresent in perinatal healthcare, rendering trans and non-binary people invisible, and excluded from this space. These factors contribute to the limiting of perinatal healthcare provider knowledge, an overwhelming finding in the literature. The absence of locally produced literature presents scope for research production here in Aotearoa New Zealand, exploring this topic from our unique cultural contexts. Such contributions may help inform whether adaptations and additions to current midwifery education are necessary to support midwives in the provision of equitable, safe, culturally appropriate, gender-inclusive care.","PeriodicalId":137118,"journal":{"name":"New Zealand College of Midwives Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139135070","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A vision of decolonisation: Midwifery mentoring from the perspective of Māori mentors","authors":"Nicole Pihema, Daellenbach Shanti, Te Huia Jean, Lesley Dixon, M. Kensington, Christine Griffiths, Elaine Gray, Dino Otukolo","doi":"10.12784/nzcomjnl59.2023.5.39-46","DOIUrl":"https://doi.org/10.12784/nzcomjnl59.2023.5.39-46","url":null,"abstract":"Background: Mentoring is a valued form of professional and cultural support among midwives in Aotearoa (see glossary for te reo Māori translations). Mentoring occurs both informally and via formal programmes, including Māori mentoring initiatives with tauira, new graduate and rural midwives. International studies identify indigenous mentorship as a viable approach to supporting the retention and professional development of indigenous health workers. However, little research exists on the mentoring relationship from the perspective of Māori mentor midwives. Objective: To examine the mentoring relationship from the perspective of Māori mentor midwives. Method: This qualitative research used focus groups of Māori mentors, identified from the Find Your Mentor database, to explore their views of mentoring from a Māori perspective. A semi-structured topic guide used seven simple, open questions to stimulate discussion. Discussions were transcribed and analysed using Braun and Clarke’s (2006) six steps of inductive thematic analysis. Findings: A vision of decolonisation lies at the heart of the mentoring relationship for Māori mentor midwives. Mentors see their role as supporting mentees to navigate the challenges of a Pākehā health system, and to strengthen their midwifery practice through Te Ao Māori. Mentors describe how they are guided by the principles of tika and pono, and work to create a culturally safe space based on mutuality and trust through sharing kai and incorporating their whānau and that of the mentee into the relationship. Being a Māori mentor also fills the kete of the mentors. Māori mentors are sustained through being part of a midwifery hapū and experience joy and hope in sharing ngā taonga tuku iho with the next generation. Conclusion: The decolonising approach to Māori midwifery mentoring has tangible benefits for Māori mentees and Māori midwifery. Māori mentoring activities evoke different experiences for Māori mentees, as evidenced by mentor behaviours that are unique within Te Ao Māori. Being part of Māori mentoring relationships also nurtures the resilience of the mentors.","PeriodicalId":137118,"journal":{"name":"New Zealand College of Midwives Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138626563","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Midwives' perceptions of enablers and barriers to pertussis and influenza vaccination in pregnancy and information sharing","authors":"Amber Young, Esther J Willing, Natalie J. Gauld, P. Dawson, N. Charania, P. Norris, N. Turner","doi":"10.12784/nzcomjnl59.2023.4.29-38","DOIUrl":"https://doi.org/10.12784/nzcomjnl59.2023.4.29-38","url":null,"abstract":"Background: Vaccination in pregnancy against influenza and pertussis protects the pregnant woman/person and their infant against severe disease. Aotearoa New Zealand has a lower uptake of vaccination in pregnancy than some other countries, despite this immunisation being publicly funded. Coverage is also inequitable, with Māori, Pacific people, and people from high deprivation areas less likely to be vaccinated. Many barriers exist to vaccinations in pregnancy, e.g., access barriers and lack of knowledge about vaccination. Discussions about recommended vaccines with healthcare professionals, particularly midwives, may have a positive impact on vaccine decision-making. Aim: This study aimed to investigate midwives’ perceptions of enablers and barriers with discussions about vaccinations in pregnancy, barriers to vaccination in pregnancy, and influences on vaccine decision-making in pregnancy. The study also aimed to gather