Calls for adequate funding for New Zealand’s midwives have led to discussions about how best to support pregnant people and their whānau through birth and beyond. Hinerangi Rhind-Wiri from Māori public health organisation Hāpai Te Hauora asks if we are considering the distinct and important needs of Māori midwives and whānau alike.
Where is the national support to have more Māori midwives working with whānau? What strategies are being implemented to improve the sustainability of the Māori midwifery workforce? How will their work be remunerated?
Māori women currently give birth to approximately 13,000 babies per year – around 22% of infants born in Aotearoa. Māori birthing rates and fertility have increased and the ages of Māori women giving birth are younger than the national average. For these reasons and more, we need to consider the lack of Māori midwives.
Currently about 8% of all midwives are Māori. These midwives say they have incredibly busy caseloads and are often working over their capacity. While they juggle the needs of many women, whānau continue to request their support and care.
The discussions over the past month about midwifery in New Zealand highlight the workforce inequities facing midwives. But Māori midwives often shoulder more responsibilities than their Pākehā colleagues due to broader Māori health inequities.
Māori access to health care is determined in many cases by institutional racism and injustice. Māori women are more likely to experience poorer health outcomes and face more complex health challenges than Pākehā women.
This need for additional health and social support regularly falls onto the workload of our Māori midwives.
Consequently, Māori midwives are disproportionately impacted by pay inequity, injustice and racism. These issues prompt the question: How much do we value our Māori midwives, our wāhine hapū, our whānau and future generations?
Whānau are desperately wanting Māori midwives to care and work with them. Families say that they better relate to and connect with Māori healthcare workers who understand the realities of being Māori.
Whānau Māori are driving from South Auckland to Waitākere to give birth to their child with a Māori midwife who provides quality care, connection and support. Māori midwives see generations of whānau returning to them for their expertise.
In doing this, we are seeing whānau experiencing better health outcomes upon receiving this specialised, culturally appropriate care.
Some Māori midwives are implementing kaupapa Māori models in their practice, which empowers whānau to make choices as they see fit. They are achieving higher success in breastfeeding duration which has both tangible and intangible impacts of health outcomes for baby.
Positive breastfeeding experiences enable mothers to sustain tikanga ūkaipō beyond the womb as a nurturer, protector and pillar of whānau ora.
Heather Muriwai shares that her previous Turuki Healthcare Midwifery team achieved a “normal” birthing statistic (meaning vaginal without interventions) of around 89%, which was virtually unseen across the country demographically.
“This is evidence of how a kaupapa Māori model could really work for women, but that was at a huge cost to us personally,” says Heather.
The model is about reclaiming what a birthing mother feels is right for herself and for her whānau. It is about telling her it is okay to find what is right for her, within a system that assumes that power and imposes a Western model of care.
The institutionalisation of Māori birthing in hospitals has resulted in a dramatic loss of whānau, hapū and iwi specific mātauranga pertaining to health and wellbeing.
Hospitalising Māori women during delivery has compelled Māori women to birth like Pākehā. This tool of assimilation has disconnected Māori from Māori ancestral practices which ensured wellbeing.
Reclaiming these practices within the current health system that legitimises Western ways of knowing is an ongoing challenge for our midwives and respective whānau.
Māori thrived under systems and spaces which reflected our ways of knowing and navigated tamariki mokopuna into te ao Mārama. These political acts in contemporary society reassert our healing practices and reclaims our right to optimal wellbeing.
The current health regime fails to empower whānau Māori to make their own choices. To equitably improve the health of whānau Māori and future generations requires a radical and innovative change.
The support and impact of Māori midwives is unwavering as they sustain whānau ora and the health of the pā harakeke (generations).
We need to continue to replenish and sustain our Māori workforce who are agents of change in retrieving optimal health and flourishing communities.
Hinerangi Rhind-Wiri is from Ngāti Paoa, Te Arawa, and Tūhoe and currently works at Hāpai Te Hauora, Māori Public Health. Hinerangi’s research background centralises Māori communities and treaty relationships. Within her new role at Hāpai she hopes to contribute to and affirm Māori-led health initiatives and the wellbeing of whānau, hapū and iwi.