Pandemic has exacerbated issues midwives face
A significant number of midwives are approaching retirement age, and not enough are coming through the ranks behind them, writes Alison Eddy.
We didn’t decide to become midwives for the money or the lifestyle. We work in partnership with women to contribute to the magic that happens when new wha¯ nau are created.
When a mother holding her newborn baby has that look on her face that tells you she feels like she’s just conquered the highest mountain she’s ever climbed, we know we’ve done a good job. Of course, she did it herself. Midwives are simply there to facilitate the process and keep everyone safe.
Midwifery requires a four-year degree, courage, heart and commitment. Life and death decisions are par for the course; technical and clinical competence are fundamentals of our work.
Midwives help women and wha¯ nau successfully navigate the amazing processes of pregnancy, labour, birth and breastfeeding. The work is time-sensitive; babies don’t wait, and even routine care can’t be delayed.
We feel privileged to do what we do, but lately this feeling is harder to hang on to. Cracks were showing before the pandemic, but Covid added fuel to the fire, inflaming workforce issues that midwifery already faced.
Throughout lockdowns, midwives kept working in hospitals and communities. Births can’t be attended over the phone, emergency assessments can’t be undertaken via video calls and routine checks need to be at least partially in person. When parts of our health system closed their doors, midwives continued providing necessary in-person care. Although the challenge of lockdowns has passed, they have taken their toll.
We face severe workforce shortages in some regions, exacerbated presently by flu and Covid.
Just when it feels like we have hit rock bottom, it gets worse. We are now skidding on the gravel, and it hurts.
It’s called moral distress. When there simply isn’t enough time to complete your work to the high standard you were educated or trained to do.
For midwives, this means rushing around maternity wards, with no time to focus on the important needs of a new mother as she learns to breastfeed and care for her baby. It means leaving a shift feeling exhausted and empty, knowing you have to turn up and do it all again tomorrow, but not knowing if there will be other midwives available for the work that needs doing.
Societal inequities are confronting and morally distressing too. New babies living in cold, damp, and overcrowded homes, families unable to afford the part-payments for essential ultrasound scans or prescriptions. A midwife recently told me of an unplanned home birth she attended.
She asked the family for some more towels, having used the three they had provided. There were no more.
Our workload and role have never been properly understood and quantified. Even when maternity hospitals were relatively well-staffed, staffing levels were inadequate. Midwives working in the community as lead maternity carers (LMCs) have had to carry higher caseloads than they’d choose because they are dedicated to making sure there is a community-based (primary) maternity service available, even if it means sacrificing time with their own families.
This crisis hasn’t happened overnight. Many who have worked in the sector for years have been signalling that a workforce shortage in our small and highly specialised profession was looming.
A significant number of midwives are approaching retirement age, and not enough are coming through the ranks behind them. Some are leaving the profession due to stress and burnout.
There’s a lack of long-term workforce planning, and an over-reliance on the professionalism, passion and personal commitment of our midwives.
There are no formal support structures to help manage community practice; inadequate pay and recognition of the complexity and responsibility associated with the job; and an ignoring of the common-sense solutions presented for almost a decade.
So what are the solutions? Enabling and supporting students to enter the profession, and ensuring we have sustainable working conditions to retain midwives in the workforce are but two.
When the Government announced policy to fund trades apprenticeships to stimulate our economy and support industries, midwives heard that it values male-dominated professions over essential health care provided by femaledominated professions.
When overseas specialist doctors, scientific and technical professions can fast-track residency while overseasqualified midwives need to wait two years, midwives hear that the Government doesn’t value the essential and specialised role we play in our healthcare system, nor the desperate strain we are under.
These policies demonstrate the Government’s lack of understanding about the downstream impacts that a critically under-resourced maternity service has on wha¯ nau.
Maternity care is the foundation of a healthy start to life. Investing in it pays dividends in the long term. Much of midwives’ work is preventive, identifying and mitigating issues before they become problems.
Midwives are in hospitals, people’s homes and communities, providing highly accessible and effective care because we are a trusted and integrated part of communities. We can make a positive difference but only if there are enough of us.
Our health system structures and entities may be changing, but our workforce isn’t. Our plea to the politicians and bean counters is – invest in us, it’s an investment in a healthy future for our nation.