‘STOCKTAKE’ ordered on support for new mums
Midwife shortages, lack of hospital space, ‘shameful’ mental health support and deaths — what’s going wrong with our maternity services? Amy Wiggins asked Associate Health Minister Ayesha Verrall
Areview of overstretched maternal mental health services has been ordered by the Government — three years after experts recommended it. Mums have been speaking out for years about the difficulty of getting any publicly funded support through swamped health board maternal mental health services.
In March, health experts, advocates and mothers descended on Parliament to speak about what they described as “shameful” maternity practices which left new mums struggling to get support.
Every year at least 10 women are lost to maternal suicide in New Zealand, one in seven new mums suffer postnatal depression after giving birth and the reported rate of maternal suicide is five times higher per capita than that of Britain.
Associate Health Minister Ayesha Verrall told the Weekend Herald she had asked the Ministry of Health for a “stocktake” of services to enable recommendations for improvements to be made.
The Perinatal and Maternal Mortality Review Committee called for just that in 2018 but nothing has been done until now. Verrall said she was also working on further recommendations by the committee.
The Weekend Herald, which has this year reported on a string of incidents and problems in the maternity sector, put a series of questions to Verrall about what is being done to solve those issues.
As well as maternal mental health, the problems include seemingly avoidable deaths of mothers and babies, severe midwife shortages and a lack of space in maternity and children’s wards.
Asked whether the care provided to Kiwi mothers was good enough, Verrall conceded there was work to be done
“New Zealand’s health system delivers quality services to most people, but some women face barriers to accessing services.”
“We must ensure maternity services and care better meet the needs of women and wha¯nau, and achieve equitable outcomes for women, pêpi and whãnau.”
As for what is being done, she trumpeted the $242 million set aside for primary maternity services in the 2020 Budget — the largest-ever funding boost for the sector, she said.
From that, $180m had already been spent on an “a suite of initiatives” stemming from the Government’s Maternity Action Plan to increase funding to some areas and improve safety programmes.
As well as the stocktake of maternal mental health services provided by DHBs, Verrall said she was working on a “bereavement pathway” to help families cope with the loss of a baby.
Midwives ‘fed up’
Verrall pinpointed the shortage of midwives as the most pressing issue for the sector.
“The maternity sector is facing widespread and well-known workforce challenges. While demand for midwifery services is increasing, there are challenges in recruiting and retaining maternity staff.”
But while the Government figures out how to do that, many midwives who are disillusioned by the poor pay are already leaving, according to their union.
“Everyone is fed up. Many are moving to Australia but not all, some are leaving the profession altogether,” said Jill Ovens, coleader of the Midwifery Employee Representation and Advisory Service, which represents district health board-employed midwives.
The big problem was lack of recognition, which was reflected in pay, Ovens said.
In New Zealand, a graduate starts on about $54,700 compared with $64,000 (A$60,000) in Australia.
Meg Williams, a Kiwi who works as a midwife in Australia, set up a Facebook page five years ago for midwives seeking contract work in Australia, to help connect them with employers.
Before this year’s Budget, Williams said she was contacted by one or two Kiwi midwives a week — but in April she became inundated with requests.
In a 24-hour period, she received more than a hundred requests from New Zealand midwives wanting to join the page.
“It was really phenomenal . . . it’s so unprecedented to get that many inquiries.”
Closer to home, Wellington midwives said they were working themselves to physical and emotional exhaustion because if they didn’t, mothers and babies could die.
In February Capital and Coast DHB confirmed that of its roughly 60 full-time midwifery staff, 17 positions were vacant and no one had applied for eight new graduate positions funded for the region.
The staffing shortage meant the maternity service had gone into “code black” — meaning it could not look after any more women — a number of times earlier this year.
Elsewhere, staff shortages in the central North Island meant Taupo¯ Hospital’s birthing unit had to close overnight for a week during June, forcing mothers who had just given birth to go home or drive to Rotorua Hospital.
But Verrall said the Government was committed to rolling out changes to retain and grow the workforce.
Last month she announced changes to how community midwives are paid with an update to the Primary Maternity Services
Notice allowing the allocated $21.25m to be used.
