Midwifery: A partnership model

Partnership is a key concept for the midwifery profession, whatever setting they work in. Midwives work in partnership with the woman and her family/whānau, providing or supporting continuity of midwifery care throughout the woman’s maternity experience. This partnership is based on a relationship of trust, shared decision making and responsibility, negotiation and shared understanding.

The word midwife means ‘with woman’ and is reflective of the midwife’s role in accompanying the woman on her journey through pregnancy and childbirth into motherhood. The midwife has a responsibility to share all the available information with the woman and to respect her values and beliefs. The midwife also acknowledges the woman’s autonomy in her own life and respects the decisions she makes for her childbearing experience.

To reflect the partnership with women, the College welcomes individual consumer members, as well as affiliated consumer organisations. All College committees have consumer representation to ensure midwifery services remain woman centred.

The partnership model is articulated in the publication The Midwifery Partnership: A Model for Practice (2nd ed) by Karen Guilliland and Sally Pairman. It is available from the College’s online shop.

The maternity service: An integrated model

The maternity service in New Zealand is an integrated system of primary, secondary and tertiary care.

Primary maternity care is provided by Lead Maternity Carers (LMCs), who take responsibility for the care provided to women throughout pregnancy, during labour and birth, and up to six weeks following birth.

The LMC integrated model of primary maternity care is the cornerstone of the New Zealand maternity service. All other services, such as obstetric or paediatric services, fit in around this model so that the woman experiences a seamless maternity service that meets her individual needs.

This model is unique in the world and has been highly successful, with women expressing considerable satisfaction with their maternity services. The outcomes for women having continuity of midwifery care are very good and the perinatal mortality rate has never been lower.

Women choose their own LMC, with the vast majority choosing a midwife and the remainder choosing an obstetrician or a general practitioner who has a diploma in obstetrics. Maternity care is free to eligible women, unless they choose a private obstetrician.

Women can choose to give birth at home, in a primary maternity facility or birthing centre, or in a secondary/tertiary maternity hospital.

There is a move to establish more primary facilities so that women have more options for normal birth. Secondary facilities have caesarean section capabilities; and the five tertiary maternity facilities in New Zealand also provide tertiary neonatal intensive care units.

Midwifery care in maternity facilities

LMCs provide care to women within maternity facilities under a generic access agreement. Copies of this access agreement can be found in the Section 94 Notice (below). The maternity facilities 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.

Most primary maternity facilities and all secondary and tertiary facilities employ midwifery staff, who provide core midwifery services to women in their facility (and who are often referred to as ‘core’ midwives). This includes 24-hour care to women and babies in the facilities and working in collaboration with LMCs.

Midwives may also be employed as LMCs or caseload midwives to provide continuity of care for their own caseload of women, in which case they must meet the DHB Funded Primary Maternity Service specification.

In secondary and tertiary facilities core midwives may also provide essential midwifery care to women who require secondary obstetric care and to women whose LMCs have handed care over to the secondary service. Secondary maternity care is free to women; obstetricians employed in the facilities provide this service in collaboration with the core midwives.

Maternity facilities are funded by the Government for all women who use them. There is an additional budget for the secondary and tertiary level services they are required to provide for women who need them. The services that they are required to provide are described in the Secondary and Tertiary Maternity Services Specification.

Section 94 Primary Maternity Services Notice

LMC Midwives work under Section 94 of the Pae Ora Act 2022. The Section 94 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 and 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, but private obstetricians may charge additional fees.

LMCs can access any necessary additional services for their clients. Additional services are usually provided as a single episode of care e.g. forceps delivery or postnatal 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 postpartum period.

• Section 94 of the Pae Ora Act 2022 and Maternity Facility Specifications can be found on the Ministry of Health’s website
• For more information about becoming a self employed LMC midwife in New Zealand visit the MMPO website.
• For more information about working conditions as an employed midwife in New Zealand visit the MERAS section of this website.
• For information about relevant Health and Disability sector standards relating to documentation, consumer rights, and safe environments see Standards New Zealand website