Study Supports Midwives' Claims of Maternity Service Under Resourcing

A retrospective study of just over 244,000 pregnancy outcomes from 2008 to the end of 2012, has reinforced claims that maternity services continue to be under pressure. 

College of Midwives Chief Executive, Karen Guilliland, says a College review of the Comparison of Maternity Care Models study highlights that private maternity care is better funded and resourced than the public maternity system. Access to timely and professional care within maternity hospitals (when needed) is an important part of maintaining New Zealand’s world class maternity service for all women and their babies. 

“This is exactly why, after years of trying to make this point to the Government, the College was left with no other option but to take legal action to ensure equity of funding for the midwifery led maternity system,” she says. That case is currently adjourned while mediation is undertaken. 

Guilliland says it’s important to make clear that this study has reported no difference in mortality (baby or mother) whether the lead maternity carer (LMC) is an obstetrician or midwife. However, it suggests morbidity for the baby (being unwell) immediately following the birth is more prevalent in cases where the LMC is a midwife, although no different to other similar countries. 

“The differences in that outcome may be explained by the way our maternity services have to operate. Most of our maternity hospitals are understaffed and often struggle to provide immediate response when midwives request medical input. This means that often women in labour have to wait to see a specialist causing unacceptable delays for them and their babies. None of our main maternity hospitals have an obstetric consultant on site after hours or weekends which are when the majority of births occur,” she says. 

Several recent DHB maternity service reviews have identified that there are chronic staff shortages (both obstetric and midwifery) in what is considered to be an “inherently high clinical risk environment”. (Crawford, Lilo, Stone, & Yates, 2008; Hendry, Page, & Farmer, 2016; Waikato DHB Women's Health Service, 2015) 

Karen Guilliland says the issues this paper raises strongly suggest a need for improved funding and better staffing of maternity services.  Examples of the impact of these shortages are illustrated by recent cases in and around Queenstown and Wanaka.  
 
In one case, a woman in labour had to travel several hours to an alternative maternity hospital because the closest hospital was short staffed and could not provide her care. Yet someone who breaks their leg on a skifield in the same part of New Zealand, can be helicoptered to a hospital straight away for immediate medical care.  

Karen Guilliland adds that that the demographic profile of women accessing private maternity care differs substantially to the profile of women accessing public maternity care and sounds a word of warning around the looming threats to an equitable maternity system. 

“Regardless of whom the primary LMC is there must be equity in access for all women. This study identifies that currently this is not happening.” she says. It identifies the differences between being rich and poor when having a baby in New Zealand. This inequity has to be addressed immediately. 
 
References 
Crawford, B., Lilo, S., Stone, P., & Yates, A. (2008). Review of the Quality, Safety and Management of Maternity Services in the Wellington Area. Retrieved from Wellington: http://www.moh.govt.nz

Hendry, C., Page, I., & Farmer, E. (2016). Review Report on the Midcentral and Whanganui District Health Boards' Regional Women's Health Service Maternity Services. Retrieved from https://www.midcentraldhb.govt.nz/HealthServices/WomensHealth/Pages/MS-Review.aspx: https://www.midcentraldhb.govt.nz/HealthServices/WomensHealth/Documents/RWHS%20-%2018Feb16%20Report%20on%20Review%20of%20RWHS%20Maternity%20Service.pdf

Waikato DHB Women's Health Service. (2015). Lifting performance and achieving sustainability. Retrieved from Hamilton: http://www.waikatodhb.health.nz/assets/directory-of-our-services/womens-health/Executive-Summary-EY-Report-Waikato-DHB-Womens-Health-final.pdf