 Okay, so I'd like to welcome Tamara and Mary, who are the next presenters, away from New Zealand, and it's a pleasure to have you both here, so I'll pass it on over to you now. Thank you. Hi everybody. Welcome to our presentation on mentorship in Midwifery in New Zealand. Today we're going to give you a brief overview of Midwifery, including a very quick history. Part of the Midwives work today, our educational system for Midwives, and of course the Midwifery first year practice program in New Zealand. So Tamara and I are from Canada and Ireland originally, but we've made New Zealand our home. We live in Christchurch, which is situated on the east coast of the South Ireland of New Zealand. We each have three children and they were all born in New Zealand. We both undertook our Bachelor of Midwifery degrees here in Christchurch as the Christchurch Polytechnic Institute of Technology. I graduated in 2005 and Tamara graduated in 2011. So we're just going to give you a really quick overview of Midwifery in New Zealand, starting with a brief history. Basically, prior to 1904, there was very little regulation around Midwifery and Midwives often had on-the-job training rather than a formal education. Midwifery regulation was introduced in 1904 and then following through the rest of the 1900s, Midwifery and nursing became really intertwined together. Maternity care became quite medicalized in that time, many of the births occurring in hospitals and women being assigned a midwife that they didn't know upon admission to the birthing unit. The midwives also needed supervision by a medical doctor and there was no postnatal care for women once they left the hospital with their babies. Later in the 1900s, in 1989, the New Zealand College of Midwives was formed and that currently the membership consists of both midwives and consumers of maternity services. So it's really quite similar to our model of practice is a partnership model. In 1990, Midwifery became an autonomous and independent profession in its own right with the enactment of the Nurses Amendment Act. And that meant that midwives were now able to practice against all the competencies within the scope of practice, providing care in the antenatal, interpartum, and postnatal areas without supervision and on their own responsibilities. They're also able to prescribe. We got access to hospitals and were able to claim from the government for our services. It was also around that time that they started with a specific, formalized midwifery training. Midwifery council set their professional standards and provides continuing education, our standards review process. It also provides our first year practice program. Today in New Zealand, well, maternity services are all funded by the government for residents and citizens. And midwives can work in a number of ways. You can be an employed midwife in a hospital or birthing unit working rostered shifts. You can be an employed caseloading midwife in a district health board or, as Mary and I are, you could be a self-employed continuity of care midwife or what we call a lead maternity care. It's quite a good system. The midwife is selected by the woman. We provide, well, we're responsible for all aspects of our care. So I'm just looking to see, can you guys hear me? Okay, great. So as an LMC, lead maternity care, we are responsible for providing all aspects of a woman's care from anti-natal, interpartum, and post-natal care. We're also responsible for referral and coordination of care with other health providers. And essentially our model here is one woman, one midwife. So just to briefly, this is a little overview of our way of working. So it's a model of partnership. This model of care, you can read that little blurb yourselves while I talk. You know, we are responsible to provide women with information so that they can make informed decisions about their care. Part of our partnership is about respecting her cultural norms, her beliefs and values, and also her own knowledge about herself and her family and her body. So in New Zealand, the midwife works in partnership with the woman. That's basically everything that we work through. The midwife understands and promotes the physiological process of pregnancy and birth as normal. We identify when things deviate from the normal and then referring and working collaboratively with other health professionals allowing us to continue to provide continuity of care. As midwives, we help prepare the women and the family for the transition to parenthood, including information on breastfeeding, newborn care and family planning. As midwives, we provide care in a variety of settings including home, primary birthing units, and secondary and tertiary facilities. And all these settings, the midwife works on her own accountability. The standards of practice that are set out by the New Zealand College of Midwives along with the philosophy and code of ethics are basically the foundation of our practice. The standards provide the framework and the benchmark for the midwife's practice and appropriate usage of midwifery's body of knowledge. It has a series of actions that are essential to the development and maintenance of the midwifery partnership with women. And some of these actions, just to give you a really top line, include the partnership model between midwife and woman, the woman's right to free and informed choice, that midwifery care is individualized to each woman, and part of our practice includes self-reflection. Alongside that, we also have the Taranga Kopapa, which is the guideline for cultural competence. And if you want to go and see more about it, you can check that website link that we've put there. So part of how we