Did you know?

 

 

Facts about our maternity system

 

Baby deaths:

New Zealand has about 600 babies who die each year at or around the time of birth.  This gives a rate of baby deaths which has been fairly consistent for about the last 10 years.  Prior to that New Zealand had a steadily falling baby death rate for many decades.  All other developed countries have continued with a steadily declining baby death rate over the years our rate has stalled. 

Poor investigation:

Only around a third of these baby deaths each year are being 'optimally investigated' according to the PMMRC (the Perinatal and Maternal Mortality Review see www.pmmrc.org.nz).  Families are not interviewed in any part of the process.

Deaths of mothers:

Professor Cynthia Farquhar has stated that the maternal death rate for 2007, one of the most recent years for which the rate is available, is at a similar level for the early 1990s.  However, all other developed countries have had a steadily declining death rate for their pregnant and new mothers over this time.

Trends in care not known:

Key data containing important details from all births has never been collected during all the years of the New Zealand maternity reforms and is still not being collected.  Women and health providers both lack important information because of this.

Trends in outcomes not known:

The full extent of long term and serious injuries to mother or child through avoidable birth problems has never been collated.

Women's opinion ignored:

There was no extensive surveying of women's opinion about maternity services prior to the series of major reforms which started in 1990.  With later changes, the wishes of large groups of women were ignored when these wishes did not coincide with the ideology of the policy-makers.

Falsely positive survey results:

Parents of babies who have died have been excluded from each of the three Health Ministry Consumer satisfaction surveys in 1999, 2002 and 2007, yet the public has never been informed that the survey results have excluded large groups with some of the worst outcomes.

No independent analysis:

An independent review of the maternity services has never yet been permitted although it is 20 years since these major reforms began.  This is despite repeated coroners' calls for such a review.

Loss of choice:

Midwives are now the only choice available to most New Zealand women in the free (publicly funded) maternity service.  There are currently only approximately thirty practicing GP obstetricians left in this country.  Looking back, by contrast in 1992 there were 60 GP obstetricians working in Auckland's North Shore alone and in the mid 1990's, a city the size of Hamilton had 35 GP obstetricians.

Access problems:

Up to one-third of women in some cities and regions cannot easily find a midwife to care for them according to Health Ministry figures.

Midwife training:

Midwives are now classed as fully qualified after four years of study across three calendar years and having attended 40 births (this may include Caesarean Section births where midwives do not carry the responsibility).  There is still no mandatory mentoring or supervision of all cases during the first years in independent practice.

College membership:

Not all independent/caseload midwives are members of the New Zealand College of Midwives.

Recommended maximum caseload:

The New Zealand College of Midwives recommends a safe maximum of 50 women per year for an independent/caseload midwife to care for.  This is a recommended upper limit not a mandatory upper limit.

Caesarean Section births rising:

The rate of Caesarean Section births has doubled since the late 1980's.

Homebirths:

The most recently available published figures from the Ministry of Health show that just 1.9% of women gave birth at home that year.

No obstetric flying squad:

Birthing centres and home births do not offer specialist backup cover beyond that of the midwife herself.  Complications in these cases require ambulance transport to where a doctor is available.

Home too soon:

More than one woman in eight was forced to leave hospital before she felt ready, according to the most recent maternity consumer satisfaction survey.  Some hospitals such as National Women's in Auckland and Christchurch Women's have a policy of early discharge within hours of birth, regardless of the time of day or the weather conditions.  No one in New Zealand has carried out a large enough study to check on the impact of these practices on the health of mother and baby, including breastfeeding rates.  Many professional groups have expressed concern over the early discharge policies.

(see http://www.moh.govt.nz/moh.nsf/pagesmh/7699/$File/maternity-services-consumer-survey-report-2007.pdf)

Under-servicing:

More than one woman in four does not receive her minimum entitlement of postnatal home visits according to Health Ministry figures.

Breastfeeding problems:

Breastfeeding rates have fallen since the reforms began in 1990.

Bonuses to midwives not to mothers:

Lead Maternity Carers (LMCs) receive a bonus of $440 for each home birth and a bonus of $250 for each birthing unit birth.  Midwife LMCs receive a bonus of $60 if a woman in their care goes home directly from the hospital wards.  Doctor LMCs are paid $30 for this event (see http://www.moh.govt.nz/moh.nsf/pagesmh/5845/$File/s88-primary-maternity-services-notice-gazetted-2007.pdf).

Unequal funding:

A midwife earns $1,090.00 for care of a first time mother through a labour and birth.  A doctor earns less than half of this, just $470.00.

Postnatal care barrier:

Doctors are barred by law from providing routine free (taxpayer funded) postnatal care, even if that is a woman's preferred choice.  If a woman chooses this option she must pay for the consultation.

Incentives:

Many of the birthing centers in New Zealand offer a cash incentive/bonus scheme to midwives if they ensure that at least 50% of their clients birth there (see http://www.hdc.org.nz/files/hdc/opinions/05hdc01760midwife.pdf page 73).

Piecemeal reviews:

Midwives are reviewed annually based in part on their Consumer Feedback Forms received by the College of Midwives.  It is currently only the responsibility of each independent midwife to present a Consumer Feedback Form to each of their clients.  There is no system in place to ensure this occurs.

Suspensions:

In the past 19 years of Independent Midwifery, only one midwife has been removed from the register of midwives although a small number have been suspended, as detailed on the NZ College of Midwives website.

Skill level checks missing:

The Health Practitioners Compliance Act (HPCA) ensures that all health practitioners attend certain refresher courses pertinent to their field at varying time frames.  However there is currently no system for ensuring those skills are practiced and that basic practice standards are met at every birth unless actions give rise to a complaint.

Lack of consumer information:

There is currently no way that a consumer can discover if any health practitioner has past complaints or breaches, apart from the consumer asking the practitioner themselves.  Restricted scopes of practice or current supervision requirements are detailed on the relevant council websites.