I had buy albuterol over the counter the opportunity to travel around New Zealand and besides meeting those beautiful places I also learned a buy albuterol over the counter about the birth model of care. A model that made my heart as a buy albuterol over the counter midwife, a woman, a dreamer, birth activist, beat faster. That made my eyes full of tears many times, like now.

A model that buy albuterol over the counter provides free and equal care for all women, babies and buy albuterol over the counter families. No matter the color, race, social class, beliefs, choices. It is buy albuterol over the counter simply inspiring.

Maternity System in New Zealand (NZ) developed a buy albuterol over the counter model for practice within its unique historical, social and cultural context. It went trough a buy albuterol over the counter period of profound changes from a medicalized to a women centered model of care.
All the buy albuterol over the counter maternity services are free in New Zealand for residents manly. This include all antenatal care, birth until six weeks after birth.
Most pregnancy and childbirth services are ‘primary maternity services’ done in the buy albuterol over the counter community by Lead Maternity Carer LMC. Women and their families/whanau can buy albuterol over the counter choose a LMC who is responsible for organizing their maternity care. They can buy albuterol over the counter be midwives, general practitioners (GP) and private obstetricians (not free).
Most women and their families choose a midwife (over 75%) as their LMC. They are buy albuterol over the counter qualified to care for women in normal pregnancy and birth. They can buy albuterol over the counter be a hospital midwife or a independent midwife. Independent midwives have buy albuterol over the counter a caseload model of care of around fifty women a year. They give a buy albuterol over the counter continuity of care from early pregnancy until around six weeks after the buy albuterol over the counter baby is born. All of them have a backup midwife and buy albuterol over the counter some work in a team of around 2-6, where they support each other but each one have buy albuterol over the counter their own caseload. She may refer the woman to an obstetrician if complications occur and buy albuterol over the counter share the care.

Some few GPs in New Zealand are buy albuterol over the counter also LMCs, but most of them have discontinued maternity care. They usually provide all of the buy albuterol over the counter care in pregnancy, including some minor problems; referring to an buy albuterol over the counter obstetrician if serious problems arise. Some of them care for buy albuterol over the counter women during labour and birth, possibly with an independent midwife who buy albuterol over the counter works with them, or with hospital based midwives. The postnatal care at home is buy albuterol over the counter often shared by a midwife.
Obstetricians are buy albuterol over the counter specialists in managing complications of pregnancy, childbirth and the post natal period. They can buy albuterol over the counter be a private LMC, providing care in normal pregnancies and buy albuterol over the counter birth for women that choose to have them and can buy albuterol over the counter pay for it. They usually share the care during labor and buy albuterol over the counter birth with an independent midwife or hospital midwife and share the buy albuterol over the counter post natal care as well.
I stayed at the buy albuterol over the counter house of a friend of a friend, she was an obstetrician from buy albuterol over the counter US that now works in a secondary maternity hospital in NZ. She said that buy albuterol over the counter in NZ, the obstetrician really play their role, that is to buy albuterol over the counter take care of complicated pregnancies, birth or post partum. But even in this buy albuterol over the counter cases, midwives continue to care for the women and baby, so they can buy albuterol over the counter have the continuity of care during pregnancy, birth and post partum (midwives are present in 98% of the births).
Women can choose to give birth at Home (around 7%); Birth centre or buy albuterol over the counter primary maternity hospital- just natural births; Private maternity hospital (not free); Large maternity hospital – for buy albuterol over the counter complicated pregnancies and if the women choose, the obstetrician is buy albuterol over the counter avaliable 24/7;
New Zealand is buy albuterol over the counter a country with many rural areas that have only primary maternity care. Sometimes the buy albuterol over the counter nearest hospital is several hours away, if there is emergency, a buy albuterol over the counter helicopter can transport, but most of the times just an ambulance is buy albuterol over the counter ok. But the woman chooses where she wants to have her baby.
Primary Maternity unit with the buy albuterol over the counter midwife Jane Scherp, Queenstown. Uma vista maravilhosa desse hospital!

Primary Maternity unit in Christchurch


Larissa Grandi showed me two birth centers in Hamilton:
River Ridge East Birth Centre
Very cozu, colorful and full of life!



Waterford irth Centre




I had buy albuterol over the counter the chance to participate of antenatal care with idependent midwives. Most of the buy albuterol over the counter times this is at the clinic but it can also happen at home. They do all the buy albuterol over the counter care just referring to the obstetrician if the mother present risks during pregnancy.
The midwives have buy albuterol over the counter an agreement with the birth centers and hospitals where they can buy albuterol over the counter come in with their client. The midwife on shift is the buy albuterol over the counter second midwife, and she is called when is necessary in the buy albuterol over the counter birth room. If they need extra help with the baby after birth they press a buy albuterol over the counter bottom where the neonatologist nurse comes right the way.
At a home birth the midwife goes to the women’s house and call the second midwife when birth in eminent.
I had buy albuterol over the counter the opportunity to participate in antenatal care with independent midwives. Most often this buy albuterol over the counter is in the clinic, but may also happen at home if is buy albuterol over the counter the woman’s desire, without extra costs. They do all the buy albuterol over the counter care, tests, and stablish a relationship with the women, refering to buy albuterol over the counter the obsterician if it is a complicated pregnancy.
With dear Sue Lennox, she was doing a buy albuterol over the counter tour with her client and family at a terciary maternity. But the buy albuterol over the counter women said she wants a homebirth.

With the midwife Fiona at the clinic – Domino Midwives – Wellington

The lovely Brasilian Midwife Larissa Grandi doing antenatal care.



