New Zealand Midwifery's Journey Towards Autonomy: A Narrative Inquiry

Abstract

This thesis explores the experiences of midwives and childbirth advocates who played pivotal roles in the resurgence of midwifery in New Zealand. This movement spearheaded a revolution in maternity, paving the way for the Nurses Amendment Act 1990, the legislation that New Zealand midwives practice under today. These midwives and childbirth advocates redeveloped structures and practices for midwifery and childbirth, which had been subsumed under medicine, and created the core principles of local midwifery: autonomy, partnership, natural childbirth, and continuity of care. Over the course of their careers, they reestablished the midwifery profession by developing the foundations in education, practice, and governance.

Using narrative methodology and methods, based on the categorical-content mode of narrative analysis and the elements of temporality, sociality, and place, this thesis examines the systemic challenges midwives faced throughout the decades, 1980 to 2025. Despite significant barriers, including professional marginalisation and inadequate remuneration, participants demonstrated resilience in upholding holistic, woman-centred care.

The findings outline the historic transition from the medically dominated system to one that briefly sustained midwives and women. However, with the systematic closure of primary units and a rise in hospital births, a fear of physiological childbirth diminished the knowledge of normal birth facilitation. With study participants nearing retirement, and fewer midwives offering primary birthing options, current student midwives are increasingly dependent on hospital-based placements. Furthermore, the New Zealand Ministry of Health continues to provide inadequate and unfair funding for the model of care that threatens to destabilise today’s midwifery profession, leaving midwives to recoup their earnings in creative ways, such as fragmenting maternity services. Despite the challenges, the passion and fortitude of participants during their careers is evident.

This thesis underscores the impact of grassroots activism on creating a midwifery-led model of care while revealing how the medical model has gradually undermined these efforts.