Is it too late to bring back doctors?


The NZ Councils of Midwives says midwifery is in crisis:

Midwives are appealing to the new Government to act urgently to deal with the unfolding crisis in New Zealand’s midwifery workforce.

The New Zealand College of Midwives warned the previous Government over many years that pay for community midwives was failing to keep pace with inflation and the level of work required of midwives. Meanwhile, under-resourcing – leading to chronic under-staffing – was undermining the morale of midwives working in our hospitals and maternity units.

“We are hearing an increasing number of stories from around the country of severe shortages as midwives continue to leave the profession,” says Karen Guilliland, Chief Executive of the New Zealand College of Midwives. “We can now see a pattern confirming that this is a service in crisis”, she says.

Mrs Guilliland says this is the result of years of under-funding in New Zealand’s maternity service however the College is heartened that the new Government has decided to enter negotiations to ensure pay equity for mental health support workers, which, like midwifery is a mainly female workforce.

“The College began fighting for pay equity for midwives three years ago when we began court action under the previous Government. This action led to an agreement between the College and the Ministry of Health to design a new funding model for community-based (LMC) midwives. We have presented our recommendations to the Ministry’s leadership team and the new Minister of Health. At this stage, we have no certainty that the recommendations from the co-design will be accepted, or funded,” she says

Mrs Guilliland is urging the new Government to reassure midwives that they will not be disappointed.

“The College is increasingly concerned that every day we wait, the sustainability of the midwifery profession continues to be negatively affected and this in turn has a significant impact on women’s access to maternity services. More and more women will be unable to find a midwife if this crisis is not urgently addressed.”

Mrs Guilliland says the new Government has an opportunity to resolve this and the College and its members cannot highlight the urgency of this situation enough.

“We need the Ministry and the Minister to act immediately,” she says.

The ODT covers the situation in Wanaka here and here.

Low pay and long hours is part of the problem.

Another part few if any midwives will talk about is the changes that drove general practitioners from obstetrics, adding to the load placed on midwives and risks for women and babies.

An Otago university study found babies are more at risk during birth if a midwife rather than a doctor is in charge.

Bad outcomes for new babies are more likely when a mother’s chosen maternity carer is a midwife, as opposed to a medical specialist, research shows. 

The University of Otago research project examined major adverse perinatal outcomes of 240,000 babies born between 2008 and 2012. 

It found that babies were less likely to encounter problems during and after giving birth, when their mother’s carer was a specialist obstetrician or general practitioner. . .

The changes were driven by the feminist movements insistence that birth is a natural process.

It is, but so is death and you only have to look at the number of women and babies in old cemeteries to see what used to happen when birth was predominantly left to midwives.

Midwifery practices are very different now from how they were then, but there still ought to be a bigger role for doctors, not just specialists but GP obstetricians, in the birthing process.

Is it too late to bring doctors back to births?

Mums & babes at risk


A review of maternity services in Wellington has concluded that poor relationships between doctors and midwives, a shortage of both these maternity specialists and poor emergency transfer procedeures are putting women and babies at risk.

However, Health Ministry officials and the independent review team said though there were opportunities for improvement, the region’s maternity care was “as safe as services anywhere else in New Zealand”.

As good as anywhere else is meaningless if anywhere else isn’t good enough.

Kathryn Ryan interviewed  Dr Lynda Exton, a Chirstchurch GP who has just published a book, The Baby Business ,in which she says women are more likely to die during child birth durning childbirth and babies are more likely to contract serious infections than any time in the last 30 years on maternity services.

Kathryn also spoke to NZ College of Midwives chief executive Karen Guilliland who disputed some of the figures and findings in the book.

The Press interviewed these two women and Dr Pat Tuohy, Ministry of Health chief advisor for child and youth health.

There is an international shortage of obstetricians and midwives. That situation has been worsened in New Zealand by changes to maternity services which began in the late 1980s and which have resulted in an exodus for GPs from obstetrics.

Apropos of this issue, it’s baby loss awareness week.

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