practice in New Zealand is that we're constantly reflecting on how well the care we provide to the women and how the women feel about that. So we ensure that we meet our competencies to practice by doing a standard review. It's first done after the first year of practice and thereafter every two years. It's a formal requirement that we need to maintain our annual practice and certificates. A lot of it is based on reflection of our own practice. The meeting is between the midwife, a consumer representative, and the midwife who is the reviewer. It's basically designed to help the midwife to maintain her professional standards of practice, to reflect on the partnership between the woman and her midwife throughout the childbirth experience using the anonymous feedback form received from the women. So the midwife should think about it. I was going to interrupt. Your slides aren't moving for us. So I just wanted to check if they should be. No, it still should be on standards review. Yeah. On standards review, we've got Welcome to New Zealand. Oh, they're working on me. So sorry to interrupt about that. That's alright, okay. Let's see what we can do. Okay, so I've got standards of practice up now. And then the next one should be standard review. Is it flicking now? It doesn't seem to be sinking. There. Okay, so. That's fine. Perhaps I will move the slides for you if you can just let me know when you would like to go to the next slide. Okay, cool. So can you put it on standard review slide? Yeah. Okay, it's on standards review. Thank you. Okay. Thank you. Yep. Where did I get to? Thank you. Sorry, just a bit of a meltdown. So the standard review takes place with a midwife, the consumer representative, and the midwife reviewer. And we use that with the standard review feedback form to work through and make sure that the midwife is meeting her standard of practice. And the standard for the college and midwives, this are accepted guiding principles of midwifery care in New Zealand. We have to make a professional plan for what's happening over the next two years to again meet our annual practice with kit requirements. But mostly we use it to examine her practice with the middle-free peers, with the woman that she works with, those collegial relationships. And just to touch base and make sure the midwife feels she's doing what she needs to do. And a lot of our education is pretty much similar to a lot of places where we have to do maternal and neonatal resuscitation. Every year we have breastfeeding study days. We have an emergency skills day. We have a midwifery practice day. We have to maintain a practice portfolio which includes reflections. And then of course the professional development plan for the next two years. Next slide, please. We have the next slide. Can you guys see that? It should be on midwifery education. Great. Okay, so recently the Bachelor of Midwifery degree is offered at four tertiary centers in New Zealand, including Christchurch Polytechnic, Institute of Technology, Otago Polytechnic in Dunedin, the Waikato Institute of Technology in Hamilton, and Auckland University of Technology. The degree underwent a big change a few years back and is now largely online rather than in the classroom. And this was so that students in rural areas could access the degree by satellite groups. It's a really rigorous degree. It's a full-time degree and is basically a four-year bachelor's degree put into three years because it's 45 weeks per year rather than usual 36 that other degrees have. It includes a lot of theoretical as well as practical hands-on education. In the first year, you do 26% clinical placement. In the second year, it's 42% clinical placement. And in the third year, it's 84%. The degree needs to be completed in four years. And there's a large focus on the continuity of care model, autonomous practice, bio-science and research and the provision of evidence-based care. There's a strong focus on normal pregnancy and birth, but also in identifying deviations from normal pregnancy and then working alongside other healthcare providers to continue giving a continuity of care service. Students in order to graduate need to show that they're competent in various aspects of anti-natal labor and postpartum care as well as breastfeeding. They also must be able to carry out basic skills such as cannulation and venopuncture, perineal repair, newborn resuscitation and newborn examination. The clinical practice that students undertake is really a great opportunity for student midwives to work in many areas of women's health. Placements are in home, primary, secondary and tertiary settings, neonatal intensive care units, laboratories, and they also have an opportunity to work with both employed midwives as well as self-employed midwives. At the completion of our degree, we spend, we write a three-hour national midwifery exam, which is a scenario-based examination that seeks to identify that a candidate can make clinical assessment across the scope of practice, identify when situations are deviating from normal and that they can carry out appropriate action. If you move along now to the next slide, which is the midwifery first-year practice program slide, you can see the program vision there. In order for a graduate midwife to be admitted or eligible, she must be a New Zealand citizen or permanent resident, although I should say he or she because we do have a few men. Midwives here, you need to attend a one-day graduate workshop and then further along in the first year of graduate sport meeting. You have to hold a midwifery degree from a council of credited midwifery education program and you cannot have received that degree any longer than 18 months prior