midwives’ insights into what might improve vaccination uptake. Method: A structured questionnaire was developed containing a mix of closed and open-ended questions. The questionnaire was sent out to 3002 midwives registered in Aotearoa New Zealand in October 2021, using REDCap electronic data capture tools. Simple descriptive statistics were undertaken on the quantitative data. The answers to the open-ended questions were analysed using a direct, qualitative content analysis approach. Findings: Fifty-one midwives’ responses were included in the analysis (1.8% response rate). Almost all reported sufficient knowledge of vaccinations in pregnancy but had varying levels of confidence when discussing them. The most common enablers to conversations were good relationships, easy communication, and having the time and resources available. Respondents perceived that barriers to conversations were negative preconceptions, communication difficulties and lack of time. Lack of awareness, cost to access services and competing priorities for time were also thought to reduce the likelihood of vaccination in pregnancy. To improve vaccine uptake, respondents identified the need for accessible and suitable vaccination venues, appropriate information and the support of all healthcare professionals involved in maternal healthcare. Conclusion: Midwives surveyed understand the importance of vaccination in pregnancy but there may be lack of confidence, time or resources to effectively engage in discussions. A trusting relationship is important but this can be affected by disengagement or late presentation to healthcare services. Resources to counter pre-existing negative ideas and support communication would help midwives to provide useful information about vaccination. Furthermore, respect and cultural understanding of hapū Māori and their needs will positively support their ability to make informed decisions.","PeriodicalId":137118,"journal":{"name":"New Zealand College of Midwives Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131743176","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Timing of cord clamping: An observational study of cord clamping practice in a maternity hospital in Aotearoa New Zealand","authors":"Tina Hewitt, S. Baddock, Jean Patterson","doi":"10.12784/nzcomjnl58.2022.3.19-26","DOIUrl":"https://doi.org/10.12784/nzcomjnl58.2022.3.19-26","url":null,"abstract":"Background: When the umbilical cord is left unclamped after birth, a significant proportion of the blood from the placenta flows into the newborn, increasing the baby's blood volume by approximately 30%. Routine intervention of immediate cord clamping is harmful as it deprives the newborn access to their own blood, resulting in impaired physiological transition at birth and lower iron stores in early infancy. Iron deficiency in early life, even without anaemia, is linked with impaired neurodevelopment. Aim: The aim of this study was to accurately record birth to cord clamping interval at term vaginal births in a tertiary hospital in Aotearoa New Zealand and concurrently to examine some of the circumstances that may influence the timing of when the cord is cut. Method: This observational study was undertaken from August 2017 to April 2018. Participants were pregnant women having a vaginal birth at ≥37 weeks gestation. Data collected included birth to cord clamping interval, mode of birth (spontaneous or instrumental), maternal position for birth and practitioners involved in the birth. Descriptive statistics were used to summarise the data. Results: Participants were 55 women with term vaginal births. The median interval between birth and cord clamping was 3.5 minutes (IQR 2.18 - 5.68 mins). There was a longer median cord clamping time in the group who had a spontaneous birth (median 3.71; IQR 2.67 - 6.23) vs instrumental birth (2.08; IQR 0.55 - 2.30); with maternal side-lying position (6.37; IQR 4.15 - 9.48) vs lithotomy position (2.24; IQR 1.87 - 3.50); with midwife-facilitated birth (4.06; IQR 2.68 - 6.65) vs obstetric-facilitated birth (2.13; IQR 1.48 - 3.28); and when the neonatal team was not called to attend (4.73; IQR3.32 - 8.26) vs when they were called to attend (2.13; IQR 1.28 - 3.27). Discussion: The median cord clamping time of 3.5 minutes aligns with current local, national and international guidelines, although clamping times as short as 0.23 minutes were observed. The study provides a snapshot of practice at one tertiary hospital, examining data on a range of vaginal births, from uncomplicated midwifery-led births to complicated obstetric-led births requiring neonatal team attendance. By identifying some of the circumstances where cords are clamped early, we may be able to modify the associated factors for these births, thereby improving newborn health outcomes in the future.","PeriodicalId":137118,"journal":{"name":"New Zealand College of Midwives Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126093574","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Editorial: \"Turn left at the large flax.