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Listen to Māori midwives – they know more than you think

The Māori midwives on the frontline of whānau care and Oranga Tamariki scrutiny say their voices are going unheard and their wisdom unheeded.

*All names have been changed to protect the privacy of those involved

Newsroom’s powerful investigation into Oranga Tamariki’s attempt to ‘uplift’ a newborn baby at a Hawke’s Bay maternity ward has alarmed many and precipitated the organisation of the ‘Hands off our tamariki’ march to parliament on July 30.

While the investigation was shocking for many New Zealanders, Māori midwives were unsurprised. For over a hundred years, Māori midwives have been at the forefront of this fight to protect and strengthen whānau Māori.

Along with Anneka Anderson and Esther Willing, I have been involved in kaupapa Māori research on the experiences of wāhine Māori with maternity services in Tāmaki Makaurau. We’ve sought to understand the complete experience of hapū [pregnant] wāhine and included interviews with health care providers about their perceptions of the barriers and enablers to care experienced by Māori in the maternal healthcare system in Auckland.

Māori midwives who support whānau during pregnancy are often referred to as kaiwhakawhānau. The name demonstrates how we, as Māori, locate the responsibility for birth within whānau.

In a system where uplifted babies are being assessed as individuals, midwives can advocate for a baby as part of a whānau in which they themselves belong to. This perspective on assisting birth differs from the Eurocentric model, one that underpins the Western colonial approach of woman-centred midwifery.

Here’s what a maternity care midwife, Janie, told us: “Women respond better and are likely to engage better if they are looked after by someone they can personally relate to and we as Māori relate to each other. We get each other, just like Pacific women might relate better to Pacific, Indian, Asian, you know? So there’s so few of us [Māori midwives] and we need to be looking after our own.  What I love is that you get the continuity… once you’ve been and done a good job with the family as the “village midwife”, you’d get the sister, the aunty, the cousin, you know, that you’ve been part of that extended family.”

Despite the purpose and calling that many midwives feel, the inequity experienced by whānau Māori is mirrored by their Māori midwives. Most midwives we spoke to said they chose to take on Māori women, but reported being grossly underfunded and undervalued. Last year, midwives rallied across the country for better working conditions in what is, for some, a less than minimum wage job. When caring for babies means strengthening an entire whānau, this can mean midwives going beyond their pay grade and job deliverables to buy nappies, cots, clothes and kai.

Sharon, a midwife, described the challenges of supporting whānau in low paid communities: “When you have people living in sheds that are cold, damp, ten people living in it – how can I dream my big dreams when this is their reality? But you can… you can. It means midwives have got to find support. I can’t do everything, and it’s not my role, and that’s whakahihi to think I can. You need social networks outside the organisation that can step in. But still, the midwife is the coordinator of all those networks. So even if she isn’t doing it herself, she’s got to get them in.”

New Zealand health legislation requires midwives to affirm Māori as tangata whenua and actively honour Te Tiriti o Waitangi, but many midwives said that practice differed from principle. Those working within the healthcare system often described it as unsafe. Themes of institutional racism emerged, with many telling us they entered the workforce ill equipped because they felt they had only been trained to support whānau Pākehā.

Emily graduated as a midwife three years ago. “I felt like we were taught that [Māori] were this minority group, like here is Māori, here is Pākehā, like you’re one or the other and you probably won’t come across that many Māori women. They were othered.”

Jessica, who also graduated three years ago, agreed with Emily. “I trained in Dunedin which is a pretty white area, pretty Pākehā, so that’s how the training was. And I had no idea of the complications within South Auckland, the diversity, what’s going on. And I think when we did our Māori health paper, they just wanted key words, they wanted everyone to tick the box and say the same thing – they didn’t want [us] to have a full understanding of how to support whānau.”

Kimiora described her training to become a midwife: “There was a Treaty paper in our first year and it was run by tauiwi. Why aren’t they bringing in experts on the Treaty to teach about it in relation to midwifery? They’re not, they are using tauiwi midwives. What I found really ironic is that we as Māori students were not allowed to set foot in the hospitals until you’d done the Treaty workshop to make sure that you’re culturally safe. We’re Māori! And I’m not just saying that because you’re Māori, you’re all culturally safe. Why I bring that up is that there’s a lot of midwives that come in from overseas like the UK or India or wherever that don’t have to do any kind of culture safety workshop before working with our people.”

Responses regarding whānau experiences also reflected this whakaaro, with many identifying the lack of cultural safety as one of the most significant barriers to appropriate care. Our findings were consistent with other kaupapa Māori literature, in that upon learning of their pregnancy, many whānau were quick to engage with services and seek support but systemic barriers lead to avoidable delays.

Mama of four Mereana described the differences in her experiences with midwives. “I had a good experience with my last midwife. She would ask me things like if there were any cultural practices I wanted for birth. And it was so nice to be asked. To be treated like a human. We moved back from Aussie with my fourth and I so badly wanted a Māori midwife. I wanted to have that connection – especially because my midwife in Australia just didn’t get me. When we gave our third a whānau name, she told me that I was being mean to my child ‘cause no one would be able to pronounce her name.”

Midwives in Auckland march for for better pay and conditions, May 2018. (Photo: Don Rowe)

This is what Kaia, a hapū wānanga facilitator and Māori midwife, told us: “It’s the language that gets used, the way [women] treated, they get no choices. Things are done to them. A lot of our women are too shy, too whakamā, they’re not the personality that will stand up and say ‘wait a minute’ because that’s the health professional. She knows best, she knows what she’s talking about, and let things be done to them.”

Many whānau felt that being Māori was a source of resilience for them but the system forces them to leave their identity at the door. As Tina Ngata wrote, the Newsroom video demonstrated the healthcare system’s unconscious belief that being Māori and young automatically puts your child at risk. But in the face of adversity and complex life stressors, many whānau shared with us that being strong in who they were was a moemoeā that they hoped to pass onto their tamariki.

Aria, a mama of two, explained how becoming hapū was a conduit for her to explore her whakapapa and connect with whānau from her rohe. As she told me, “how am I supposed to teach my baby who she is, if I don’t even know who I am?”

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Midwives also discussed how wāhine are hungry for this knowledge because we as Māori have been so disconnected from who we are – to the point where birth becomes something to be feared and our inherent strength during labour is being undermined. It was this hunger for mātauranga hapūtanga (knowledge of Māori birth practices) that guided many to continue seeking support from kaupapa Māori services, despite the many structural barriers like cost and transport.

Here’s how Kaia put it: “Women aren’t given that belief in birth anymore, that they are strong. They’re made to fear it, and that’s really sad. But it’s the way it’s gone. But in our wānanga, we’re working really hard to turn that tide, turn things around, bring women back. You’re not sick, this is normal, you don’t belong in a hospital. So we go back to how our tūpuna birth. That’s the only way out.”

The solutions lie in recreating a system that protects, not dissects, whānau. This means following midwives’ lead and returning to whānau as a model of health. This perspective diverges from those shared by leaders within our healthcare system. For example, last week, Ministry of Health director general Dr Ashley Bloomfield was asked for his thoughts on an independent Māori health authority, and he replied that he would prefer to fix the system rather than create a new one. But the current system is not ‘broken’. It was built to be this way – built to oppress, control, to shape our culture and health in a specific way that keeps some babies healthy and connected to whānau, and some not.

Institutional racism lives off us, off our tax payer dollars, off our votes and off our diffused responsibility. It is incumbent on us to speak up. Māori babies will continue to be uplifted until we do.


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