to starting the program. Also, you can, you can start practicing, but you can't have practice for more than four months before joining the program. You need to have a registration with midwifery council and also an annual practice certificate and you need to either be working as a self-employed lead maternity care midwife, trying to build your caseload up to 20 clients by the end of the year, or you can be an employed midwife working a minimum of 32 hours per week, but that is somewhat negotiable on a case-by-case basis. Moving on to the next slide. So, the definition of a mentor. Some of the requirements for eligibility to be a mentor midwife is you have to have completed the mentor midwife prerequisite workshop and this clarifies the difference between being a mentor and a preceptor or supervisor. Then we also do a two-day development mentor workshop or one year if you're a returning mentor. You need to be chosen by a new grad midwife. You need to be registered with midwifery council and be in good standing with no restrictions on your registration to have a current annual practice and certificate. You have at least three years of practice experience across the midwifery's global practice. You have met all the requirements that midwifery council recertification program over the previous three years to have good working relationships in the community and practice in a culturally safe manner with all consumer groups. Next slide. An overview. So the midwifery first year of practice program, it's got a few main components. The mentoring hours, they can range between 32 and 56 hours. Mandatory professional development hours is 41 to 52 hours. A left of professional development is about 28 hours. During the year we have four reporting periods to communicate the progress of the graduate regarding hours and professional development. We use some of those mentoring hours to do things like the support and development partnership agreement. We clarify our partnerships in terms of things like access and boundaries and we make a professional development plan and get some goals in there. We have face to face formal mentoring sessions, probably between 12 and 15 over a 12 month period. The feedback session we have between a graduate and her mentor and then another healthcare professional in a different setting from where she would normally practice. Educational requirements in the first year of practice are the same of those as any registered midwife. Plus there's the funding to go alongside for this elective education. The program has its own administrator who is freely available to provide any clarification or support as needed. And the midwifery standard review at the end of the year is what completes the program. The next slide is just a wee definition to try and clarify the difference between mentoring and supervision. So this one provided by the New Zealand College of Midwives. Mentoring is a term used in New Zealand to describe the process of supporting in particular newly graduated midwives entering into self-employed practice versus supervision. A supervisor is a person who has the authority to examine, control and regulate the tasks of individuals underneath them. And if we move to the next slide, this is the New Zealand consensus statement on mentoring. It's a relationship of negotiated partnership between two registered midwives with the purpose of enabling and developing professional confidence. In New Zealand the duration of the midwifery first year of practice program runs for 12 months typically. And they have two intakes per year to count for graduates at different times. Now the next slide is Mary. So this is my practice partners. There's four of us and we all practice together. So as I've already stated, I'm a midwife who lives and works in Christchurch and the surrounding areas. I enjoy continuity of care as a major factor in my work. I work in a practice that I've been with since I became a midwife. I've known these midwives since I was a student. I spent some of my placement time with them and then joined them when I graduated as a midwife. The midwifery first year of practice program has been running since 2007. It appears to be very successful. There's currently some research being reviewed that will be presented at ICM in Prague later this year. The research has been done over four years as a program and I'm betting the research will be very positive. Just like the midwives I know who use the program really enjoy doing it. So if you're interested in those results, keep a watch on the journal publications or tune in to ICM. Unfortunately the program wasn't around when I finished my degree and some of the midwives who graduated with me have since changed their careers. I feel the first year of practice program has helped improve retention in our workforce. The focus of the midwifery in New Zealand is based on partnership between the midwife and the woman and her family. This partnership we share with the woman is parallel with the relationship we have with the new graduate midwife. I feel the first year of practice program is part of the support network we provide to women who are our colleagues to assist them to do a great job in our community. The program is voluntary for new grads to join and voluntary for mentor midwives to support them. The uptake of the program is quite high, probably in the high 90%. Each midwife is responsible for the care she provides, whether she's a new graduate midwife or a very experienced midwife. We need to be good communicators with mentors to be able to probe for the questions to support our colleagues. For me the biggest benefit is of sustaining our colleagues so they can practice in a way that suits