The maternity service in New Zealand is unique in the world. Of the 91.3% of women who chose a Lead Maternity Carer (the practitioner responsible for providing the women’s care during her maternity experience), 85.2% choose a midwife (MOH, 2014).
The midwifery model of care in New Zealand is based on the principles of partnership. The woman and midwife are equal partners, the care is woman-centred: women have the right to choose their carer; continuity of the carer is the norm if the pregnancy and birth are progressing normally and the woman is healthy. Women have the right to make informed choices about the care they receive and birth is accepted as a normal life event (Guilliland & Pairman, 2010). This programme model provides a suitable theory for the evaluation of the midwifery service.
Individual midwives in their practice promote physiological birth, providing an appropriate physical, psychosocial and cultural environment, which avoids unnecessary intervention. Yet little has been researched of what influences midwives’ practice, or how women influence the care they receive from the midwife and how women's choices influence the outcomes.
Although the issues which interrupt physiological birth are well known, the effects of the interaction between the physiological, the psychosocial and the neurohormones are frequently not acknowledged in practice. This study will explore these mechanisms using realist evaluation.
There are a number of elements that are central to the promotion of physiological birth. How these elements may effect, or be effected by, what happens during the childbirth process will be explored, including the significance of interventions (Context) and their consequences (Outcomes).
As is the case in government-funded health services, the extremely complex programme works really well for many women. The outcomes are positive and the majority of women are satisfied or very satisfied with their care, but 15% of women are not satisfied with their care (MOH, 2014). It has been argued that this maternity programme is largely an unevaluated health experiment, but this is not the case as there are many official reports and databases generated by the service providers and government. A significant amount of qualitative research has also been undertaken. The complexities of the service demand a research approach such as realist evaluation, which allows the researcher to evaluate the contexts, mechanisms and outcomes in an integrated way (Pawson, 2010).
REFERENCES
Buckley, S.J. (2015) Hormonal Physiology of Child Bearing: Evidence and Implications for Women, Babies and Maternity Care. Washington D.C.: Childbirth Connection Programs, Partnership for Women and Families.
Guilliland, K., & Pairman, S. (2010). The Midwifery Partnership: A Model for Practice (2nd ed ). Christchurch: New Zealand College of Midwives.
Ministry of Health (2014). New Zealand Maternity Consumer Survey. Wellington: Ministry of Health.
Pawson, R., (2013) The Science of Evaluation: A realist Manifesto. London: Sage.
Please select one of the following:: Realist evaluation , Please select a maximum of two themes from the following list:: Theory in Realist Approach , Please select a maximum of two themes from the following list:: Realist Methodology in Und
