In good hands: Lead Maternity Carer midwives and fetal growth assessment in Aotearoa New Zealand
Author: Sheryl Morris
In good hands: Lead Maternity Carer midwives and fetal growth assessment in Aotearoa New Zealand
Sheryl Morris
30 September 2020
Abstract
Primary maternity care in Aotearoa New Zealand is largely delivered by community based, autonomous, case-loading, lead maternity care or LMC midwifery practitioners. In Aotearoa New Zealand, lead maternity care midwives work in a unique setting, providing continuity of care for women antenatally, intrapartum, and postnatally. This practice ethos benefits both women and their babies by ensuring women are seen regularly by the same midwife, or group of midwives, providing the opportunity to develop a sound understanding of the woman and her pregnancy. An integral aspect of LMC midwife care is routine antenatal assessment of fetal growth to ensure the wellbeing of both the woman and her baby during pregnancy. But what does it mean to ‘assess fetal growth’ in the unique context of continuity of midwifery care in Aotearoa New Zealand?
This research explores the meanings of fetal growth assessment to midwives, how the actual assessment is completed, and the knowledge, skills, and experience that midwives draw upon to undertake assessments. This qualitative descriptive study included semi-structured individual interviews with 14 LMC midwives. The findings were analysed using thematic analysis with key themes emerging from the data.
The findings of the analysis are presented in two chapters. The first findings chapter, ‘Midwifery knowing and fetal growth assessment’ discusses the art and science of this holistic aspect of midwifery practice. The midwife-woman partnership, the importance of consistency, navigating measurements and intuitive knowing form the themes revealed in discussion with the participants. These themes resonate strongly with midwifery practice in Aotearoa New Zealand and exemplify a midwifery epistemology. iii
The second findings chapter, ‘Navigating the medico-midwifery realm’ captures the participants’ experiences of working within a maternity landscape dominated by a medical epistemology and grounded in pathologising and medicalising reproductive care. The themes within this chapter are: the medicalisation of fetal growth assessment, and midwives’ negotiation of and response to the medicalisation of fetal growth assessment. The implementation and expected adherence to protocols is discussed by the participants, as is the marginalisation of midwifery knowledge within this context. Equally, the self-knowledge of pregnant women also appears to be undervalued within this paradigm.
A midwifery epistemology specific to fetal growth assessment is illuminated and affirmed. Scientific, holistic, experiential, and intuitive knowledge is combined and applied expertly within LMC midwifery care. The marginalisation of this expert knowing within the scientific paradigm is a loss both for women and midwives. As a body of primary maternity care professionals, midwives must represent the midwifery epistemology underpinning our fetal growth assessment practices in the medically dominant maternity landscape by transforming the status and value of midwifery knowing, rather than acceding to the medicalisation of fetal growth assessment.
Keywords: midwifery knowing, abdominal palpation, fetal growth assessment, antenatal assessment
Sheryl's thesis was supervised by George Parker and Karen Wakelin.
License
This thesis is available under Creative Commons Attribution-NonCommercial licence CC BY-NC 4.0 International.