The midwife Shelley

I found it buy albuterol over the counter interesting that many midwives use Pager. If women needs to talk to buy albuterol over the counter the midwife she calls for the central and leave a message for buy albuterol over the counter the midwife, that returns her call. This means that they do not get overloaded with text messages on cell phone and buy albuterol over the counter calls.

There are buy albuterol over the counter pregnant groups available for women and their partners. Some of them are buy albuterol over the counter free of charge at and some are paid. I participated of a buy albuterol over the counter free group at a primary hospital with the midwife and buy albuterol over the counter writer Lorna Davis. They couldn’t believe when buy albuterol over the counter they heard about the cesarean section rates in Brazil. One of the buy albuterol over the counter games Lorna would say a topic, like: Do you agree women should have buy albuterol over the counter choice for elective cesarean? Some of them said yes, because the buy albuterol over the counter woman should be free to choose what’s best for buy albuterol over the counter her and have options. The other group said no for buy albuterol over the counter some reasons like: birth is natural and this an option that buy albuterol over the counter interfere with the natural process and can be harmful, should be buy albuterol over the counter used only if necessary; most woman are afraid and uninformed about birth to buy albuterol over the counter make this decision. That was interesting to hear…


During labor the buy albuterol over the counter women should be free to move, choose the positions she feels more comfortable to buy albuterol over the counter have her baby and can deny any procedures. Vaginal exams are buy albuterol over the counter not done often, and sometimes not done at all if the buy albuterol over the counter woman doesn’t want. It’s recommended to buy albuterol over the counter do delay cord clamping, the baby straight into mothers arms after birth and buy albuterol over the counter the breastfeeding in the first hour after birth. The midwife does all the buy albuterol over the counter baby examination close or with the mother. The baby is not bathed in the buy albuterol over the counter first day, unless the parents want it. Vitamin K is given with parents consent. No routine eye drop for buy albuterol over the counter the baby.
The placenta is buy albuterol over the counter sacred for Maori people. They always bring their placenta home to buy albuterol over the counter do a special ceremony (more information about Maori culture of birth soon)
At the buy albuterol over the counter hospital women stay around 2 days for a normal birth and buy albuterol over the counter 5 days for a cesarean section. But she can go home few hours after birth and buy albuterol over the counter receive care from her midwife at home. At the hospitals and buy albuterol over the counter birth centers women also receive care from the hospital-employed midwives who buy albuterol over the counter are there 24 hours a day 7 days a week.

I participated of some visits post partum with midwives at home and buy albuterol over the counter at the hospital. After birth all women should receive a daily visit from buy albuterol over the counter their LMC while in hospital and a minimum of seven visits and buy albuterol over the counter more if necessary, five of them should be at home. After this buy albuterol over the counter period the LMC refer the woman to the local Plunket Nurse who buy albuterol over the counter is responsible for the care after this period.
The midwife Fiona doing a 3 weeks post partum visit – Wellington


Lot’s of documents to fill, very complete!

Larissa doing a buy albuterol over the counter 3 weeks post partum visit. Detail of the picture: the mother is buy albuterol over the counter breastfeeding her other daughter, beautiful!

The birth model of care in New Zealand can buy albuterol over the counter be considered the best in the world. But we are human and buy albuterol over the counter there is always room to improve ourselves and thus the relationship with other people, whether they are buy albuterol over the counter clients, colleagues, friends, family. The diversity also provides a mach for buy albuterol over the counter the different range of professionals and women.
New Zealand College of Midwives (NZCOM) have buy albuterol over the counter a big concern about the quality of service that is given for buy albuterol over the counter women, babies and families. After the midwifery care is completed, every women receive a buy albuterol over the counter form were she writes how was she cared, called the feedback forms. The midwive don’t see this buy albuterol over the counter paper, it is analized by the NZCOM and if necessary the buy albuterol over the counter midwife is advertized and sometimes retrained. Every year all midwives must renew their Annual practicing certificate, passing trough a buy albuterol over the counter recertification process.
As one of the buy albuterol over the counter UN Millennium Development Goals to improve maternal and child health, I consider this buy albuterol over the counter model an example that could be adapted by other countries who buy albuterol over the counter want quality care, with great maternal and neonatal outcomes, low cost and buy albuterol over the counter based on primary care.
I leave here with a buy albuterol over the counter heart full of hope, ideas and plans. Believing that change is buy albuterol over the counter possible. Believing it’s possible a change in the whole birth system and the well being of women and babies come before any other interest.
As William Reich said: “Civilization will begin on the buy albuterol over the counter day that the welfare of newborns prevail under any other consideration.”

In the buy albuterol over the counter next article will explore the historical, social and cultural context that buy albuterol over the counter made the development of this model of care possible in New Zealand.

I can buy albuterol over the counter just say THANK YOU SO MUCH for all these wonderful people that buy albuterol over the counter were part of this wonderful learning journey in New Zealand.
Some datas (By Larissa Grandi):
• Women’s Age average: 30,3
• Vaginal Birth: 64.7%
•Cesarean section: 24.9% (OMS 5-10%)
–14.6% emergency
–10.3% elective
•Instrumented birth: 9.3%
• Birth atended by Midwife: 98%
•Neonatal Mortality: 2,8 por 1000
Maternal Mortalitality: 14 deaths/100,000 live births (2008)
• Place of birth:
– Terciary Hospitais: 42.4% (PN 57.4%)
– Secundary: 41.8% (PN 64.2%)
–Primary: 15.8% (PN 85.9%)
- Home Birth: 7-10%
•Indiction: 19.8%
•Epidural: 28.8%
•Episiotomy: 12.4%