Content warning: This article mentions infant loss and suicide.
In 2021, a workforce survey found Aotearoa had 3283 midwives. Just 231 were Māori.
While Māori are underrepresented in the midwife workforce, they are overrepresented in negative birth statistics.
Ministry of Health figures show Māori mothers are more likely to die in childbirth and Māori pēpi are nine times more likely to experience sudden unexpected death in infancy.
And if both make it through, it's still not smooth sailing as Māori mothers are three times more likely to die by suicide than non-Māori mothers, a 2024 Otago University study shows.
Māori midwife Aroha Harris (Muriwhenua, Te Aupōuri, Ngāti Kahu, Te Rarawa, Ngāpuhi) says the statistics are incredibly sad.
In 2019, 270 infants died, 114 were Māori.
In 2021, 273 infants died, 99 were Māori.
In 2023, 204 infants died, 75 were Māori.
“We know that we, unfortunately, are the population that represents those high statistics.
“As practitioners, what are we going to do differently? Are we prepared to change the spaces? We need to be able to share the education with people.”
Aroha Harris and pēpē (baby) Waimana. Photo/supplied.
Harris says there is a loss of connection, kāinga (home) and hope, which is a direct result of colonisation, and loss of land, culture and identity.
“Research supports this within all Indigenous Peoples and the effect this has on health and wellbeing ā tinana, ā hinengaro, ā wairua (physical, mind and spiritual wellbeing).”
Harris says Māori are relentlessly impacted by the systems, processes, policies and practices within the health sector.
“They don't reflect us and they don't value us as tangata whenua (Indigenous People).”
Harris says fostering strong relationships within whānau can create a supportive and nurturing environment for tamariki to grow and thrive.
“Encouraging whānau to actively participate in community events, marae activities, and cultural gatherings fosters a sense of belonging and connection to wider Māori networks.”
“Acknowledging the crucial role Māori health providers, midwives, caregivers, whānau support networks play in the wellbeing of all whānau, tamariki and mokopuna.”
“We need to go back to move forward - and whakamana our mātauranga our tikanga (empower Māori knowledge and tikanga) and the ways of our tūpuna for our whakapapa and intergenerational healing to stand in our tū rangatiratanga (sovereign position).”
“We need tāne to return to this space because it was predominantly tāne in these spaces once upon a time and that connection is almost severed, not quite, but almost.”
The difference between a Māori midwife and a non-Māori midwife is the understanding of tikanga Māori, Harris says.
Through her journey of reclaiming mātauranga Māori, she’s seen and used traditional practices like using muka (prepared flax fibres) to tie the umbilical cord.
“We tautoko (support) the use of ipu whenua, something to hold the whenua (placenta) in whether it be hue (a cultivated plant) or a clay pot. The thing is as midwives we tautoko what we've learned, but also what whānau bring in. I’m always learning.”
“We just naturally weave together and we become whānau. We always find that connection.”
Midwifery advisor Claire MacDonald from the New Zealand College of Midwives says midwives undertake education on Te Tiriti o Waitangi, Cultural Safety and Kawa Whakaruruhau (a safe place made from principles) during their undergraduate degree.
“Midwives are expected to reflect on how they integrate Tūranga Kaupapa (guidelines for cultural competence) into their midwifery practice at their Midwifery Standards Review – a quality assurance process required by each midwife for their recertification by the Midwifery Council.”
MacDonald says the college has integrated Cultural Safety and Kawa Whakaruruhau into all of their continuing education workshops over the last few years.
“We are currently developing a consensus statement on Cultural Safety and Kawa Whakaruruhau, which applies to midwifery practice with tangata whenua and people of all cultural backgrounds and identities.”
The Midwifery Council has recently released the recertification programme for the next three years.
For the first time, it includes compulsory Cultural Safety education for practising midwives, which includes Tūranga Kaupapa.
“This will mean that all midwives will undertake ongoing education in Te Ao Māori, Te Tiriti o Waitangi and culturally safe practice,” MacDonald says.
The experience with a Māori midwife
Mother of five Ellyce McLeod (Ngāi Tūhoe, Ngāti Awa, Ngāpuhi) says having a Māori midwife made her pregnancy and birthing experience much more special as it aligned with her worldview around mātauranga Māori and te taiao (the environment).
“It allowed me to be more comfortable in making decisions that sometimes don’t align with Western practices.”
McLeod has experienced both a non-Māori midwife as well as a Māori midwife. She says when she had a non-Māori midwife there was a lack of cultural knowledge about different practices.
“The importance of having a Māori midwife for me was the understanding of the Māori worldview, someone you can relate to and be comfortable with because they truly understand.”
McLeod says she decided to look for a Māori midwife for her last two hapūtanga (pregnancies) because her previous experiences with non-Māori midwives felt like they were ticking the box and didn’t make the experience special.
She used traditional practices such as tying the umbilical cord with muka, tying the pito (belly button) with muka, using an ipu whenua (something to hold the placenta) and her baby slept in a wahakura (woven harakeke bassinet for infants) for the first few months.
“Having a Māori midwife gave the experience the mana it deserves.”
Māori representation in midwifery
Harris says it’s incredibly important to have Māori representation in midwifery.
“We’re the ones who represent the statistics, so we need our workforce to grow.”
She says being a Māori midwife means looking after her clients like they’re her niece, daughter or whanaunga (relation).
Aroha Harris (right) and Te Kowhai (left) and pēpē Waimana. Photo/supplied.
Specialist obstetrician Nicholas Walker (Whakatōhea, Ngāti Porou) has attended around 8000 births in his career and says having a midwife of the same ethnicity as you is a comfort thing.
“The level of comfort and engagement with your health practitioner directly affects all of your outcomes, including being receptive to advice around reducing risk for mother and baby birth before and after the birth.”
“[They] will have the same cultural references that you both share, and you will trust that person because they have a similar cultural and linguistic mindset.”
Walker says having a larger population of Māori midwives will make Māori mums feel more confident and comfortable in the maternity care provided.
Nicholas Walker. Photo/supplied.
He says a lot of work would need to be done looking into aspects of traditional values and practices so that they could be reincorporated into conventional spaces.
“Another factor is that Māori midwives align culturally and socially with Māori while having a dual benefit of perhaps influencing the Western models of care.”
“There are greater numbers of Māori patients than there are Māori midwives, Māori reasonably feel disengaged with the system and therefore can be expected to be in a position where their outcomes are not the same as other ethnic groups if you’re more comfortable and more engaged in the Health system.”
“This is not just in terms of maternity but across the board in many areas of health and education.”
Where to get help:
- 1737: The nationwide, 24/7 mental health support line. Call or text 1737 to speak to a trained counsellor.
- Suicide Crisis Line: Free call 0508 TAUTOKO or 0508 828 865. Nationwide 24/7 support line operated by experienced counsellors with advanced suicide prevention training.
- Youthline: Free call 0800 376 633, free text 234. Nationwide service focused on supporting young people.
- OUTLine NZ: Freephone 0800 OUTLINE (0800 688 5463). National service that helps LGBTIQ+ New Zealanders access support, information and a sense of community.
- Sands New Zealand is a network of parent-run, non-profit groups supporting families who have experienced the death of a baby.
- Miscarriage Matters improves the experience of miscarriage in New Zealand by empowering people with information, advocacy and support.
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