Changes to the maternity system!!

Are any of you aware the changes the current minister of Health has planned for the maternity system and midwives?

As a bit of a background just over 20 years ago the women of New Zealand fought for the maternity system we have now. Previous to that most women were cared for by doctors and midwives would look after them in the hospital and change each shift. Now we have the continuity of care model which is looked on highly by the world of midwifery as the best care model for women. New Zealand is often used as an example of how to do things!

Unfortunately in New Zealand it is not viewed as highly and one of the changes the minister of health wants is for new graduate midwives to work a year on a secondary/tertiary unit (secondary or tertiary are the hospitals that offer caesarean sections) before being 'allowed' to work as an LMC in the community.

The thought of new grads working in a hospital probable doesn't seem like such a bad idea so I'll point out the flaws in this plan:
-The hospitals are not set up to deal with that many new members of staff. So where will these new grads go then? We already have a shortage of midwives and the fact that the midwife population has an older average age meaning we need newly qualified midwives to stay in New Zealand! As well as the fact hospital midwives are paid quite poorly compared to other countries. Anyone that has had to ring around several LMCs before they could find one who would take them can understand why we need more LMCS!
-We know working in a secondary/tertiary gives midwives a hugely skewed view of 'normal' birth as a lot of what they see are complex situations. Hospital staff have very little to do with normal births, they might be in the room for 10 minutes and then leave. Therefore once these midwives become LMCs they are more likely to use interventions. As it is intervention is widely overused in all countries not just New Zealand without any decrease in the maternal or neonatal mortality rate.
-There are huge shortages of midwives in rural areas of New Zealand, the urban centres have just about come right with midwife numbers. The new midwifery programme was set up so students could do the course in their rural areas and then be able to stay and work there. This new 'plan' means students will have to leave once they are qualified doing nothing for the shortage in rural areas.
-New graduate midwives are safe practitioners! The outcomes for new grads was recently looked into and there was no difference for livebirths, stillbirths, babies born with abnormalities and babies that died within a month of birth with a new graduate as an LMC or a more experienced midwife as an LMC. On average it will take a midwfe 13 years of practice before getting a HDC complaint, the rate of complaints against new grads is about 0.02% despite the fact that new grads have an overall higher risk caseload than more experienced midwives.
-New graduate midwives have the option of joining a programme called the first year of practice programme which joins them up to an experienced midwife as a mentor . Most new grads take this up and the ones that don't are usually either working in the hospital or delaying starting practice.
-What is the reasoning behind this decision? It can't be due to lack of skills of new grads. There is no research to show new graduate midwives are anything less than as competent as their more experienced colleages. As well as the fact that midwifery students are now taking part in a longer degree since these studies have been done. The hours have increased from 3600 to 4800 which is the equivalent hours as a four year degree. The final year has 33 weeks of practical and is essentially an apprenticeship type year.

So how does this affect you?
Firstly it will not affect hospital services at all if it doesn't go through.
This will change the way midwives will practice in years to come. It will affect the numbers of LMCs available, it will affect intervention rates. As well as the cost of such a programme! We need midwives who specialise in normal birth. We have plenty of midwives and doctors who specialise in complications and they do an awesome job! Midwives are there to protect normal birth and identify when the situation is becoming abnormal. This involves being able to support women through childbirth without using unnecesary intervention. Basically the women of New Zealand deserve midwives who trust them to birth their babies, this may be lost with the proposed changes!

What can you do?
Ideally vote out national but honestly that seems quite unlikely so talk to your local MP about what their plans are, talk to the media on how we do not want these changes to go ahead. Talk to each other about how this is not okay. Birth has been 'taken' by medicine before and we had to fight hard to get it back. Talk to your mothers and grandmothers on what it was like to give birth then. We cannot sit back and watch as choices get taken away.

Anyway thanks for reading my novel I will leave it with a quote...
"Before birth belonged to medicine it belonged to women"

Edited by RachandJack

Completely unaware! thanks for informing us Rach

I hope they dont change the current model in NZ. Im in Aus and use the 'Shared Care' option, so most care with my GP and 5 milestone appts with the Obs and/or MW's at the Hospital. Technically no LMC.

If in between normal visits I need to see someone in relation to my health or baby's health, I can choose to pay to see my Dr (who will refer me to the hospital anyways cos he doesnt have the facilities or knowledge) or go to the Hospital and wait to see a MW I'd never met before.

I spent Saturday and most of Sunday at the hospital and although the care was great from the MW's, I waited forever. I checked in at 1.30pm with a leakage complaint (turned out to have blood and protein in pee), saw a MW at 3.30pm and didnt see a Dr until 11pm Saturday night, before deciding it was best to keep me in. 9.5 hours after first arriving at the Maternity Ward! Sunday morning was a bit better. Had scan done to check baby and my Kidneys at 9.45am and saw a Dr at 1pm who then wanted me to stay but agreed to let me go.

Anyways before I digress, I dont know if I had of been in NZ if I'd have gone through the same hideous process but my god, I'd hate for NZ to adopt a model like this one.

I am all for having ONE LMC, I cant wait to get back to NZ in 4 weeks so I have that consistent care.

SophieD wrote: I know nothing about midwife training (I'm hopelessly naive when it comes to any medical profession,lol) but it actually amazes me that midwives don't currently have a prescribed ongoing training program for their first few years practicing. As a teacher, I had a 2 year provisional period before becoming a fully qualified teacher and most professions I know about (granted that is by no means all of them lol) have some kind of required training during your first few years.

Yea, I totally know what you mean here! It would make me a bit nervous having a new MW, even though I know they do lots of work with experienced MWs while training. I think about how much I stuffed up in my job in the first few years and how much more confident I am now...

