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A chronic shortage of hospital and community midwives has brought the maternity services sector to crisis point after years campaigning for pay increases. Just a few days before the Wellbeing Budget, baby Levi was born in an ambulance on the side of the road en route to Southland Hospital in Invercargill. His mother, Amanda McIvor, had met her midwife at a maternity hub in Lumsden, Northern Southland, four days earlier on May 26 but could not have the baby there as there was no oxygen or back-up life-saving equipment.
On Friday, a Southland woman gave birth to her baby in a car park in Lumsden outside a maternity hub and was sent home two hours later because there was no postnatal care available.
It was the third emergency birth in the area since the Lumsden Maternity Centre was downgraded from a primary birthing unit to a maternal and child hub in April, providing antenatal and postnatal care, but not birthing or postnatal inpatient care. But the commitment left midwives disappointed. Statistics on "births before arrival", or BBAs as referred to by maternity staff, are not routinely collected by District Health Boards DHBs so it's unknown how many actually occur each year.
Eddy said these situations were not acceptable and affected the confidence of women at a time when they need the best quality support. The quality of maternity services was being undermined by a lack of suitable facilities and a critical staffing shortage, Eddy said. From , when midwives gained the right to practice independently, maternity services have been provided by them in most cases. But poor pay, which doesn't recognise the huge responsibilities of midwives, was making the profession unsustainable for many.
Wanaka-based midwife Justine Quirke prays to God every time a woman goes into labour. Quirke is so concerned about the lack of support, large caseloads and inadequate facilities in the region she resigned from her Southern District Health Board job as a locum providing cover for Wanaka's two midwives. I feel we were stretched too far. If one of the midwives got called away, you are responsible for the other 19 left behind and also the other on the caseload. There is absolutely a crisis and there is no solution going forward.
There were midwives in Wanaka with practising certificates but no-one was willing to work in current conditions - she could not even find someone to cover her for 24 hours to give her a break.
Midwives just don't want to work as LMC because it's isolated and scary. Sometimes you can't get an ambulance or helicopter It's challenging.
I am relieved every time I get home from a birth," Quirke said. The midwives, and community, wanted long-term planning from the health board - a mother and baby hub due to open in was not the solution. Wanaka has got the numbers to support a primary or even secondary birthing unit. Short staffing affected city-based midwives, too. A Christchurch community midwife, who didn't want to be identified, recently found herself supporting her client in the midst of a long and complex labour at Christchurch Women's Hospital while "significantly" sick herself.
The maternity ward was "crazily busy" and a shift coordinator had earlier sent a call out to community midwives asking for help. After eight hours, burning up with a temperature and exhausted, the community midwife sent her own SOS to a group of Canterbury midwives.
As the minutes and then hours went by it was clear no-one would come to her rescue. I was absolutely desperate. Eventually a colleague cancelled plans for a dinner with friends and came to relieve her. By then the midwife, clearly in the grip of a bad cold or even flu, had been on the job for more than 12 hours without a break. If you are unwell it's not good to expose others to that risk, or for yourself, but there is no plan B, there's no other way you can do it. Another Christchurch community midwife, Jay Beaumont, said most community midwives work 12 days on and two days off.
Self-employed community midwives were paid set fees for each aspect of pregnancy care, birth and postnatal care to six weeks after the birth by the Government. They had no ability to negotiate over those fees, unlike hospital midwives, who have a union to advocate on their behalf. The low and insecure payment model easily led to burnout, Beaumont said. When she returned to work she joined a practice which collected individual fees and split the amount evenly between the midwives in the form of a salary.
This allowed Beaumont to work seven days on and seven days off and receive a regular pay. But the majority of midwives made individual claims for fees, she said. In the College of Midwives, a professional association, stepped in and took an equal pay claim against the Government to the High Court on behalf of community midwives. Fee rates had not changed since , even in line with inflation.
The profession was "choking", Eddy said. The parties opted for mediation and by November the Ministry of Health agreed a new funding model was needed and to put in a budget bid which reflected this. The college wanted an independent entity to act as an advocate for community midwives.
It also proposed new fees of "at least double" the existing payments, excluding business expenses, Eddy said. Despite fee increases of 8.
At a midwives conference in August, Ministry of Health deputy director-general, health system improvement and innovation Keriana Brooking apologised.
The college returned to mediation and received assurances a new funding model incorporating the pay equity principles would be completed by July Eddy said community midwives had not received assurance Cabinet would commit to forming a new funding entity to represent them. A workforce report by the DHBs on hospital midwifery highlighted critical shortages and warned of the situation worsening. A significant proportion of the workforce - about 30 per cent - were 10 years away from retirement, the report said.
Of 20 DHBs, 15 reported midwifery vacancies in December Midwifery student numbers had declined, with just students completing their training at the end of Since the report's publication some DHBs, including Auckland and Mid Central, had employed registered nurses, unable to recruit midwives.
Eddy said the response to the workforce issues by the ministry had been "slow to non-existent". Brooking said Budget "reflects the Ministry's ongoing support of commitments made last year to facilitate change that will improve the financial situation for midwives".
Initiatives from the Budget included the 4. Health Minister David Clark said the Government had high regard for midwives and wanted to "see them remunerated better".
