Ignoring the importance of family, culture and environment in pregnancy and childbirth

A proposal by the Whanganui DHB (WDHB) and MidCentral DHB (MCDHB) ignores the importance of family, culture and environment in pregnancy and childbirth.

The New Zealand College of Midwives and its members are opposed to the proposal which would see the removal of acute maternity and gynaecological services from Whanganui Hospital, forcing up to 400 women to travel more than 70 kilometres to Palmerston North Hospital, each year.

College CEO, Karen Guilliland says the proposal has not adequately considered all the practical and emotional implications for women and their families, the cultural impact on local iwi, and the workforce impact on both Palmerston North and Whanganui Hospitals or the midwifery service. She says the regions women and babies deserve better.

“This proposal overlooks the needs of women at a time when they can feel particularly vulnerable and should be near their homes and whanau,” she says. “The importance of local iwi and whanau has been poorly considered; their relationship to the land and their whanau being ignored,” she says.

Maori women and their whanau make up almost 50% of the population currently using Whanganui Hospital’s full maternity service.

“Many babies will have a different and distant birthplace from home and expected iwi affiliations, and many families will not be able to afford the extra child care for other children, travel and accommodation required when mothers are transferred out of their own communities,” adds Ms Guilliland.

Continuity of care and whanau support are key in ensuring good outcomes, particularly for vulnerable families. Maternity services should promote continuity and trust in caregivers, not make it more difficult. In-patient care in Palmerston North Hospital for Whanganui women means fragmented care away from home and their LMC,” she says

The College says Whanganui achieves good outcomes for mums and babies under the current system, according to the recent information in the Ministry of Health’s Clinical Indicators (March 2012). Conversely the high intervention rates for some procedures at Palmerston North require investigation before more women are transferred there.

”Hundreds more women having their babies in at Palmerston North Hospital will no doubt put extra pressure on the midwives and maternity teams, women, babies and families. No extra birthing rooms are planned for Palmerston North Hospital, and only three extra antenatal beds are to be added, creating a likely situation of overcrowding, shorter postnatal stays and overworked staff. This stretches an already busy service’s ability to provide the best possible outcomes for women and their babies,” she says.

Despite the WDHB stating that they have been unable to recruit obstetrics and gynaecology specialists, the College believes fragmented management systems and employment practices are more likely to contribute to the lack of successful retention of locums and other staff.

“We are also concerned that there is little in the proposal that suggests adequate measures will be put in place to support the midwifery workforce, neither employed nor self employed,” says Ms Guilliland.

“The additional responsibility this proposal places on midwives in this region has so far been undervalued and underestimated. Should this plan go ahead, midwifery practices would require significant expansion to cover not only Whanganui but the regions outlying areas.  Access, transport and emergency protocols have not been discussed with midwives. This must occur before any changes are considered, let alone decided on. This proposal needs more time to develop solutions which advantage women, babies and the community as well as enhancing the health workforce ability to provide them in a way which improves maternity outcomes,” she adds.

The College contends that the DHBs need to go back to the drawing board, use appropriate and comprehensive avenues for consultation and advice, and base any new service configuration and allocation on the needs of the community, and the ability of the workforce in total to provide the best maternity support and care, safely and effectively.

ENDS

For further information please contact Ali Jones on 027 247 3112.

A full fact sheet is available at www.midwife.org.nz