Uncovering the structural mechanisms that reduce intervention-free births in healthy women
Dr Suzanne Miller’s research explored the experiences of healthy first-time mothers with uncomplicated pregnancies who choose to give birth in a tertiary-level maternity setting.
A Principal Lecturer and Postgraduate Programme Leader in the Otago Polytechnic School of Midwifery, she completed her PhD in Midwifery at the School of Nursing, Midwifery and Health Practice in the Wellington Faculty of Health Te Wāhanga Tātai Hauora in 2020. She tells us about her experience.
Less than 25 per cent of healthy first-time mothers giving birth in a tertiary setting in New Zealand achieve an intervention-free birth, Dr Miller says.“[This] has implications for their ongoing physical and psychological well-being, as well as resource implications for health service delivery.
“Using a critical realist theoretical lens and an ethnographic data collection approach, I was able to uncover some of the structural mechanisms that give rise to and continue to reproduce this poor, but not uncommon outcome”.
These mechanisms include the reproduction of deep-seated cultures of power wielding which fail to appreciate and value birthgiver's and midwives’ ways of knowing/being and instead privilege a risk-averse medical hegemony, she says.
“This is underpinned by educational, social and industrial discourses which prioritise efficiency and drive our understanding about what it means to be a ‘good’ mother, midwife and doctor.”
Dr Miller chose Te Herenga Waka—Victoria University of Wellington because she wanted research supervisors who were midwives that would appreciate the nuance of practice within the clinical setting, especially given the critical theoretical underpinning of her research.
She had also completed her Master of Midwifery at the University, and “valued knowing the staff, systems, and processes”.Dr Miller says the thing she enjoyed most was knowing her supervisors really understood what drove her and supported her kaupapa.
“I was also stimulated by learning alongside other tauira whose study journeys were both the same and different from mine—we shared our joys and challenges in a spirit of collegiality and genuine curiosity about each others’ worlds.”
Joining a writing group with PhD students from all different areas expanded her thinking even further, she says.“The conversations we shared over kai stepped me into other ways of seeing and being that have enriched me enormously both professionally and personally.”
Studying part-time enabled her to continue in her role as the Postgraduate Programme Leader in the School of Midwifery at Otago Polytechnic, and helped her gain additional skills relevant to this position.
“Part-time study also meant I could maintain a small midwifery caseload—supporting whānau to transition to parenthood or expand their families—which kept me deeply connected to the emotional and clinical rejuvenation I gain from practice.”
She says what keeps her grounded as a life-long learner is the connections she has made with “people who are inquisitive about their world and are keen to make a difference within it”.
“The University environment proved a fertile ground for meeting such people and I am grateful for the ways these connections were facilitated for tauira.”
Dr Miller is a member of the New Zealand College of Midwives, and holds a position on the Midwifery Council of New Zealand Professional Conduct Committee. A practicing Lead Maternity Carer since 1991, offering both hospital and home births, she has been teaching since 2010. She is also an expert advisor to the Health and Disability Commissioner.