He said many fulltime midwives were earning more as a result of heavier workloads "due to a workforce shortage that has taken many years to build". Hospital midwives received an increase to their pay rates after a new collective was settled in April, following a strike in November. The settlement will give most a It may not be enough to stop some midwives heading to Australia.
Rotorua Hospital midwife Kate Oxley, 53, completed four short-term contracts in remote areas of Australia for the first time last year. Oxley is one of eight Rotorua midwives who have taken work in Australia, with three now in permanent roles. West Australian agency rates were almost double what she earned in New Zealand. The work had helped her pay off debts, visit family in the UK and help pay for her daughter's wedding. Back in Rotorua, Oxley's maternity unit had about four roles vacant and she noticed the impact of short-staffing.
A recent increase in pay had helped to boost morale but more was needed to keep midwives, she said. Queenstown midwife Sharon White said Wanaka's hub was a "bandaid" and lives were being put at risk. It's just another room for midwives really. It's a bandaid Central Otago had the second-fastest growing population, easily big enough for a secondary birthing unit, but the SDHB was "turning a blind eye" to the need, White said. About women in Queenstown were due to give birth, and across Central Otago, White said.
Maternity care was a critical service and the distance from a base hospital, and unreliable transport, put mothers and babies at risk. The SDHB had improved access to helicopter transportation but in winter they often could not fly so relied on ambulances which caused huge time delays, she said.
Ambulance services in Queenstown were often not available at night, forcing midwives to rely on the Alexandra service. SDHB executive director strategy, primary and community, Lisa Gestro said it was "committed" to having discussions around Central Otago and Queenstown Lakes maternity services' longer-term needs.
Gestro said the Lumsden facility was not sustainable as it had one birth a week and hour cover. The priority was sustaining that workforce I stand by that decision.
Meanwhile, plans were in motion for a new primary birthing unit in Dunedin as part of its redevelopment plan that would operate "side by side" with the secondary unit, she said. Other regions with large rural populations were grappling with similar issues, she said. Will more babies be born on the side of the road? Queenstown midwife Sharon White says there is a midwife shortage across the region as they grapple with challenges of high caseloads and geographic isolation from a secondary maternity facility.
Amanda McIvor, holding daughter, Alexis, 2, and fiance Gordon Cowie, with Levi who was born in an ambulance on the side of the road, near Lumsden. Because of the Lumsden Maternity Home being closed recently they were unable to use the facility so were trying to get to Southland Hospital in Invercargill. Queenstown midwife Sharon White says midwives are burnt out, and women and babies are being put at risk by inadequate facilities, geographic isolation and unreliable transport.
Wanaka-based midwife Justine Quirke quit working for the Southern District Health Board covering Wanaka midwives over concerns of high caseloads and lack of adequate resources. She continues to work as a locum midwife in Queenstown and in rural communities. Christchurch midwife Jay Beaumont says she was burnt out after three years working as a community midwife, but a new practice model meant she was able to continue in her profession.
I am available for consultations to discuss this, although this service is not publicly funded. If you wish to take these, you will need to see your general practitioner GP for a pharmacy script, or visit your supplement supplier and ask what they have. Optimal nutrition is ideal, however, so we can discuss foods that support this too. You can contact me here. If you think you might have a bun in the oven and want a free pregnancy test to be sure, contact me.
Are you a home birth midwife in New Zealand not listed here? All the midwives listed on our site have specifically registered with us as home birth midwives. Check out our your home birth page for advice and guidance on choosing a midwife, or read about the maternity system in New Zealand here. Having a student midwife at your birth is a wonderful opportunity for them as future midwives, as well as for you and your whanau. It is great to have an extra pair of hands helping out with your birth, student midwives can do everything from supporting your midwife, to bringing a cuppa and the hot cloths.
Southland Hospital, Invercargill
Study our internationally-recognised midwifery programmes and benefit from experienced teachers, flexible delivery options and hands-on learning. As a teacher I was willing to help someone learn, but I got so much out of it myself. It was a really nice experience, having a second person caring for me, especially during the birth. My student midwife was involved from 12 weeks on. She did a really good job of communicating information to me. I would definitely recommend having a student midwife. You will be helping to educate the midwives for the future.
Thousands of women unable to find midwife for Christmas holiday births
Southland For a full list of midwives in this region and to refine your search, click here. Melanie McTainsh. Debbie Jensen. Tomoko Clark. Amy Darragh.
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Will more babies be born on the side of the road?
Welcome to the official site of the New Zealand College of Midwives, the professional organisation for midwives. The College is governed by a National Board comprising a number of nominated and elected representatives from throughout New Zealand. As a member of the College you have the opportunity to contribute to all the representations the College makes to government, health organisations, consumer groups and the public. The College encourages and values individual member input very highly.
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A midwife is a health professional who cares for mothers and newborns around childbirth , a specialization known as midwifery. The education and training for a midwife is similar to that of a nurse , in contrast to obstetricians and perinatologists who are physicians doctors. In many countries, midwifery is either a branch of nursing or has some links to nursing such as a shared regulatory body, though others regard them as entirely separate professions. Midwives are trained to recognize variations from the normal progress of labor and understand how to deal with deviations from normal. They may intervene in high risk situations such as breech births , twin births , and births where the baby is in a posterior position , using non-invasive techniques.