WORKING AS A COORDINATOR MIDWIFE IN A TERTIARY ...

Guidelines’, however these guidelines remain open to interpretation with ongoing
challenges for DHB midwives, LMCs and women. Ultimately the coordinator can find
herself ‘on the spot’ and faced with managing these grey areas of interpretation.
Birth planning
Birth planning is an integral part of a woman’s preparation for the birth of her baby. Her
birth plan is documented in her clinical notes within a framework of informed consent
(Ministry of Health, 2002; Code of Health and Disability Services Consumers Rights,
1996). In the event of complications during pregnancy, labour or the puerperium birth
plans require amendments and there is not always time to formalize this. It is often the
DHB midwife who is at the bedside and needs to effectively communicate with the
woman and her family as she explains the need to amend or abandon a prior birth plan.
Dann (2005) identifies the challenges which exist and describes the delivery suite
environment where “ women are accessing the maternity services, expressing their
autonomy and making decisions, which may not always be seen as appropriate by all
midwives and obstetricians” (p.634). Ethical dilemmas can ensue for all involved when a
woman, her family, her whanau or her LMC express conflicting viewpoints to their
secondary caregivers. It is often the coordinator who becomes the facilitator and manages
these situations.
Tertiary hospital DHB midwives are highly skilled professionals whose skills range from
the normal to the complexities of high dependency unit midwifery care. A challenge for
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