Midwife shortage puts mums and bubs at risk

By Meg Waghorn

Meg Waghorn is a primary school teacher and mother of two who lives and works in the Hutt Valley. She is the secretary for Lower Hutt Parents Centre and cares deeply about the birth and parenting experiences of women.

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Following damning reports and repeated calls to prioritise the safety of newborns and mothers, maternity services at Hutt Hospital are to receive an upgrade.

However, none of the government allocated $9.4 million will address staff shortages.

Meg Waghorn describes the midwife crisis affecting the Wellington region, and calls on the government and DHB to step up and fix it.

A few days after I returned home from hospital with my second baby, an external review of Women’s Health Services at Hutt Hospital, where he was born, was released. It had found major safety concerns in the Hutt Hospital maternity unit. Reading the report fresh from my own pregnancy and birth experience was stomach-churning.

I was already aware I had been lucky to have had a community midwife to act as my lead maternity carer in pregnancy and the postnatal period. The attentive and highly-skilled care I received from community midwives during my pregnancies was hugely important to my physical and mental wellbeing, and undoubtedly helped me to birth and parent the way I wanted to. But with community midwife numbers down to around 20 in the Hutt Valley from over 30 two years ago, I’m worried that midwifery care as I experienced it will become a rare privilege for women in our region.

The shortage of community midwives also affects our hospital maternity wards. More women need hospital midwives to provide their care during pregnancy, and fewer women arrive at hospital in labour with a community midwife to lead their care. As our hospitals also face their own staff shortages – both Hutt Valley and Capital and Coast DHBs have multiple maternity care vacancies – this is extra pressure the hospitals do not need. Hutt and Wellington maternity units have both had “Code Reds” over the past year, when they are so full they cannot safely take any more admissions. Despite this, the Hutt DHB has so far refused to allow any of the funding allocated for birthing women in the Hutt to go to the Te Awakairangi Birthing Centre, which has made the survival of the centre uncertain. 

After reading the report of the external review, I wrote to the DHB, local MPs, and the Associate Minister of Health to express my concerns. I started to receive stories from local women who felt their pregnancy and birth experiences had been adversely affected by the under-resourcing of maternity care in the Hutt. In their accounts women wrote of feeling abandoned on understaffed wards, of essential appointments changed at late notice, and of being scared by the obvious fatigue and stress of hospital staff. They spoke of rundown facilities and a clear lack of basic equipment. Some linked diagnoses of postnatal depression directly to their hospital experiences.

At a public meeting in Lower Hutt in November 2019, tearful midwives echoed these concerns. They spoke of the extreme stress they felt turning up to dangerously understaffed shifts, and frustration accessing vital equipment. The community is deeply concerned about the current state and future of our local service, and women and midwives are in real distress.

One of the benefits of our current midwifery model, where women build a relationship with their community midwife from early pregnancy, is the formation of an individual birth plan, in which the woman’s preferences and hopes are balanced with the clinical expertise of her midwife. However, this sense of birth as a wholly individual experience can obscure the fact that currently our birth experiences and outcomes are affected by systemic failings and under-resourcing. No woman wants to feel that decisions around birth are being made for any reason other than her own and her baby’s well being. The review of Hutt maternity services pointed to the high rates of caesarean sections and of babies being admitted to the Special Care Baby Unit, and linked both to understaffing.

Every day more and more births are affected by the overstretched staff and facilities in over-stretched hospitals, and every day midwives and others providing maternity care are pushed closer to leaving their profession by the stress and anguish of trying to meet the needs of mums and babies. We simply cannot afford to lose a single midwife, from the community or the hospitals, in the Wellington region. 

The constant response from the government and DHBs has been that this is a national crisis and that staffing shortages take time to fix. The New Zealand College of Midwives has stated there are currently more midwives with an annual practicing certificate than ever before. We do not have a shortage of midwives, we have a shortage of midwives willing to practice under current working conditions. Women, families and midwives cannot change those conditions; only the government and the DHBs have the power to do so.

We need them to act now. 

We need our Wellington region DHBs to prioritise improving work environments for their staff and to respond effectively to their concerns about safety and conditions.

We need to stop government funding specifically allocated for maternity care being diverted by DHBs into other areas. DHBs across the country, and especially in the Wellington region, have shown that they will not prioritise maternity care of their own accord. The Minister of Health needs to seriously consider how maternity funding can be protected.

We need the Ministry of Health to urgently implement a better funding model for community midwives, and complete the pay negotiations that started in 2015.

We need the constant shuffling of responsibility for this crisis between the Ministry of Health and the DHBs to stop.

After five months immersed in the ongoing emergency in maternity care in our region I am exhausted from hearing stories of distress from local women working and birthing in our maternity system. Those who have been working for change in this area for much longer are heart-sore and angry.

Midwives are hanging in there because they care about women, babies, and birth. I’m just not sure how much longer they will be there if the government, the DHBs, and the general public don’t get in behind them, and fast.

We cannot wait any longer.


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