them best for a long time. Support for the mentor and the mentee is through the New Zealand College of Midwives, Midwifery first year of practice, other midwives in the community and our practice partners. The program supports the emerging midwives from competence to confident midwives during her first year of practice. As a mentor I support the midwives through reflections and also scenarios that can arise to ensure her confidence in practice. I am passionate about midwifery and by very supportive practice we all regularly have student midwives through IC year and we all enjoy mentoring new graduate midwives. Mentoring has now become embedded in New Zealand Midwifery. The benefits work both ways. New grads may be liking an experience of sole responsibility but they are an invaluable place of having spent a lot of time going through all the most current evidence through practice, up-to-date technique and seeing how many different midwives operate in different areas. This year will be my fourth time being a mentor and midwife. Each time seems different because the needs of the new grads are individualized and we are fortunate enough to have a flexible program that meets their needs. I'm fortunate to have it supported by full government funding. We share a lot of our experiences through storytelling. As a mentor I get a great feeling of helping a new graduate midwife integrate into the Midwifery community. In Christchurch we are a reasonably large group for our populations but we all work well together. Midwives who work around me are a great bunch. We've spent time together in many situations, especially the earthquakes. Over the last few years they've helped us knit together even tighter than what we were before and we can be quite social when we need to be. As a mentor I try to encourage the midwives to try to find a good, worth-life balance. So far I've only mentored midwives who work in the community like I do and being on call 24-7 can be exhausting. Putting some boundaries in place can be crucial to everyone's survival. I tell the women that I care for that they need to be aware I am a mum too and need to look after my own family well before I can give them advice and support on how to look after theirs. I try to encourage the new graduates to do the same. They need to work out a way of working that they can sustain. Practice issues can be an issue for a new graduate going into an established practice with more experienced or well-known midwives so helping and supporting them to find ways of solving the issues that have arisen is crucial. My role is not to find the solution for them but instead to help her find a way to solve issues on her time on a way that works within her boundaries and values and hormones and beliefs. Having a new graduate midwife who has all the most up-to-date knowledge but maybe not a lot of experience on her own is a positive but we encourage them to embrace not to be hiding the fact she's new to the profession but to tell women, sing it from the rooftop if she feels like it but definitely not to be wary of sharing the fact that she is a new graduate and has her practice partners to support her and also a mentor midwife who walks alongside her on her journey through the first year of practice. I've been fortunate to mentor Tamara. We've known each other through many different circumstances. From the midwife-woman relationship, midwife-student relationship, mentor-mentee relationship and now colleagues. We have similar views and outlook in life. I think when we first met we had a lot in common. My boys were born here in New Zealand and we didn't have any family here to support us. We had great friends instead who helped us settle into parenthood. I saw on Tamara a similar scenario. Tamara and I spent time going over scenarios and situations. For example emergency scenarios and her walking step by step through this process. We negotiated through paperwork and tax. Didn't know the plan of contact and when to be organised on holiday. We talked about the plan of education over the years and accessing support when she needed it. We met at places that suited us both. At her place or mine, at the hospital to organise scenarios and where to find items and storage. With other health professionals, we went for coffee, bumped into each other in the wee small hours on this and sweet and driving on the bumpy roads of Christchurch a friendly way through the traffic. We have become great friends over the years. I've laughed and cried with her, shared my worries and listened to hers. Watch her beautiful girls grow and she's heard my stories of two niche boys. It has been a very rewarding experience being a mentor. I don't think anyone who does this could feel more rewarded. Aww. Aww. We're mashing. Now that Mary's making me cry. I'll have to pull myself together. This is a picture of me on my graduation day with my husband and my three little daughters. All of whom I had during my degree. So when I started Clio, my oldest in the pink tights was six months old. And then I had my twins when I was in second year. And just to the side of that is a picture of some of my practice colleagues. Unfortunately the picture was a bit wide so one got cut off. Two of the girls that I started studying with and they graduated ahead of me. And the girl standing beside me is Molly and she's Canadian. And Sylvia was a new grad who joined our practice last year. Anyways, I will get on with it. Because we're obviously online here, I would love to know how many of you are actually recent graduates versus how many have been out in practice for a while. But obviously that's not going to happen. So what I will ask you is to think about something, whether you're