Gutless economics behind gaps in support
‘‘I WAS pretty gobsmacked.’’ That was the reaction of a woman who suffered terrible injuries to her vagina, perineal and pelvic muscles, and rectum, from the birth of her daughter, when told last year that the Accident Compensation Commission cover provided till then shouldn’t have been approved, and would end.
Her reaction’s understandable. What’s puzzling, though, is why she (and other women with birth injuries) were ever granted ACC cover, unless her injury resulted from mismanagement by health professionals.
The ACC has, since April 1, 1974, funded medical, rehabilitation, and other care, and financial support, for those suffering accidental injury or workrelated illness. It also covers mental injury caused by some crimes, and injury or illness arising from mismanaged treatment by health professionals.
It’s never covered other nonaccidentrelated illness.
Section 25(1)(a) of the ACC Act defines ‘‘accident’’ as ‘‘a specific event or a series of events, other than a gradual process, that (i) involves the application of a force (including gravity), or resistance, external to the human body; or (ii) involves the sudden movement of the body to avoid a force (including gravity), or resistance, external to the body; or (iii) involves a twisting movement of the body’’.
The critical phrase is ‘‘external to the human body’’.
Injuries to a woman’s vagina, perineum, pelvic muscles, and rectum during childbirth are certainly due to the application of force, but that force isn’t ‘‘external to the human body’’. It comes from the (very strong) contractions of the uterus, which, after dilating the cervix, push the baby down the birth canal to deliver.
The mother’s perineum must stretch to let the baby’s head (the baby’s biggest diameter) deliver. Ideally, with encouragement from her birth attendant, the mother can control her pushing enough to allow time for this to occur.
At times the perineum can’t stretch enough, or in time, to allow delivery without it tearing. Then (and electively for forceps and breech deliveries) the midwife or doctor may (using local or regional anaesthesia) cut the perineum (perform an episiotomy), enlarging the aperture, to prevent a tear.
It’s easier to repair an episiotomy than an uncontrolled tear, which may, at times, extend to involve the rectum — either a third degree (involving the anal sphincter muscle) or fourth degree (extending through the sphincter and involving the anus and, perhaps, the rectum) tear, both of which require much more complex repair, often under general anaesthetic.
Experts say the increased age of many women having babies is a factor in the apparently increased incidence of perineal tears in New Zealanders giving birth. Anecdote suggests, too, that some midwives are very reluctant to perform an episiotomy (‘‘unnatural’’), and one wonders if that’s a factor in the rising incidence of problematic tears.
Whatever the cause(s), as ACC’s chief clinical officer Dr John Robson says, ACC can only apply what the ACC Act allows.
‘‘ACC can cover perineal tears that are the result of treatment, or the failure to provide treatment (a treatment injury). However, most perineal tears are not caused by treatment but by the birthing process and would be addressed in the normal course of care provided by the [public] health system.’’
The ACC can fund private medical care. But why is it now often hard to get prompt treatment through the public health system? Answer: years of chronic underfunding, due to politicians’ (both major parties) reluctance to tax fairly, progressively, and adequately, has led to major, increasing resource constraints.
Why is there such a (morally indefensible) difference in other support for disability from ‘‘accidental’’ and from ‘‘nonaccidental’’ cause? Answer: see above.
It’s long past time for ‘‘transformation’’ of New Zealand’s health and social security systems, and taxation.
But if the Government’s too gutless to tax adequately to enable proper provision for ‘‘nonaccidental’’ illness and disability, it should at least, now that two incomes are essential for many families even to eat, stop meanstesting the sickness benefit against a partner’s income.