Time to deliver for midwives
Self-employed midwives work up to 26 per cent longer than the standard working week.
Midwives have long argued that their funding does not reflect the increasing pressure, complexity and sheer number of hours they work. It’s time the Government did more than listen to calls for an overhaul of such a key health service.
A report on Thursday, commissioned by the New Zealand College of Midwives, has some stark numbers. Among them is that self-employed midwives work up to 26 per cent longer than the standard working week. Their average caseload is almost 47 cases a year, well above best practice guidelines of 40.
The workload is also increasingly complex, both medically and socially, due to issues such as obesity, poor housing and cultural diversity. Because their fees are fixed they cannot recover costs of extra consultations for high needs. Throw in callouts at any hour, and long waits for government payments, and it’s no surprise that burnout is common.
Ironically, there is a record number of midwives with practising certificates in New Zealand, around 3200, made up of hospital-based midwives and self-employed midwives in the community. However, the college says many are choosing to work part-time or not at all because of the lack of rewards.
The New Zealand Institute of Economic Research report calls for an overhaul of the midwife funding system. For a start, it recommends an extra $50 million a year to reflect the status quo of midwives working those extra unpaid hours and to cover a special fee for increased consultations for mothers in socially deprived areas who inevitably have greater needs.
It’s a life and death issue – in the most deprived neighbourhoods, there were on average 73 more perinatal deaths a year from 2013-17 compared with other neighbourhoods.
Underpinning arguments for a better-funded service is the wider principle of pay equity. In 2015 the College of Midwives launched an equal pay claim that argued self-employed midwives, overwhelmingly women, suffered gender-based discrimination because their pay was lower than comparable male-dominated jobs.
That case was taken under the Bill of Rights Act, not the Equal Pay Act, because community midwives are self-employed. It was withdrawn in 2017 when the Government stumped up with a
6 per cent pay increase, with the college taking the practical approach of money now, instead of a lengthy court process.
But with an increasing number of pay equity negotiations across the state sector – following the settlement of the Kristine Bartlett carer case in 2016 – there is a stronger appetite to reduce such gaps.
There are current pay equity claims for nurses, hospital administration staff, and other nonmedical workers such as occupational therapists. Hospital-based midwives have started their own equity negotiations.
College chief executive Alison Eddy says mediation with the Government since it withdrew its equal pay claim for self-employed midwives has moved at a ‘‘glacial pace’’.
The NZIER report, and a petition with more than 23,000 signatures backing the midwives’ case, are attempts to jolt that process into life ahead of the Budget in May. While it’s unfortunate timing, with the coronavirus outbreak consuming so much attention, the Government would do well to heed the health message from midwives.
It’s billed as the Wellbeing Budget. What better place to start than at the beginning of Kiwis’ lives?