a recent graduate or a seasoned midwife. Can you remember when you were newly graduated? Can you remember the feeling of excitement and achievement? The pride in your accomplishment and the anticipation of helping your first baby of its mother as a realized midwife? How did you feel when you were about to embark into practice for the first time with that sort of safety net of being a student? Can you remember your first day of work? Because I can. I got called by my new midwifery colleague in my practice to come and help out at the hospital because there were four women in labor and only three midwives. They needed me. And to say I was nervous would be a pretty big understatement. I suddenly had to jump into it and I wasn't really planning on doing that that day. I needed to trust my training and try and exceed the confidence of a midwife who'd had a little bit of experience behind me not just being a new grad, which not just a new grad, you know what I mean? No longer, you know, I needed to trust my ability. And I knew that I could carry out the clinical path even though I was nervous. I did trust my ability. But again, of course, I was nervous. No longer was I, I was in a hospital where I'd done a lot of my training, but I wasn't there as a student anymore. Now I was there as a midwife in my own right. My colleagues were busy in other rooms with other women. And the woman that was in my care was my responsibility. And I can still remember when I entered into the documentation that back up LMC to Mara Ribble, you know, into birthing suite to look after so-and-so, and I signed it with registered midwife and not student midwife. And that was a fairly surreal experience for me. But what was the first thing I did on that morning? I phoned Mary because I was freaking out. And I talked with her about how nervous I was, but also how excited I was to sort of make this transition from student to midwife, you know. I was worried about gaining the respect of the colleagues in my practice and I didn't want to disappoint them. But I was also really worried about how the staff at the hospital would perceive me. But I was really lucky that day because, of course, the coordinator on the floor that day was one I'd worked with as a student. Before I went in, Mary suggested that I go and speak to the coordinator and tell her it was my first time and that I might need a little bit of extra support. So that was actually the best advice. I did that and the hospital midwives were so happy to help me out and give me all kinds of support. You know, and after that, I guess it was in that moment that I kind of realized, well, I think I can find my way through this with the support of Mary and also the other midwives in the hospital. When I got through the day, I called Mary again and at that time it was sort of a debrief of my experience and celebrate the fact that my self and also the mother and baby had all survived. It was generally a pretty good start to my career. You know, I've wanted to be a midwife since my early 20s and it took me many years of working as a birth doer back in Canada to believe that I might actually be able to achieve the dream of this. And so I came into my midwifery study with quite a good variety of experience in the labor room with birthing women. But even with my doula experience and with the solid degree behind me filled with awesome clinical practice experiences and all sorts of places, my first days of work as my own midwife under my own scene still made me feel a bit anxious. I recognize then as I still do today that there's a lot of stuff I still don't know and that midwifery is truly a profession of ongoing learning and I think that's one of the things I love about midwifery. Every experience is different. So I thought it was maybe important to share about how I chose my mentor. As I mentioned earlier, I had my first child, Cleo, in August of 2007 and the midwife that I had at the time was off call for the weekend so Mary was the midwife back up who came into my room to help me out a couple of times in the hospital and my husband and I really liked her. So when I became pregnant a second time, just at the end of my first year of school, we chose Mary and that was about, yeah, that was in 2008. So besides, and I was just finishing up with my first year of midwifery study, so besides babies and pregnancy, we had lots of other stuff to talk about. I think that's when we formed a really nice relationship and we had our lovely woman-midwife partnership which actually felt much more friendly than it did clinical. You know, we talked a little bit about clinical but there was a lot of tea drinking involved, if I recall. Over the following years of my study after we no longer had that midwife-woman relationship, we maintained contact and I had really hoped to have my third year continuity placement with Mary. That's the longest placement in the degree at 14 weeks and although that didn't happen, Mary was always kind of there in the wings, you know, and she was always willing to talk to me about stuff. She was really helpful at the end of my third year when I was trying to decide whether I was going to go to work with a self-employed midwife or go to work in the hospital and then again when I was trying to decide what practice I was going to join. Joining the midwifery first year of practice program was never a question for me because I had many midwifery friends who had graduated in the years before me that have done it and I knew that was on my cards no matter which way I went and that there was only one mentor I really wanted and that was Mary. So of course as soon as I decided I asked her straight away because everybody wants Mary. Anyway.