Support needed to end the silence of miscarriage

Too little support is available to women who suffer miscarriages, says midwife and academic Dr Cassie Kenney.

Dr Kenney, the first Mäori to gain a PhD in midwifery, graduates from the Manawatu campus today. She is based at the University of Alberta, Canada, where she is a postdoctoral research fellow in ethnicity and health. Her ongoing research is focused on improving health care for minority and indigenous women.

A registered midwife and occupational therapist, she has more than 20 years' experience as a health professional and health services manager in New Zealand and Canada. She lectured in undergraduate and postgraduate papers at Massey's School of Health and Social Services from 2004 until last year.

Miscarriage is defined as the loss of a baby from natural causes before the 20th week of pregnancy. It occurs in up to a quarter of confirmed pregnancies.

“Given the frequency of miscarriage, it poses a significant issue for midwives who provide the majority of maternity care for women in New Zealand.”

Dr Kenney (Ngäti Toa Rangatira, Te Ätiawa ki Whakarongotai, Ngäi Tahu) says that, given the birth rate amongst Mäori is proportionally higher in relation to the national birth rate, miscarriage is a significant concern for childbearing Mäori women.

She says increased funding is needed to improve resourcing of miscarriage-related care, “specifically in relation to developing health workforce capacity so that women have better access to information, counselling, support and follow-up visits”.

Within the Wellington region there is a miscarriage support group, “but if you live elsewhere, there is limited organised support for women who miscarry”. Dr Kenney says that miscarriage is a socially silenced topic. “Silencing of women’s and families’ experiences denies women’s identities as mothers, the human identities of their unborn children and families’ experiences of loss and may be extremely detrimental to family well-being.”

During an eight-month period while she was conducting her doctoral research Dr Kenney became aware of five women who committed suicide after having miscarriages. “Maternal mental health statistics indicate there may be a correlation between miscarriage and women’s experiences of mental ill health directly following miscarriage and in subsequent pregnancies.”

“The challenge for the health system will be addressing miscarriage related issues in a timely manner rather than the current practice of funding the ambulance at the bottom of the cliff.”

The focus of Ms Kenney’s doctoral research has been developing a new methodology Te Whakamämatanga (The Enlightenment) that aims to addresses gaps in areas of midwifery, miscarriage-related care, health professional development, Mäori health and health research literature.

The methodology interweaves indigenous and European world-views, theories and research. It also incorporates extensive consultation with Mäori and midwifery stakeholders and is informed by the views and stories about miscarriage of 20 midwives and women from European, Mäori and Pasifika backgrounds.

Dr Kenny says she has been aware of gaps in midwifery-care, particularly for Mäori, since she was a student midwife. Whilst studying for her PhD she was awarded several scholarships including a Massey University Doctoral Scholarship and two Pürehuroa Awards, a Ministry of Health Hauora Scholarship and grants from the Royal Society of New Zealand and the Maurice Paykel Trust. Ms Kenny is also the first Mäori scholar at Massey to be awarded a place on the Dean’s List of exceptional doctoral theses for her doctorate Me aro ki te hä o Hineahuone – Women, midwifes and miscarriage stories: Towards a contextually relevant research methodology.