In saying that, I also agree that perhaps churning out MWs with hospital backgrounds isn't ideal. I do like the idea that in theory, they'd be experienced in things that can go wrong, and that suits me. On the other hand, like the OP said, birth's a natural process and I'd say you'd get to see more intervention at the hospitals, and we might end up with a lot of MWs tending to recommend it because that's what they're familiar with.

Edited by Hopes

My friend is a training MW, in her second year, and the amount of hospital shifts she is doing surprised me.

They are doing their training in a hospital environment as well as having to train under an independent mw as well as completing all their course work and assignments/exams. I hardly see her because she's always studying or working.

Their studying year is far longer than a normal student, they definitely don't get the weeks off that other students do.

Making the mentor program compulsory sounds like a much better idea then making everyone start in a hospital at least then they could practice in an environment that suits them.

In saying that, I don't believe 1 year in a hospital environment would fundamentally change a persons beliefs about intervention, if anything it would probably reinforce them. I also believe woman can have completely in control natural experiences in a hospital environment, we are much more educated these days and aware of what we are entitled to iykwim, so an inexperienced mw would still get the benefit of lots of different experiences.

SophieD wrote: linda wrote: Not about to vote out National and I'm a kind of hospital with intervention type person when it comes to me having children so I guess in a way I don't mind the new measures I'm the same really so I guess it doesnt really bother me. I know nothing about midwife training (I'm hopelessly naive when it comes to any medical profession,lol) but it actually amazes me that midwives don't currently have a prescribed ongoing training program for their first few years practicing. As a teacher, I had a 2 year provisional period before becoming a fully qualified teacher and most professions I know about (granted that is by no means all of them lol) have some kind of required training during your first few years. Can understand that HAVING to work in a hospital environment would not suit everyone though and might be difficult to implement given what you say about hospitals taking first years.

Just wondering what will happen when your children want to have children and there are limited or no LMC's left to care for them? What if they dont want hospital intervention type care?

Well said Anna, I do think that the Midwifery system needs changing. There are babies dying that don't need to, and I do realise they are the exception not the rule, but MW's need to be more controlled and accountable just like (as previously said) Teachers, nurse, doctors are.
The way RachandJack has said that they are planning to change is not feasible because you will then end up with the situation where there are only new graduate MW's in the hospital and thats not safe, but I do think having some hospital experience is important because its good to know what normal and abnormal looks like and in a hospital where many births are happening each day you are going to see that much more than 3-4 births a month on a normal caseload.

The point I'm trying to get across is not that there isn't a place for hospital midwives but that there is a choice for every woman to be able to choose a midwife that suits her philosophy. As I have said the course is the equivalent hours of four years, add on the mentorship year and that is 5 years. I would personally quite like the mentorship programme be compulsory and I think it will probably be that way in the next few years.

As I have said previously midwives going before the health and disability commissioner are very rarely new graduates. There are plenty of doctors/nurses/any health practitioner that go before the HDC the media just likes to make us believe it is mainly midwives. Look at the statistics!

Anna - The new programme does offer training in Invercargill, that is what I was meaning. The 'satellite' groups that are based in smaller areas are the ones that want to stay. Like anything you cannot guarantee students will stay but it's aimed so that more will. In my original post I said hospital midwives are valued greatly and have always been, its the fact that is was a different midwife at each shift that wasn't so great. 17 year olds can get into the course but who is to say they will, anyone under 20 got extensively interviewed, midwifery doesn't have a huge amount of places and you would be surprised at the amount of life experience some 18 years olds have compared to the lack some 40 years old have. Lastly I have done many shifts in nursing areas and can honestly say I find midwives attitudes a lot better than some nurses but who can really say given that I haven't met every nurse and you haven't met every midwife.

Anyway the main point I wanted to get across was it is all about choice. If you want a high intervention birth that will still be available but in twenty years will there still be the same option for women wanting a no intervention birth?

I'm quite interested to hear what people think the 'ideal' maternity system would be then? Because if you don't want continuity of care it will go back to different midwives doing visits, shifts changing during labour and a doctor walking in to catch the baby? Because if you want that you can easily go through the hospital system anyway or pay for a private OB. GPs chose to stop doing obstetrics, they can still do it easily but they don't want to. Lastly has anyone ever watched '16 and pregnant' or 'maternity ward'? That is the opposite of our system and funnily enough with all those doctors and intervention their outcomes are worse than ours! Holland has a high home birth rate and have some of the best outcomes in the world...

Yes some 18 year olds do have a lot of life experience and generally can be more open to new ideas and education than older people. But a lot don’t.
Not all GPs chose to stop obstetrics, when the system changed it made it harder for them to practice mostly due to funding changes so ok yes ultimately they did make the choice to stop that part of their practice, it was not made "freely”. They were pushed out.
I have watched 16 and pregnant, and in my opinion part of the reason for the high intervention rate is because the 16 year old body is not ready to have babies! At 16 girls most girls are not finished puberty so while it is possible for them to get pregnant doesn’t mean that they should.
No I have not met every midwife, and yes there are probably midwives, who give the job everything and then some, but to come across these ones who were LMC’s I would hate to think what they were like outside the hospital environment. But they may not have been hospital people.
The satellite programmes allow you to do your theory papers online, but all practical papers or assessments need to be completed at the base school and are number dependant. But the same could be said for any programme.
How can using your GP not be continuity of care??? Again using myself as an example I have been with the same GP practice since birth (by a GP) it is also the same practice my parents are with, so effectively my GP has a complete health history not only for me but also for my parents. The shift change is going to happen no matter what system is used and the different person each time is tried to be minimised as the staff member should have the same patients for the duration of their work week where possible.