\" How times have changed","authors":"Jean Patterson","doi":"10.12784/nzcomjnl58.2022.0.4","DOIUrl":"https://doi.org/10.12784/nzcomjnl58.2022.0.4","url":null,"abstract":"This year major health reforms have commenced which will change the structure and delivery of health services throughout Aotearoa New Zealand. It is unclear at present what these will mean for midwives but there is no doubt that there will be some impact on how midwives work. Communication technology has already changed the way in which we work. I was recently rummaging through some old midwifery notes when I found a yellowed, pencilled map with the inscription: Turn left at the large flax, carry on to the sheep yards on the right, turn left up the gravel road - we are on the 3rd bend on the left, blue house, dogs under control.","PeriodicalId":137118,"journal":{"name":"New Zealand College of Midwives Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129447420","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring the ways communication technology is used by midwives and pregnant women/people: An integrative review","authors":"Karen J Wakelin, Judith McAra-Couper, Tania Fleming, Gwen D. Erlam","doi":"10.12784/nzcomjnl58.2022.2.11-18","DOIUrl":"https://doi.org/10.12784/nzcomjnl58.2022.2.11-18","url":null,"abstract":"Background: Pregnant women/people globally are increasingly using digital technology such as texting, emailing, instant messaging, pregnancy applications, social media and the internet to access information about their pregnancy. There is little information, however, on how the technology is used to enable midwives and pregnant women/people to communicate with each other and what effect this may have on the quality of maternal and newborn health within Aotearoa New Zealand. Aim: To explore the literature on how communication technology has been used to enable midwives and pregnant women/people to connect with each another. Method: An integrative literature review of peer reviewed studies between 2010 and 2021 was undertaken to explore how communication technology was used to enable midwives and pregnant women/people to connect with each another. The initial search elicited 450 articles, of which five met the inclusion criteria. These were then assessed using the Critical Appraisals Skills Programme checklist. Results: The five relevant studies were summarised using an evidence table to enable comparison of themes or relationships between the studies. Four main themes were identified: (1) connecting, (2) access to healthcare, (3) privacy and confidentiality, and (4) lack of skills and knowledge. Using communication technology appeared to provide a safe space for information sharing within which pregnant women/people and midwives could connect. A feeling of connection was important, in supporting the pregnant woman/person in their access to maternity services. This emotional connection was enabled regardless of whether the pregnant person and midwife were known to each other. However, concerns were identified relating to issues of privacy, and the skills pregnant women/people and midwives needed to access and use the technology. Conclusion: Gaps in the published literature were highlighted through undertaking this integrative literature review. The first was in the understanding of how midwives and pregnant women/people use communication technology when communicating with one another, and the second was in how communication technology is used within a midwifery continuity of care model.","PeriodicalId":137118,"journal":{"name":"New Zealand College of Midwives Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133672072","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The microbiota of the vulva and vagina: Ways of washing to optimise the protective function of the vulvo-vaginal microbiota during pregnancy","authors":"L. Banga","doi":"10.12784/nzcomjnl57.2021.5.34-40","DOIUrl":"https://doi.org/10.12784/nzcomjnl57.2021.5.34-40","url":null,"abstract":"Background: The microbiota of the vulva and vagina has a crucial protective function, which is important for all women and has particular significance in pregnancy. Yet this microbiota is part of a delicately balanced ecosystem, susceptible to extrinsic factors which include the simple matter of how women wash themselves. Clinical observation and anecdotal evidence indicate that women in Aotearoa New Zealand have washing practices that may compromise the naturally