Weighing in on maternity care
Congratulations to Donna Chisholm on her maternity research story (“Birth control”, October 8). Less to the Ministry of Health, Royal Australian and New Zealand College of Obstetricians and Gynaecologists and New Zealand College of Midwives for their response in a September 30 media release, which states, “It is very important to reassure New Zealanders that the maternity system we have here is safe.”
Who could possibly disagree with such a weighty pronouncement made ex cathedra by such an exalted group? I feel like a medieval heretic facing the wrath of the Pope if I express some feeble misgivings.
Safety is a relative concept. It could be said that childbirth is safe in the modern world compared with the past, but only if one is prepared to accept that in the world’s near-worst conditions, today 2% of mothers die (and a lot more babies, but in today’s “woman-centred” maternity universe that hardly counts). That means that 98% of mothers in those places survive. Some might regard that as safe, but don’t count me among them.
How safe should we be?
That is for those using and providing the services to decide. More important than the crude figures is preventability, of both deaths and damage. When I last heard, some 19% of deaths were regarded as preventable. Too many, I suggest, to justify the use of the word “safe” in the press release.
I have been in and around the field for 60 years. Aspects of maternity care have improved, but I am in no doubt that standards of safety have declined since 1990.
New Zealanders can be reassured that our maternity system is excellent in parts. The problem for many people may be finding those parts. Those in doubt should consult their general practitioner. GPs should know or make it their business to find out. Ross Howie Retired associate professor in neonatal paediatrics, University of Auckland
The maternity research at the centre of your cover story categorised care according to who was first registered to provide it. Picture this. As a former lead maternity carer (LMC), I registered a woman who had a severe clotting/bleeding issue. I worked in a multidisciplinary team with an obstetrician, obstetric physician, haematologist, anaesthetist, coagulation nurse and paediatrician, but I remained her LMC.
In terms of the research, the outcome of this woman’s birth would have been attributed to midwifery care, yet I was not making the majority of decisions. The woman, with many helpers, was making informed decisions about her care. Diane Hirst (Palmerston North) “Where the revolution went wrong”, the cover line on your maternity research story, misrepresents the article and the research on which it is based. So do the photoshopped hippy couple in 1970s dress – the reforms happened in 1990.
There is general agreement that the reforms were good and are working and satisfaction is high. However, most also agree it is time to reassess the mechanics of the system – but not to go backwards. Keeping a world-class service and system is the focus and putting the heat on midwives is not the way forward.
The research by Ellie Wernham has gaps that are discussed in the article. The 2016 Cochrane review suggests women who received midwifeled continuity models of care were less likely to experience intervention and more likely to be satisfied, with adverse outcomes for these women or their infants being at least comparable to those of women under other models of care.
The woman-centred midwifery care model works well, so long as district health boards’ maternity units have the resources to provide secondary and tertiary care when it is required. Current levels of funding and staffing put pressure on this. Memo Musa Chief executive, New Zealand Nurses Organisation (Wellington) The maternity research article ignored a vital point: 37,691 women did not have a lead maternity carer and probably received no antenatal care.
This accounts for 13.5% of all births in 2008-2012.
It is a shame that the adverse outcomes for this group were not also included in this study. It is certain that their outcomes are significantly worse than either of the other two groups.
I hope we do not get diverted into a futile argument about whether doctors or midwives provide better antenatal care while ignoring the women who get no care at all. Dr Ben Gray Senior lecturer, Department of Primary Health Care & General Practice, University of Otago