Shock report on midwives prompts official action

Ministry of Health intends to investigate findings showing care by doctors better

The Ministry of Health is investigating after a study revealed higher rates of damage to babies born under midwives’ care. The findings have been criticised by the College of Midwives as simply showing a rich-poor divide.

The five-year University of Otago study of more than 244,000 babies born from 2008-12 found mothers with medical-led care, such as by obstetricians or GPs, had babies with lower odds of adverse health outcomes at birth.

These included 55 per cent lower odds of oxygen deprivation during delivery, 39 per cent lower odds of neonatal encephalopathy, which can cause brain injury, and 48 per cent lower odds of poor health, as measured by a low Apgar score, which measures infant well-being immediately after birth.

Ministry of Health chief adviser child and youth health Dr Pat Tuohy and principal maternity adviser Bronwen Pelvin said the findings were unexpected and contradicted international evidence.

“The Ministry of Health has referred the study to the National Maternity Monitoring Group for advice on whether further research needs to be undertaken to help us better understand whether the findings reflect something about the way the study was done, differences in the maternity care provided by midwives and doctors, and whether there are things we can change to get better outcomes,” they said.

Issues that needed further exploration included looking at what other care was provided to women in the midwifery-led group, looking at differences between the types of women compared in the study, and investigating how quickly specialist services respond to complications in pregnancy, labour and birth.

A report on the study said it was not possible to definitively determine if one model of care was associated with fewer infant deaths during birth.

Co-authored by a former midwife, the research is the first major safety review of the autonomous midwifeled system adopted in 1990.

Published in Plos Medicine this week, it found that adverse health outcomes were substantially lower for babies born to mothers registered with medical-led maternity carers.

“These findings demonstrate a need for further research that investigates the reasons for the apparent excess of adverse outcomes in midwife-led care,” co-author Professor Diana Sarfati said.

Co-author Ellie Wernham said that as a former midwife she saw firsthand the benefits of a midwife-led model but the research showed aspects of New Zealand’s maternity system could be improved.

Action to Improve Maternity (Aim) founder Jenn Hooper, whose 11-yearold daughter, Charley, was left severely brain damaged after a botched birth by midwives, welcomed the research and called for urgent investigation into the findings.

Hooper said the 700-plus families whose babies were damaged at birth that Aim had helped since it began eight years ago had “paid the price” for the midwife-led model.

“I would like to think that further research would delve into the education, the training and the lack of internship [of midwives]. I wouldn’t be surprised at all if that’s a big part of the cause.”

Newly graduated midwives do not require nursing training and can be self-employed in the community.

I would like to think that further research would delve into the education, the training and the lack of internship [of midwives]. Aim founder Jenn Hooper