acidic vulvo-vaginal environment crucial to optimising the protective function of the microbiota. Aims: The aims of this review are: to determine if there is dissonance between how women are washing their vulva and vagina and recommended washing practices; and to raise awareness of the emerging significance of the vulvo-vaginal microbiota to women’s health, particularly in pregnancy. Method: A literature review was undertaken to discover what is reported (in the published literature) about the ways women wash themselves, products used, and their effect on the vulvo-vaginal microbiota. The evidence behind the “wash with water” recommendation was investigated. Findings: There is a lack of primary research on ways of vaginal washing used by women in Aotearoa New Zealand. Globally, women are routinely using a variety of products that include soap, anti-bacterial wipes, gels and baby wipes, and invasive vaginal washing practices such as douching, flannel scrubs and internal soap cleansing. All washing products, including gentle soap but excluding lactic-acid based gels, alter pH levels when used on either the vulva or the vagina. Washing practices that alter vaginal pH levels can cause a microbial shift into a sub-optimal state that compromises the protective function of the vulvo-vaginal microbiota and is more susceptible to bacterial vaginosis and group B streptococcus vaginal colonisation. The frequency and duration within suboptimal states may be predictors of risk. Conclusion: There is dissonance between the ways women wash their vulva and vagina, and evidence-based advice to just wash with water. The back-to-basics message “just wash with water” promotes a way of washing that optimises the protective function of the vulvo-vaginal microbiota, while also protecting the integrity of vulval skin, and supporting physiological self-cleaning of the vagina.","PeriodicalId":137118,"journal":{"name":"New Zealand College of Midwives Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121886919","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Promoting positive interactions between midwives and obstetricians at the primary/secondary interface","authors":"R. Cassie, Christine Griffiths, George Parker","doi":"10.12784/nzcomjnl57.2021.6.41-48","DOIUrl":"https://doi.org/10.12784/nzcomjnl57.2021.6.41-48","url":null,"abstract":"Background: Interprofessional communication is a critical component of safe maternity care. The literature reports circumstances in Aotearoa New Zealand and overseas when interprofessional collaboration works well between midwives and obstetricians, as well as descriptions of unsatisfactory communication between the two professions. Aim: To explore and define effective collaboration between midwives and obstetricians at the primary/secondary interface in maternity care, in order to generate suggestions to foster positive collaboration. Method: Eight primary care midwives, three obstetricians and two obstetric registrars from a single District Health Board in Aotearoa New Zealand were interviewed about their interactions at the primary/secondary interface and their understanding, and use, of the Referral Guidelines. The theoretical perspective was Appreciative Inquiry. Data were analysed using thematic analysis. Findings: Results indicate usually positive interprofessional interactions. Dominant emergent themes are the need to negotiate differing philosophies, to clarify blurred boundaries that sometimes lead to lack of clear lines of responsibility, and the importance of three-way conversations. Of the three themes, this article focuses on three-way communication between midwife, obstetrician/registrar and woman. Participants reported that, when effective three-way communication between woman, midwife and obstetrician occurred, philosophical difference could be negotiated, blurred boundaries clarified and understanding of the respective roles of the LMC midwife and the obstetric team promoted. Participants value the Referral Guidelines but report some limitations to their applicability. Conclusion: Effective three-way communication promotes good maternity care. This study has identified ways to support optimal communication.","PeriodicalId":137118,"journal":{"name":"New Zealand College of Midwives Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134564928","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A daunting journey: A qualitative comparative study of women’s experiences of accessing midwifery care","authors":"Adrienne Priday, D. Payne, Marion Hunter","doi":"10.12784/nzcomjnl57.2021.4.27-33","DOIUrl":"https://doi.org/10.12784/nzcomjnl57.2021.4.27-33","url":null,"abstract":"Background: Early engagement with a maternity carer is recommended as a means of reducing