Where’s the $35 million maternity plan?
Year after year, babies are being born into a dangerously underresourced maternity system. With hospital wards nationwide short of 200 midwives and women having to fight for basic care, the minister previously in charge of the sector questions the political will to fix the problem. National correspondent Michelle Duff investigates.
Hours after Kelly gave birth by emergency C-section, she was ordered to get up and change her own maternity pad. She’d just had invasive abdominal surgery, was bleeding, and could not stand up.
But Kelly, 37, says a harried Wellington Hospital nurse pointed her to a stack of pads, and told her she’d need to change them herself every four hours. ‘‘I was so shocked, I just didn’t know what to do,’’ she says. ‘‘For the next 12 hours I had no help and I just wanted to go home, but I couldn’t move.’’
The morning after she gave birth to her first baby, Palmerston North mum Julie (not her real name) was told her discharge papers were ready. ‘‘I was terrified,’’ the 22-yearold says. ‘‘I didn’t even know how to look after my baby.’’
Her hospital notes mentioned her previous suicide attempts and her struggles with depression and anxiety. ‘‘I don’t know if they weren’t told, or if they just didn’t read anything.’’
Struggling with a diagnosis of a high-risk pregnancy, Lower Hutt mum Kirsten Van Newtown couldn’t get an urgent obstetric appointment and was instructed to simply call an ambulance if she started haemorrhaging.
‘‘It got to the point where I was just like, ‘I’m going to go to the hospital and camp out.’ It’s not good enough,’’ she said. ‘‘Women die because of this.’’
January 2021. July 2020. February 2021. Three new babies, three birthdays that should have brought joy. Instead, these children – now aged between 5 weeks and
9 months – are being born to a generation of parents in danger of being hurt and traumatised by a maternity care system that is stretched to breaking point.
Research is firm on the repercussions of substandard maternity care before, during and after birth. The first 1000 days of life are crucial. Poor outcomes for mums and babies include premature birth, injuries and trauma, antenatal and postnatal depression and anxiety, and preventable death. Data show that progress in New Zealand has stagnated in many areas and is in some cases worse than a decade ago.
It’s been three years since a Stuff investigation found maternity care was in crisis.
At the same time as documents reveal there are now 211 midwife vacancies in hospitals nationwide, former Associate Health Minister Julie Anne Genter tells Stuff she left the office questioning why it was so hard to get change.
The transformation that wasn’t
While minister in charge of maternity in the previous Labourled Government, Genter – a Green Party MP – wrote a Cabinet paper titled Maternity System Transformation that was intended to highlight the problems facing maternity services and chart a path forward.
‘‘Specific action is required to address the sustainability of maternity services,’’ notes with the draft paper, obtained under the Official Information Act, say.
‘‘Issues with New Zealand’s maternity system are becoming increasingly visible.’’ This included increasing preventable medical interventions on those giving birth, and pressure on community midwives and hospitals.
The paper says the current system is inadequate and outdated, and that longstanding structural issues have led to midwife shortages and inequities in care for Ma¯ ori, Pasifika, and other at-risk communities.
‘‘This Government has the opportunity to safeguard our model of care, strengthen our maternity workforce [and] drive better integration of maternity services with other health and social services to ensure all women and wha¯ nau can access equitable, safe, high-quality maternity services.’’
This would mean major changes to the way maternity was organised, and a cash injection.
But the Cabinet paper hit a brick wall. After going out to other ministers and a raft of government departments for consultation, it was shelved in early 2020.
Genter still doesn’t know why. She told Stuff she could not understand why Prime Minister Jacinda Ardern’s office was not receptive to it, and why Ardern did not discuss it at Cabinet.
The issues in it were welldocumented, she says.
‘‘There was never a logical explanation . . . I honestly couldn’t tell you why. The whole thing was one of the most bizarre things I went through as a minister. I didn’t understand what the problem was.’’
Although the Health and Disability System Review was going on concurrently, Genter says this was not a good reason to have excluded the paper, which had a much tighter focus.
A spokeswoman for Ardern would not comment on specific papers, but noted that part of the consultation process was that other ministers, including the prime minister’s office, had an opportunity to comment.
A Maternity Action Plan was written in late 2018, to be attached to the paper. This document received $35 million of funding in last year’s Budget, with $8.75m to be spent on its implementation in the year to May 2021.
But no-one outside the Ministry of Health has seen it. The Royal Australian and New Zealand College of Obstetricians and Gynaecologists, the Perinatal and Maternal Mortality Review Committee (PMMRC), and the New Zealand College of Midwives are among those questioning where the money has gone, and when the plan will be made public.
‘‘There are now major problems, and hospitals are struggling,’’ says PMMRC chairman Dr John Tait, also an obstetrician and the chief medical officer of the Capital and Coast District Health Board.
‘‘From our perspective, nothing has really changed in the past 10 years. If anything, the inequities for Ma¯ ori and Pasifika almost seem bigger each year.’’
The New Zealand College of Midwives (NZCOM) has viewed one version of the document that the ministry describes as the ‘‘driving force for improvement across the maternity sector’’, but only because it requested it under the Official Information Act.
‘‘It’s hard knowing how to plan when you don’t know what’s coming,’’ says Alison Eddy, the chief executive of NZCOM. ‘‘It’s really not clear why it hasn’t been published, or what the details are.’’
