26 April 2022
Dr Sue Calvert
Midwifery Council
Email:
[email address]
Tēnā koe Sue
Re: Feedback on the Revised Midwifery Scope of Practice 2022
Please find below the feedback from Capital & Coast and Hutt Valley DHB on the revised Midwifery
Scope of Practice.
Firstly, we would like to thank the Midwifery Council and the Collaborative Reference Group (CRG) for
the considerable work that has gone into revising the Midwifery Scope of Practice (‘scope’).
Alignment of the scope with Te Tiriti o Waitangi
We fully support the inclusion and application of Te Tiriti o Waitangi within the scope, and the use of
mātauranga Māori perspectives and cultural views.
Equitable and culturally responsive care
We are pleased to see that the revised scope presents a professional framework, which aligns closely
with the need for midwives to provide equitable and culturally responsive midwifery care. The move
from cultural competency to culturally safe care is an important transition for the profession and
institutions whilst working towards achieving equitable health outcomes.
Terms / language
We applaud the full te Reo Māori translation of the revised scope of practice. However, we would like
to bring to your attention two words that may require increased explanation and understanding by the
sector if they are to be used commonly:
Kahu pōkai
Whānau – as a descriptor for wāhine/women/people and as a family group
Expansion of the scope
While the intent of an expanded scope is to allow more flexibility to the role of a midwife, there are
some key areas which we believe require greater clarity:
We support the NZ College of Midwives view that “
With no defined time period explaining when
a midwife may provide midwifery care in the revised Scope, it is difficult to ascertain the
boundaries of clinical practice within which a midwife is authorised to practise.”
The removal of a time parameters (‘pregnancy, labour and the postpartum period up to six
weeks’) is likely to create complexities for midwives which may have unintended detrimental
consequences. From the perspective of midwives practicing in hospitals, the removal of time
parameters leaves them vulnerable to redeployment across non-maternity areas which they
may not feel appropriately skilled to work in.
Hutt Valley DHB | Private Bag 31907, Lower Hutt 5010 |
04 566 6999 l www.huttvalleydhb.org.nz
Capital & Coast DHB | Private Bag 7902, Newtown, Wellington 6342 | 04 385 5999 l
www.ccdhb.org.nz
The definitions and educational requirements for the expansion to whānau sexual and
reproductive health, preconceptual and infant health and wellbeing, we believe, should be
clearly detailed within the competences.
The use of all infant heath, rather than the term newborn changes the timeframe to which care
is provided by the midwife. Further clarity is required to this within the revised scope as the
definition of an infant is by many in health and educational settings to be up to one year of age.
For students completing undergraduate midwifery education, expansion of the midwifery scope
will require changes to the current undergraduate programme. This could result in significantly
longer programme requirements to ensure midwives have the required education to practice
across the full scope. Currently there are insufficient numbers of midwives graduating each year
so any lengthening of the undergraduate programme would be detrimental.
For existing midwives, any scope expansion has the potential for midwives to specialise in areas
outside of maternity care, further impacting on midwifery workforce shortages.
Inclusion of practice settings
The inclusion of practice settings (marae, home, community and hospital) we would like to see re-
introduced in the revised scope to protect the provision of midwifery care across all settings.
Autonomous practice
The ability for midwives to practice autonomously, rather than under the direction or delegation of
medicine or nursing has been a fundamental principle of midwifery in New Zealand since the 1990s.
While it may be the view of the profession that autonomy is embedded in normal midwifery practice,
the revised scope does not provide enough clarity of this principle for other health professionals or the
general public. Midwives practise ‘on their own professional responsibility’ and we would support the
NZ College of Midwives view that this should continue to be protected within the scope.
Thank you for the opportunity to provide feedback. If you have any questions, please do not hesitate to
contact us.
Ngā mihi
Carolyn Coles
Wendy Castle
Director of Midwifery 2DHB
Associate Director of Midwifery 2DHB