‘She saved Jess’s life’
Town's last midwife delivers baby on side of rugged, remote road
Jess had complications which Morgan was able to fix on the side of the road, basically saving Jess’s life. We’re very grateful for the dedication of our midwives.
Joe O’Sullivan
Dingle Burn Station is character-building country. It says so on the sign at the start of the winding gravel road deep into the heart of Otago’s Southern Alps.
Driving into the isolated high country sheep station along the narrow track blasted into the bluffs above Lake Hawea is a grim challenge. Driving out, pregnant and in labour, the contractions coming fast – that’s unbelievably torrid.
Farm managers Jess and Joe O’Sullivan, both 29, have lived on the remote back-country farm since 2015. But when Jess became pregnant with their first child, they made careful plans to deliver the baby at the Alexandra birthing unit, two hours away.
At 3pm on February 11, Jess’s waters broke. She felt she had more time but, as dusk gathered, Joe became adamant it was time to leave: he didn’t want to drive the bluffs in the dark.
Jess’s midwife, Debs Harvey, was on a rare day off, so they arranged to meet on-call midwife Morgan Weathington at 8pm at their friends’ place in the Lake Hawea township, before heading another hour down the highway to Alexandra.
They set off from the farm. Contractions were coming fast and strong. They got just 200 metres down the track before Jess had to ask Joe to stop so she could breath, stand up, walk around. With no cellphone coverage on the track, Joe was tempted to turn back.
Instead, he drove slowly and calmly through the bluffs, stopping frequently. Then. as soon they were over the worst section, he ‘‘floored it’’. As they crested the top of the Timaru River Road hill, Jess was beginning to push. They were just inside cellphone reception.
Joe pulled over on a grassy bank next to a large rock. ‘‘Let’s ring that midwife,’’ Jess said.
The birth of their daughter Olivia in the back of the Hilux was complicated. But for the arrival of the midwife in their friends’ truck, Jess might have died that night.
Now she’s adding her voice to the chorus of mothers around New Zealand calling for improved funding and resources for midwifery services, especially in remote rural areas.
New Zealand has more than 3150 practising midwives. And according to government careers advice, they earn from $49,000 to $115,000 per year.
That’s a big range, given they mostly have the same degree and registration. But there is a stark and potentially divisive difference between the decent pay and conditions for staff midwives at the country’s district health boards, and those self-employed midwives who say they are working up to 100 hours a week with little support in provincial New Zealand or even in the tougher corners of our biggest cities.
Of the 3000-plus midwives, about a third are lead maternity carers (LMCs) working in small independent practices alongside DHBs and obstetricians. According to the College of Midwives, they deliver about 90 per cent of New Zealand’s babies. Paid a fee for each baby, they may gross about $100,000 a year, but their income drops to half that by the time they cover rising overheads such as rent and petrol.
The demands of pregnant women have increased through the high risk of obesity, mental health issues, domestic violence and smoking and drug use. And thanks to cellphones, email and social media, midwives are expected to reply instantly, 24/7.
Worst of all, their pay relative to the rest of the community has declined rapidly. In the past, GPs offered maternity care for women in the community, but that changed 28 years ago when midwives gained the legal right to claim for their services. Now, only a handful of GPs are classed as LMCs, compared with about 1000 midwives, 99.9 per cent of whom are women.
With the return to maternity care as a female-dominated profession, midwives’ relative pay plummeted to 30 per cent below comparable professions – to the point that the College of Midwives took their case to the High Court as a gender equity battle. Midwives earned less in their pockets than receptionists, College chief executive Karen Guilliland warned, yet hold the nation’s future in their hands.
Last year the Government agreed a 6 per cent pay increase and a place at the table for community midwives to design their pay structure and working conditions – one small step. But on its own, it was not enough to stem the flow of midwives leaving for Australia for better pay and conditions, or leaving the profession altogether.
This week, though, Guilliland met the acting director-general of health – and that may have been a breakthrough.
Morgan Weathington was waiting anxiously in Hawea. The agreed meeting time had passed and Jess and Joe O’Sullivan had not turned up to the home of their friends Nat Lane and Eliot Ryan. And there was no answer on their phone.
