Midwives increase babies’ health risks

Chief executive of the College of Midwives Alison Eddy says midwives already do a work placement in their final year and there is no need for more.  Photo: Photo / 123RF

Childbirth is straightforward for most healthy young women, but when complications develop during pregnancy, New Zealand women don’t have the best outcomes. In the 1990s most general practitioners stopped delivering babies, and only the well-heeled can afford a specialist now.

Action to Improve Maternity (AIM) is lobbying to increase midwife training. Spokesperson Jenn Hooper said our world ranking for perinatal and maternal death has been steadily dropping. Quote.

In 2009 for perinatal and maternal death we were 15th and 17th, three years ago we were 22nd and 23rd respectively, now, I checked again last week in preparation for this and we’re sitting at 24th and 27th.

“So we’re now solidly in the bottom third.

“Our figures aren’t actually necessarily [getting worse] but other countries are getting better.

“We’re dropping in the rankings by default, so if that’s happening we’ve got to look at what we’re doing differently surely. And the thing we do differently is midwifery.”

Radio NZ

A major four-year study of more than 240,000 births in New Zealand between 2008 to 2012 found that babies born under midwife care had more health risks. Quote.

The University of Otago study found that babies under the care of doctors had a 55 per cent lower risk of oxygen deprivation during delivery and a 39 per cent lower chance of neonatal encephalopathy, which can lead to brain damage. There was a 48 per cent lower risk of having a low Apgar score, which is a measure of the baby’s health immediately after delivery.

Stuff / Dominion Post end quote.

It is three years since this report was released and still nothing has been done.

A revision is well overdue, and the fact that it hasn?t happened points to politicking due to the old conflict between doctors and midwives. Quote.

Lead researcher [in the Canterbury University study] Ellie Wernham, a midwife training to be a doctor, points out that these are important findings based on a huge amount of data. The study looked at more than 240,000 births in New Zealand from 2008 to 2012.

College of Midwives chief executive Karen Guilliland said the babies of women cared for by midwives were at higher risk because the women were more likely to be younger, sicker, obese, or Maori or Pasifika – well-known risk factors for health problems among the new-born.

But a co-author of the study, Professor Diana Sarfati, says it took account of these factors, and they “didn’t even come close” to explaining the difference in health outcomes.

It’s important not to overstate the problems uncovered by the study. It found no statistical difference in the death rates among mothers and babies under the two forms of care. And the overall rates of adverse outcomes in New Zealand were low and compared well with those of other advanced Western countries such as Australia and Britain.? End of quote.

Okay, so babies and mothers did not die ? but what about brain injury from oxygen deprivation? Compared to overseas training our midwifery training falls short. Quote.

She [Hooper] said coronial findings and reports from the Health and Disability Commissioner were proof that preventable incidents with babies and mothers were happening and that there had to be room for improvement.

“They’re all the same, lack of documentation, lack of urgency, the CTG interpretation is one thing, poor resuscitation skills seems to be another factor, deviation from the referral guidelines is huge.

“We know these things are happening, there’s evidence and it’s all down to practitioners error essentially.”

She said New Zealand should look to similar jurisdictions like Australia, where midwives must practice for three years in a hospital and the UK where it’s two years. End of quote.

Currently, New Zealand midwives leave university and go straight into employment with district health boards or community-based organisations. They are buddied up with a mentor for a minimum of 56 hours in the year but compared with overseas practical training this is extraordinarily light.

AIM is recommending a post-graduate internship as part of a midwife’s registration but the Ministry of Health disagrees, saying ?a forced hospital placement would not be beneficial?.

Doctors and midwives should put aside their politicking and get on with sorting out the best training for midwives.

Wouldn?t you think that with a prime minister who had a baby last year we could at last make some ground on this issue? Dollars to doughnuts our PM was under specialist care for the pregnancy and birth and possibly thinks all women receive that same standard of care.