stillbirth and neonatal mortality. This is especially important for women who live in high deprivation areas, as these areas have been associated with late access to maternity/midwifery care and significantly higher rates of stillbirth and neonatal mortality. Co-locating midwives at general practitioner (GP) clinics in such an area was established with the aim of facilitating women’s early access to midwifery care. Aim: To explore the experience of multiparous women who live in socio-economically deprived communities within the Counties Manukau Health region and who accessed the services of midwives at co-located clinics. Method: Interpretive descriptive methodology was used to explore the experiences of each woman before and after using a co-located midwifery clinic. One-to-one, semi-structured interviews were undertaken and data examined using thematic analysis. Findings: The eight women interviewed found accessing Lead Maternity Care (LMC) midwives during early pregnancy a daunting journey before being able to use a co-located clinic in the Counties Manukau Health region. Barriers identified were: a lack of knowledge about how to find a LMC midwife, limited finance and limited time. These impacted on women’s ability and confidence to find a suitable LMC midwife. The women expressed the need for help to circumvent the maternity care maze through receiving a recommendation for a LMC midwife and having access to a midwife co-located at their GP clinic. Conclusions: The participants encountered numerous barriers accessing early LMC midwifery care. Enablers to accessing early LMC midwifery care include receiving recommendations from GP clinic personnel, and midwives being co-located at GP clinics to make maternity care convenient and with a smooth transition from GP to LMC midwife care.","PeriodicalId":137118,"journal":{"name":"New Zealand College of Midwives Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133907491","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Health policy and its unintended consequences for midwife-woman partnerships: Is normal pregnancy at risk when the BMI measure is used?","authors":"S. Knox, S. Crowther, Judith McAra-Couper, A. Gilkison","doi":"10.12784/NZCOMJNL54.2018.4.30-37","DOIUrl":"https://doi.org/10.12784/NZCOMJNL54.2018.4.30-37","url":null,"abstract":"Background: Little attention has been paid to understanding the unintended consequences of health policy for midwife-woman partnerships. The measure of Body Mass Index (BMI) is one such policy example which has become established in contemporary midwifery practice as a tool for assessing pregnancy risk. The universal acceptance of BMI creates an unsettling paradox for midwives concerned with promoting woman-centred practice. The increasing focus on BMI is challenging for midwives as they navigate ethical tensions when directed to undertake practices which have potential unwonted consequences for the midwife-woman partnership. Aim: The aim of the study was to explore the use of an indicator, using BMI as an example, to provide an international perspective on obesity prevention policy and maternity care provision. Method: A comparative case study approach was taken, using descriptive cross-national comparative analysis of obesity prevention policy, weight management guidelines and midwifery models of care in New Zealand and Scotland. Discussion: Despite promoting healthy weight gain in pregnancy, New Zealand and Scottish health policies may be missing health promotion opportunities. Focusing on BMI in maternity, per se, should not prohibit other assessment of lifestyle issues or delivery of services based on individual needs, capacities, histories and sociological characteristics. Relying solely on pre-pregnancy BMI as a marker of health in all women has remained relatively unchallenged and, as such, constitutes a policy problem because it occludes the factoring in of other lifestyle issues that may significantly alter individual risk status. Further, such an assessment of risk status is ideally arrived at within a partnership model of maternity care, rather than reliance on an a priori medical test. Conclusion: Decontextualised policies are challenging for midwives where medical and midwifery values are in conflict. Policy which fails to consider the multiple and complex contexts of women's lives is confronting for midwives as they attempt to re-articulate the meaning of woman-centred practice. Furthermore, BMI as a tool may be ineffectual. The current focus on BMI in policy and practice requires re-consideration.","PeriodicalId":137118,"journal":{"name":"New Zealand College of Midwives Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126879338","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}