The Midwifery Council of NZ has revised its Guidelines on Midwifery Practice to remove the words ‘wife’ and ‘mother’ entirely.
The omissions are among a series of changes to the document to be more comprehensive and “address an adverse imbalance in the representation, understanding and appreciation of Māori knowledge, values and practice”.
Health researcher and former midwife Dr. Sarah Donovan has questioned the move, saying it likely won’t live up to public expectations of the midwifery profession, including the way it describes who it cares for.
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On its website, the Midwives Council says that revision of the wording used in the guidelines has been in preparation for at least two years in response to “strong signals of the need for a radical transformation of the healthcare system, including midwives”.
A collaborative reference group led by co-chairs Dr. Hope Tupara and Dr. Judith McAra-Couper was appointed to review the current guidance. The group included members of both Tangata Whenua and Tangata Tiriti.
The group agreed that there should be English and Māori language versions of the Scope Guidelines as an English version alone is not sufficient.
“The longest of all deliberations took place” using the word “whānau” instead of the word “woman”.
Tangata Whenua held that whānau was a much more appropriate word instead of woman “philosophically consistent with the mātauranga paradigms of holism in social structures”—the idea that diverse systems should be viewed as a whole rather than just a collection of individual parts.
The decisions made by the group resulted in a number of changes to the wording of the Scope of Practice guidelines.
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This included changing the wording “identifies complications that may arise in both mother and child” to “and recognizing complexity”.
The sentence “[…] To provide women with the necessary support, care and advice during pregnancy, childbirth and the postpartum period, to facilitate childbirth and to care for the newborn’ was changed to ‘[…] for whānau who are planning pregnancy, pregnant, childbearing and postnatal”.
NZ College of Midwives executive director Alison Eddy said the college had submitted a detailed submission to the Midwives Council to revise its practice guidelines and understood and supported the reasons for their decision to revise the wording used in the guidelines.
“Some of the questions we asked the Council in our feedback concerned the use of the term ‘whānau’ to replace the use of the word ‘woman’ and what that meant in relation to a midwife’s clinical role and what exactly their field of activity is,” said Eddy.
Mentoring a woman in a whānau context has always been part of her holistic approach,” she said.
“We do not remove the word ‘wife’ or ‘mother’ from any of our publications. We believe we can have an additive approach where we can talk about women and whānau, mothers and parents.”
Donovan said given that midwifery is arguably the most woman- and mother-centric of all health professions, removing the words “woman” and “mother” probably won’t make sense to many people.
“When it comes to inclusion, terms can be used side by side.
“My understanding of what inclusive language means in healthcare is that it is actually inclusive rather than excluding; it adds new terminology rather than removing widely accepted and culturally valued terms like ‘mother’ and ‘māmā’.”
Clarification is needed as to what the evidence base and advice underpinned the decision to remove the words entirely, she said.
“A reasonable question would be whether the Midwifery Council actually sought the opinion of the population it serves and the wider New Zealand public in order to remove the words ‘mother’ and ‘wife’ from midwifery care in New Zealand?
“Have you asked expectant mothers as a group how they would like to be described instead?”
Christchurch midwife Jay Beaumont said using the word whānau instead of “mother” or “wife” means no one is excluded.
“As a Māori midwife, I provide whānau-centered care rather than woman-centered care, which allows me to enter the whānau space and meet the needs of the whole whānau.
“And to me, whānau means ‘as determined by the woman.’ So it’s not the western concept of whānau, it can be your roommate if you consider them your family.”
She said the wording change did not change the way midwives provided care but legitimized their approach as a Māori midwife.
“The Māori word for whānau was formerly kaiwhakawhānau, which puts the responsibility for birth and continuation from generation to generation on the whānau.
“As a midwife, I am the expert on normal births, but the Whānau are the experts on their knowledge of themselves, their dreams and desires, and how to maintain their own tikanga as part of their care plan.”
Beaumont said the use of the word “woman” also excludes people who give birth and use midwifery services but do not identify as women.