Midwifery: an autonomous profession

Midwifery in New Zealand regained its status as an autonomous profession in 1990.  The Nurses Amendment Act of that year restored the professional and legal separation of midwifery from nursing and established midwifery and nursing in New Zealand as separate and distinct professions. The legal changes in 1990 also made it possible to offer pre-registration midwifery education to people with no previous nursing registration (i.e direct entry midwifery).

Midwifery is a profession with a distinct body of knowledge and its own Scope of Practice, Code of Ethics and Standards of Practice. The midwifery profession has knowledge, skills and abilities to provide a complete maternity service to childbearing women on its own responsibility.

Midwives work in many ways to provide maternity services to women and their whanau. All midwives are expected to work in partnership with women, providing or supporting continuity of midwifery care throughout the woman’s childbirth experience. Midwives work collaboratively with other health professionals when necessary to meet any additional medical, health or social needs of mothers and their babies.

Midwives may be self-employed providing continuity-of-care to individual women and their families as Lead Maternity Carers (LMCs); employed by District Health Boards (DHBs) to provide a continuity-of-care service; or employed by DHBs to provide 24 hour, rostered shift cover in a maternity facility. Approximately half of New Zealand’s midwives are self employed while the other half are employed. A significant percentage of employed midwives are employed as caseloading midwives to provide LMC services.

Midwives work in partnerships with other midwives, as practices of midwives, as part of continuity-of-care teams or as core rostered-shift staff in hospitals. All midwives contribute to the safe and effective maternity services in New Zealand. 

Over 78 per cent of all pregnant women in New Zealand now have a midwife as their Lead Maternity Carer. The maternity service in New Zealand has undergone massive change in the last decade and these changes continue. The outcomes for women having total midwifery care are very good and the perinatal mortality rate has never been lower. Women are increasingly satisfied with their maternity experience.

Contexts for practice

The maternity service in New Zealand is an integrated system of primary, secondary and tertiary maternity care. All maternity care is free except if a woman chooses a private obstetrican, who may charge the woman on top of the set fee the obstetrican receives from the government.

Primary maternity care is provided by Lead Maternity Carers (LMCs) who work under Section 88 of the New Zealand Public Health and Disability Act 2000. LMCs are selected by women to provide their lead maternity care, LMCs can be midwives, general practitioners with a diploma in obstetrics or obstetricians. LMCs take responsibility for the care provided to women throughout pregnancy and the postpartum period including the management of labour and birth. One LMC is expected to take responsibility for all modules of care (registration, second trimester, third trimester, labour and birth, services following birth) so that each woman receives continuity of care. 

Copies of the Section 88 Maternity Services Notice can be downloaded from the Ministry of Health website under publications. This notice sets out the terms and conditions under which LMCs are paid by Government and details the minimum service specifications to which all LMCs must work. All LMCs are paid the same as all are expected to provide the same level of service. Midwives and GPs cannot charge women on top of the fee they receive from the government.

Women in New Zealand can give birth at home, in primary maternity facilities or birthing centres, or in secondary maternity hospitals. Primary facilities are often in rural settings although there is a move to establish more primary facilities in urban centres so that women have more options for normal birth. Secondary facilities have caesarian section capabilities. There are five tertiary maternity facilities in New Zealand that also provide tertiary neonatal intensive care units.

All maternity facilities must allow access to LMCs under a generic access agreement. Copies of this access agreement can be found in the Section 88 Maternity Services Advice Notice. The maternity facilities must all provide a certain level of service to women birthing in the facilities and a certain level of support to the LMCs. These expectations are set out in the Maternity Facility Specifications. These can also be downloaded from the Ministry of Health website publications page.

Some primary maternity facilities and all secondary and tertiary facilities employ midwifery staff. These employed midwives may be employed as LMCs to provide continuity of care for their own caseload of women, in which case they must meet the Section 88 service specifications. Midwives may also be employed on shifts to provide core midwifery services. This care includes 24-hour care to women and babies in the facilities and working in collaboration with LMCs. These midwives are often referred to as ‘core’ midwives because they provide the core essential care to women in hospital.

In the secondary and tertiary facilities core midwifery may also provide essential midwifery care to women who require secondary obstetric care and whose LMCs have handed care over to the secondary service. Secondary maternity care is free to women and obstetricians employed in the facilities provide this service with the core midwives. Core midwives and maternity facilties must meet the maternity facility service specifications. Facilities are paid a facility fee for all women who use the facilities and there is an additional budget for the primary, secondary and tertiary services they provide for some women.

The maternity service: an integrated model

The maternity service provides a good example of an integrated health service because LMCs can access any necessary additional services such as obstetric or paediatric services for their clients. The woman does not require another LMC and the additional services are usually provided as a single episode of care eg. forcep delivery or post-natal consultation. Responsibility for the woman’s care may transfer from one practitioner to another for the time of the episode of care, but the LMC responsibility for coordination of care does not transfer. Occasionally a woman may move completely into the secondary service for her pregnancy and birth care but she will return to the primary service in the post partum period.

The LMC model of primary maternity care is the cornerstone of the maternity service. All other services fit in around this model so that the woman experiences a seamless maternity service that meets her individual needs, whatever these might be. This model is unique in the world and has been highly successful in New Zealand with women expressing considerable satisfaction with their maternity services.

For the Section 88 Advice Notice and the Facility specifications see the publications page on the Ministry of Health website:

For more information about becoming a caseloading midwife in New Zealand visit the MMPO website.

For more information about working conditions as an employed midwife in New Zealand visit the MERAS page on this website.

For information about relevant Health and Disability sector standards relating to documentation, consumer rights, and safe environments see Standards New Zealand website