So, with her life-saving equipment, Weathington clambered into the back seat of Nat and Eliot’s truck and they set off towards Dingle Burn.
They found the Hilux at 8.20pm, Jess in the back seat.
Joe vividly recalls that moment: ‘‘It was all go. It was the most magic evening. The sun was setting behind us on the hill. It had been raining that day but it had cleared. It was dead still.’’
Jess laughs now, but she was not looking at the view then. She was bleeding and her life was in danger.
Within 30 minutes of Weathington arriving, Olivia was born on the back seat of her dad’s Hilux. Her aunt now calls her ‘‘Crumpy’’.
But the dangerous delivery was one of the final straws for Weathington. That week, she resigned her job, exhausted after years of working 100-hour weeks.
Wanaka’s population has been growing steadily for more than 15 years, on the back of tourism and construction. Ten years ago, 100 babies were born. This year, they’re expecting twice that.
Weathington describes the lead maternity carer funding model as ‘‘exploitation for caring’’. It caps payments. Emergency obstetric care is not compensated.
‘‘People have been surprised at how bad it is for us. We’ve masked that to this moment. We don’t want women to stop calling us because we are too busy. That is not conducive to a well, anxietyfree pregnancy, labour and postnatal period. But now it has been revealed and people are really surprised.’’
She finishes at the end of March, leaving Debs Harvey as the sole midwife for the area from April 1.
Canadian-born Weathington is a funny, warm-hearted woman who feels dreadful about resigning.
‘‘It feels bitter-sweet. I love my job and the town I am working in. I would love to come back to it if it was structured and more stable ... We have midwives who cannot make ends meet,’’ she says.
All she wishes is that midwives’ work is valued. ‘‘And someone to push the button on reform’’.
Her resignation shocked the community into action. Kristi James, a tech customer engagement manager, moved to the district eight years ago and, with her boat-builder partner Michael, is renting a house at Hawea Flat.
Their daughter Mia was born 21 months ago in the care of Debs Harvey, ‘‘an absolute warrior’’.
James didn’t have any idea of the pressure Harvey was under.
She and other local mums are calling for immediate action to reform the rural and community midwife funding model, retain and recruit more midwives and build a birthing unit. There are plans for a 9-to-5 maternity hub and two locum midwives to join Harvey in April – but that’s nothing more than a ‘‘bandaid’’, according to James.
‘‘We need to figure out a plan for the future because Wanaka is not going to stop growing.’’
She wants the Government to hear mothers’ voices, so she’s organising a petition to Parliament, and lobbying the Southern District Health Board.
Weathington is impressed with how quickly the mothers have rallied. ‘‘To think they have little tiny babies, are sleep-deprived and are doing all this political work. It is massive work. I am really impressed ... their voice is much more powerful than ours.’’
Waikato community midwife Christina Campbell pulls out two big black toolboxes from the back of her little silver Volkswagen. They contain files on each pregnant
I’m not saying we’re going to get pay equity overnight – that’s an impossible achievement – but I think we will achieve it in the long term.
The College of Midwives’ long-serving boss
Karen Guilliland
woman she is caring for – and they’re chocka.
Most midwives are turning women away as they’re already booked up now leading into November. It’s first in, first served.
There’s a large blue suitcase in the boot called her ‘‘emergency kit’’, with fully sterilised equipment and necessities to help women and babies anywhere, any time. A birth kit, neo-natal resuscitation equipment, anaesthetics, IV fluids, medication, test tubes, oxygen mask, pads, dressing wounds. She has a full change of clothes, a spare pair of practical shoes, and a toothbrush. She is always prepared.
Christina has already had a busy day. She had a meeting at Hamilton hospital that morning, a clinic appointment, a couple of home visits, including helping a woman with a miscarriage. Her phone is to hand, as another woman is past her due date and had a false alarm a couple of days ago.
Midwife shortages in the provinces have made the headlines (Wanaka with just one midwife remaining; the Coromandel down from 11 to four) but cities like Hamilton and Auckland are also struggling – and even the big DHBs.