NZCOM is still stuck in a fiveyear mediation with the ministry for fair pay and a new funding model for lead-maternity-carer midwives that would address inequities and workforce shortages. ‘‘We’ve hit a brick wall, it’s quite dispiriting, and it speaks to the value that is placed on women and maternity,’’ Eddy says.
Associate Health Minister Ayesha Verrall acknowledges maternity care needs attention.
‘‘There is a real need to make faster progress in a number of areas in women’s health, including improving maternity care.’’
Verrall says key areas of focus will include increasing the number of midwives and improving stretched maternal mental health services. She is expecting a briefing from the ministry on a stocktake of maternal mental health services nationwide in the coming weeks.
When asked why the maternity action plan was not publicly available, the ministry said it was an internal work programme and a ‘‘living document’’ that is being constantly updated.
‘‘The MAP will continue to evolve in response to maternity system needs. The ministry’s latest focus is to consider how the MAP can better align to Te Tiriti. We are committed to continuing work to improve the maternity system in New Zealand, building sector relationships and developing better communications channels.’’
This year’s $8.75m is being spent on expanding district health board Maternity Quality and Safety programmes, IT development, and introducing Te ara o¯ Hine, an initiative to increase the number of Ma¯ ori and Pacific midwives, the ministry says.
It did not say when or if it would make plans for maternity public.
A three-page version of the plan was released to Stuff under the Official Information Act.
Working around the system
About 24 hours after surgeons pulled her baby through a cavity in her abdominal wall, Kelly asked to be allowed to go home from Wellington Hospital’s postnatal ward. The recommended stay after the surgery is three to five days.
Dosed with tramadol and feeling faint, she hobbled to the car with the aid of her husband. At home, he took care of her while looking after their other two children and handing her the baby she still couldn’t get up to reach.
She worried about ripping her stitches by sitting up in the nonhospital bed, and had to regulate her own pain relief while teaching her baby to breastfeed and stopping the other kids from jumping on her wound. But it was still better than being in hospital, she says.
‘‘It was painful, but I knew I could do it. In the hospital there was no help and being asked to change my own pad was just so degrading, especially when I couldn’t move.
‘‘I have three babies, so I know that’s not OK, but what if I were a new mum and just thought that was normal? It’s dangerous advice.’’
She wishes there had been somewhere safe she could’ve stayed and bonded with her baby for a few days. ‘‘I would have loved that.’’
Documents released under the Official Information Act show that in December 2020, there was a nationwide staff shortage of 211 midwives on hospital maternity wards. When Stuff started reporting on this in 2018, at least three major hospitals had been reporting unsafe staffing levels for more than a year.
Midwives are working double shifts in unsustainable conditions, nurses are being seconded to do midwifery work they have not trained for, and still there are not enough staff.
Van Newtown, who also had her baby in Wellington Hospital, a month after Kelly, was so alarmed by what she saw that she began writing a petition from her hospital bed.
After a scan at 32 weeks that revealed she had placenta accreta, Van Newtown needed to be seen urgently by the maternal foetal medicine team.
But she says multiple appointments were cancelled and rescheduled and her anxiety levels were through the roof. ‘‘I felt like I was being put in a really vulnerable and compromising position, and just being told to call an ambulance if I started bleeding is not good enough. I needed medical care.’’
Her care when she was admitted to hospital at 34 weeks was excellent. But after her caesarean section, on the postnatal ward, she ended up setting her own alarm to call for pain relief.
‘‘Every time a midwife came into the room, they were so apologetic about how much time it had taken.
‘‘They were subbing in from different parts of the maternity ward. It’s just really, really chaotic.
‘‘This is not just my experience – it is the experience of women throughout the country. Women carry the burden of underresourcing, and the Government has consistently exploited the goodwill of midwives and doctors.’’
Her petition, which has almost 4000 signatures since Paisley, now 5 weeks old, was born, calls on the Government to implement years of recommendations from the PMMRC, support recruitment of midwives, create a women’s health strategy, and remove barriers to care and make it more equitable for Ma¯ ori parents and their babies.
Joy Farley, a director of provider services for the Capital and Coast and Hutt Valley district health boards, says the service is under strain. It aims to provide quality, comprehensive and compassionate care and support for parents and infants. ‘‘We apologise if this was not the experience of the patients you have referred to.’’
On the edge
For some new mums, the current situation is not just frightening. It is life or death.
Julie, whose first baby is now
9 months old, was discharged from hospital hours after she gave birth.
She has a history of mental illness and suicide attempts. She says her midwife knew of this and was supportive, and they had written a birth and postnatal plan that included a longer stay, a support person, and a private room.
But after she gave birth at
8.50pm, her main support person, her mum, was asked to leave. Julie stayed awake all night, too anxious to leave her baby even to go to the toilet. First thing the next morning, she was given her discharge papers.
‘‘A nurse came in and said, ‘Great, you’re ready to go!’ I was so nervous because I had no clue how to look after a baby.’’
Her mum supported her through the newborn period, and Julie says she’s coping – apart from a ‘‘rough patch’’ recently when her baby was not sleeping well. Her midwife did not bother with a referral to maternal mental health services, telling Julie it wasn’t worth it.
Suicide is the leading cause of maternal death, with Ma¯ ori women more than three times more likely to take their own lives than Pa¯ keha¯ .
The rate is five times that of the United Kingdom, where governments have invested heavily in maternal and perinatal mental health.
Verrall says this is where she plans to start.
But right now, three more babies are being born. What are the stories their mums will tell?