WORKING AS A COORDINATOR MIDWIFE IN A TERTIARY ...

New Zealand perspectives of secondary and tertiary hospital midwifery dynamics from
the outside ‘looking in’
The vision of establishing a partnership model of midwifery care for New Zealand
women was first written about by Guilliland and Pairman in 1994 and has become central
to New Zealand midwive’s philosophy of care; however the theory and reality do not
appear to necessarily correlate in the workplace. Skinner (2005) writes that the
partnership model “belies the complexity of the real lives of women and working
midwives”. She goes on to observe “although the model has significant uses as an
organizational and political tool and as a practice ideal, there is little assistance as to how
it might be worked into the everyday messiness of practice” (p.262).
The tertiary hospital DHB midwife works in an environment where legislatively,
obstetricians are the decision makers in partnership with the woman and her LMC in
relation to the provision of secondary maternity care for the woman (Ministry of Health,
2002). Skinner (2005) makes the point that the New Zealand midwifery profession is
unique, with LMCs having access to secondary and tertiary hospitals and able to provide
secondary skills to their clients in areas such as epidural management and augmentation
of labour. She writes this practice “is now mainstream and ‘real world’” (p.152).
The research by Skinner (2005) goes on to identify the place of the LMC at the
primary/secondary interface where LMCs felt a diminishing of their power particularly in
relation to obstetricians. These midwives found they needed to “work the system” and
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