The changes would better fund care for women and wha¯nau in rural areas, and those with complex clinical or social needs, she said. It will see midwives paid from the commencement of care, for travel, care associated with pregnancy loss and missed birth fees for rural areas.
“How this will impact each midwife’s pay will vary depending on their caseload, and the circumstances of each woman they care for,” Verrall said.
“As an example, a rural midwife may receive more than $1500 additional funding per woman, and an urban midwife may receive more than $800 additional funding per woman.”
This week, Verrall also announced $5m to provide clinical coaches at each DHB to support graduate midwives, those returning to the workforce and others who felt they needed support.
The Government was also offering financial support for up to 60 midwives a year to complete the “return to practice” programme in the hope of encouraging some to rejoin the workforce.
And in March, Te Ara õ Hine was launched to provide pastoral and financial support to Maori and Pacific midwifery students.
“This initiative aims to reduce attrition rates, and increase the number of Mãori and Pasifika midwives providing care to their communities,” Verrall said.
Maternal, baby deaths
The safety of women and their babies has also been called into question this year but Verrall says that too is being addressed by funding in last year’s Budget.
In March, the Weekend Herald revealed Auckland DHB blamed lack of access to care and increasing capacity pressure for the deaths of four women during or shortly after birth last year — up from one death in the previous three years.
None of the women was Pãkehã, and an internal report linked their deaths to wider concerns about some mothers and babies — particularly Mãori and Pacific, along with some Asian groups — not getting the care they need amid increasing capacity pressure.
In one case a woman who was 21 weeks pregnant lost her baby due to a premature rupture of membranes and, after a C-section, developed a blood infection which ultimately claimed her life.
Emerald Tai and her 3-day-old son were also among the deaths. The mother of seven died from sepsis from a post-birth infection. The baby also had sepsis but “unsafe sleeping” contributed to his death. The DHB found a number of failures contributed to Tai’s death.
Since then, work to overhaul the maternity service had begun.
This year the Herald has told the stories of Nilakshani Silva, who died after undergoing an emergency C-section in an ambulance; Laura Mallin and Bruno Rovani Neves, who lost their unborn son at 37 weeks gestation due to a series of failures including a shortage of beds at North Shore Hospital; and Limna Polly, whose baby was dropped when she gave birth in hospital at 22 weeks pregnant.
In recent weeks the Health and Disability Commissioner has also criticised the care given to a woman whose baby died after a difficult pregnancy and the failure of a midwife to read ultrasounds, so a couple had to make the decision to terminate later than usual.
Verrall said an extra $2.2m was given to the Maternity Quality and Safety Programme to help DHBs support a full-time MQSP coordinator to facilitate initiatives that would improve quality and safety, improve access, remove barriers, and develop kaupapa Mãori services.
Full to the brim
Overflowing hospitals grab headlines every winter but not only emergency departments struggle to cope. Neonatal and paediatric intensive care and maternity wards are often under pressure too.
An Auckland DHB report in March said its neonatal intensive care unit had been “extremely busy” for two or three months and Starship surgical health director Dr John Beca admitted mothers with high-risk pregnancies were at times transferred out of Auckland to give birth because of the bed shortage.
Beca said occupancy in the hospital’s intensive care and paediatric intensive care units was at a critical level every second day so Starship was planning a $40m expansion.
Middlemore’s neonatal unit had regularly been caring for about 10 per cent more babies than its maximum this year and had been given $5m for an upgrade.
The same is true in Christchurch where the neonatal intensive care unit had been averaging 50 babies between January and April despite having only 44 cots. Mothers with high-risk pregnancies at times also had to be moved to other hospitals.
Verrall and Health Minister Andrew Little both deferred questions about these problems to the Ministry of Health, which said it was an operational matter for individual district health boards.
“District health boards have the responsibility for meeting the needs of their communities,” a ministry spokeswoman said.
“There are a number of projects in place considering new maternity facilities, both in primary and secondary care, that will increase the number of postnatal beds that are available.”
We must ensure maternity services and care better meet the needs of women and whãnau