Although the hours may be better, says Guilliland, appearances can be deceiving for DHB midwives. They’re like ducks. ‘‘Underneath they’re paddling furiously, juggling 10 women and 10 babies in an 8-hour shift.
‘‘They just don’t feel like they’ve done anyone the justice they deserve, so every day becomes stressful and that leads to burnout.’’
Figures released under the Official Information Act showed there were 30 midwife vacancies in the Auckland region hospitals from December last year. Waikato DHB had 13 midwife vacancies and the Capital and Coast DHB had one. Canterbury DHB is fully staffed but has short-term vacancies for four midwives as ACC cover. Southern DHB has a 0.6 full-time equivalent vacancy in the maternity units/ post-natal wards.
Waikato has lost 30 to 40 midwives in 2017, with more planned exits this year. And the crisis also affects the hospital with women turning up out of the blue to give birth, having been unable to find a midwife for antenatal care.
With a case file in one hand and her phone in the other, Campbell knocks on the door for a postnatal check-up with Cambridge mum Tori Veysey and three-week-old Cruz. It is her third visit with the pair; she will see them weekly after birth for six weeks.
‘‘And how’s Cruz’s tongue?’’ she asks Veysey, who is breastfeeding as they sit comfortably on the couch. ‘‘He’s latching OK, now?’’
‘‘It was Christina who picked up on it in the first week that it was a problem,’’ Veysey says. ‘‘I don’t know if I would have been able to breastfeed if she hadn’t seen that.’’
Campbell tries to keep to the recommended caseload of four women a month, which should equal around one birth a week, a day of antenatal appointments and a couple days of postnatal visits. But it’s never that simple.
She’s hopeful the Government will take urgent action to address the midwife shortage.
‘‘We are specialists in maternity care and we are really undervalued for the community resource that we are. We deserve better – but women and babies deserve better.’’
For his part, new Health Minister David Clark blames the previous Government for leaving midwifery in a mess.
He is managing down expectations, saying the Government won’t be able to do everything in one budget. The midwives crisis will take time to fix, he says.
But there are fresh faces and perhaps a new broom up the road at the Ministry of Health after the sudden departure of beleaguered director-general Chai Chuah, who oversaw costly blunders by officials, including the miscalculation of $38 million in Budget funding to DHBs.
Midwives are among those hoping for change. Guilliland feels officials failed to adequately advise ministers on the midwives pay and conditions partnership.
After her meeting with acting director-general Stephen McKernan this week, she is feeling confident, for the first time, about progress on the co-design model.
‘‘I’m not saying we’re going to get pay equity overnight – that’s an impossible achievement – but I think we will achieve it in the long term ... I’m now more hopeful than I’ve ever been.’’
Just a week before Olivia’s birth, Jess O’Sullivan had to make the long trip out from Dingle Burn Station on foot, because storms and slips had closed the road around the precipitous bluff.
Since the birth, things haven’t been much better. O’Sullivan spent four nights recovering at the birthing unit in Alexandra before returning home. The level of support has been entirely unsatisfactory, she says.
Back on Dingle Burn Station, there’s a farm to manage, sheep to run, a little baby girl to care for.
Aside from an on-call midwife staying one night with her at Dingle Burn Station, Jess and Olivia have been making a fourhour return trip to Wanaka once or twice a week to see the midwife.
You see, no-one comes here to Dingle Burn. Not midwives, not lactation consultants, not Plunket. They don’t have the resources, and they can’t afford to put other mothers at risk by going out of cellphone range.
Jess knows some will say the lack of support is the price she pays for choosing to live so remotely. But she argues her baby daughter is entitled to healthcare just like any other child.
Jess holds Olivia, now four weeks old and wrapped in a pink-striped baby blanket to protect her from the mountain chill. She strokes the little girl’s back.
‘‘Jess had complications which Morgan was able to fix on the side of the road, basically saving Jess’s life,’’ Joe says. ‘‘We’re very grateful for the dedication of our midwives.’’
And the experience of having their first baby on the gravel goat track?
‘‘It was definitely characterbuilding,’’ says Joe, with understatement.