Invested as an Officer of the New Zealand Order of Merit for Services to Midwifery last month, Dr (Florence) Joyce Cowan looks back on a career leading to life-saving advancements within her profession. She talks to HELEN PERRY about the joys and challenges.
Dr Joyce Cowan may have formally retired in August, but this serene, quietly spoken innovator may take some time to adjust to life without an engaging workload.
“I’m still getting my head around putting professional meetings behind me and, instead, tackling my garden,” she says with a smile. And, what a beautiful cottage garden it is although the former long-time Howickian, now living in Clevedon, admits that re-focusing is not easy – understandably so.
A leading authority on pre-eclampsia (previously referred to as toxaemia), Dr Cowan is co-founder and former director of the charity, NZ Action on Pre-eclampsia (NZ APEC). She also introduced the Growth Assessment Programme (GAP) to New Zealand hospitals in 2014. Her work in both areas is considered, by most, as revolutionary.
“APEC is primarily focused on raising awareness and educating health professionals about pre-eclampsia whilst also supporting those with the condition and their whanau,” she says.
“It came about when a client developed severe pre-eclampsia and became dangerously ill. After she recovered, we heard about APEC in the United Kingdom and, together, we set about establishing the organisation here, never thinking it would still be going strong 30 years later.”
Dr Cowan says although people are generally aware of this fairly common pregnancy complication, understanding is far from complete.
“We know it affects women, usually in the second half of their pregnancy, but we don’t know why some develop it and others don’t, although there are recognised factors which increase the chance it will develop.
“It can’t be cured but mother and baby can now be monitored, and informed decisions made to plan birth for the best time. This can still be tricky if an early baby is very small.”
With APEC helping to inform pregnant women about the importance of blood pressure and other tests, Dr Cowan says this knowledge has given them some power and insight as to why a particular care approach is being undertaken.
“Of course, the ultimate achievement has been a lower perinatal mortality rate from severe pre-eclampsia,” she adds.
While NZ APEC has played a significant role in her life, the instigation of GAP has consumed even more of her time.
“Initially, in 2013, I attended a fetal growth conference in the USA where Professor Jason Gardosi (director of The Perinatal Institute) outlined the use of growth charts to plot the growth of the fetus in the womb.
“I then travelled to The Perinatal Institute in Birmingham to learn how to teach other midwives and doctors to use these charts with the view of bringing the GAP programme to New Zealand.”
Subsequently, GAP was first introduced to Middlemore Hospital then rolled out nationally, leading to improved detection of smaller babies during pregnancy and enabling ongoing monitoring to reduce stillbirth and to improve outcomes.
“Importantly, detection of small babies, who could potentially be stillborn, has more than doubled in most districts with stillbirths of small babies reducing. That’s a wonderful outcome but there is more to be done,” Dr Cowan says.
Though the two projects, plus study for her doctorate in health sciences and teaching roles, have virtually consumed her working life, Dr Cowan’s nursing pathway began in 1966 when she began training as a registered nurse at Middlemore Hospital.
“I really wanted to be a doctor and travelled to Dunedin for study after finishing my nursing training. However, I was just 21 and had recently met my husband to be [well-known photographer, John Cowan].
“Realising it would take at least another six years to qualify as a doctor, and probably putting home life and children on hold, I decided to carry on with nursing.”
Still, with a taste for greater challenges, Dr Cowan saw midwifery as a new and stimulating avenue to further her career.
“Until the 1990 introduction of the Nurses Amendment Act, midwives assisted their clients up to birthing at which point the GP was called in although, in some instances, the GP would arrive too late and the midwife would support the mother to give birth,” she explains.
The new Act enabled midwives to provide all maternity services from booking in early pregnancy until six weeks after a birth. This included responsibility for normal pregnancies without supervision of a medical practitioner.
These days, midwifery is a four-year, stand-alone degree, “and a significant financial commitment,” Dr Cowan says. She would love to see student midwives paid during training as they contribute to the workforce.
“Of course, training also overlaps aspects of regular nursing; a midwife needs to know how to handle many complex medical conditions which can affect pregnancy,” she says.
“The role is an exacting one. A midwife is on call 24/7 and usually has four to six clients due to give birth each month. Sometimes, she can be away from home for 24 hours and can feel pressured when more than one baby decides to come into the world at the same time! In such cases the support of colleagues is wonderful.”
Dr Cowan adds that the need for more midwives is pressing and acknowledges that the wage debate is ongoing.
“Yes, the role can be stressful and extremely tiring but, then, working with women throughout their pregnancies is so very satisfying. Providing that continuity of care often results in long-lasting friendships.
“But, best of all is the joy of being at a birth – it has been called ‘the moment of starlight’. It really is something divine seeing a new baby come into the world and its life begin”.
What is pre-eclampsia?
High blood pressure, a high level of protein in the urine and, in some cases, swelling in the feet, legs and hands, are often the first signs of pre-eclampsia.
Symptoms can result in the mother developing liver or kidney problems, seizures and even a stroke. If left untreated, the condition can develop into eclampsia which can be fatal for the mother and baby during or after childbirth.
Pre-eclampsia generally appears during the latter part of the second or third trimester of pregnancy although it can occur earlier. Early delivery may be recommended depending on the severity of the pre-eclampsia and the stage of pregnancy.
Careful monitoring and medications to lower blood pressure and manage complications are carried out before delivery.
GAP – Growth Assessment Programme: GAP is an international programme involving evidence-based care training for all maternity clinicians in the use of GROW charts to monitor a baby’s growth during pregnancy with auditing of those results.