Thursday, November 29, 2007

Midwife shortage in Wellington, New Zealand

Apparently, there is such a midwife shortage in Wellington that women are being 'bribed' to go home straight after birth.

In some ways, that's not such a bad idea. Post natal wards are notorious for providing conflicting advice to new mothers, especially about breastfeeding. And there's the risk of infection, lack of privacy and inconvenience of being away from home and family, which is accentuated if home is some distance away from the birthing facility.

In New Zealand, we have a post natal follow up system of at least five midwifery home visits, up to six weeks post partum - this is set out in the Section 88 Maternity Notice 2007 which is the document that prescribes what services lead maternity carers/midwives must provide . Many midwives carry out far more than five visits.

As a practicing midwife, I am very keen to get women home as soon as possible because I believe it is easier for them to bond with their babies at home. This can require a significant commitment from me, especially if the woman is having breastfeeding problems and needs me to provide frequent home visits to support her feeding.

But in the end the choice must be the woman's. If she has little or no back up at home, or if she has had a difficult birth, she may be better off staying in hospital for a few days. A $100 food voucher is a poor exchange for a woman who is unable to breastfeed due to lack of midwifery support. What do you think - should there be a minimum stay in hospital following the birth of a baby?

Suffice to say, the underpinning problem of the shortage of midwives is concerning. I am convinced that one way to go is to offer free undergraduate education to women to encourage them to become midwives. What would encourage you to become a midwife? If you are a midwife, what do you see as the problems that threaten retention?

Reference: Chapter 45. Mother and Baby: A guide to effective in pregnancy and childbirth. 2000. Murray Enkin, Marc J.N.C. Keirse, James Neilson, Caroline Crowther, Lelia Duley, Ellen Hodnett and Justus Hofmeyr. Oxford University Press.

Image: 'Wie ben jij?'


Hannahjade said...

Hi Sarah,
I plan to start my midwifery degree in the future (maybe 2-4 years). Free education would definately be great! But Im not sure if it would actually encourage women to become midwives. I dont think someone could be a midwife if their heart wasnt in it. Maybe there could be some incentive for RNs to become midwives. Maybe there needs to be more exposure to professions experencing shortages during highschool. And regarding the minimum stay.. I think there should be a minimum entitlement, but no a compulsory minimum stay.

Sarah Stewart said...

Thank you very much for your comments - all of which are very valid.

Doing more work and mentoring with high school students is a great idea but... we also need to know why we cannot recruit young people into health...something to do with the lifestyle of a midwife is no doubt a big factor. Then we need to deal with that in away that will then attract these young people.

I do not know if people see health professions as a vocation like they used to. Apparently, people are likely to have at least 6 careers in their life time. So I believe we need to consider this when we do our recruitment drives and market midwifery in a way that appeals to young people who have that mentality rather than the "become a midwife so you can do good" banner.

A complex situation that is only going to get worse, in all health professions.

Meanwhile, back at the ranch...Wellington hospital have back tracked and are no longer offering the $100 vouchur!

PS: good luck with your own plans to become a midwife!

Dot said...

With my usual enthusiasm for sticking my small oar I said in my blog post, I was glad to be in hospital for a couple of days after the birth of my baby; I was offered the opportunity to go home after 24 hours and chose to stay an extra night. I did get some rather conflicting advice but not seriously so. The main thing was that I felt that there was always someone knowledgeable, kind and competent available, day and night, to help me with the baby. Despite having a pretty easy time with the birth I was still tired and sore and, more important, desperately inexperienced. I'd never so much as changed a nappy or given a baby a bath before and I was grateful for the crash course I got from the hospital nurses. I wouldn't have wanted to go home straight away unless there had been someone in my home who was completely confident about looking after a baby, someone who wasn't just visiting from time to time but was there constantly for the first couple of days. But not everyone is so inexperienced and nervous as I was. In the public ward there was a woman in the next bed who'd just given birth to her second baby and wanted to go home immediately. I listened as a procession of nurses and doctors came to bully and cajole her to stay in until the following day. One kindly nurse was trying to get her transferred to the Domino scheme so the Domino midwives could visit her at home, but it turned out she lived too far away for this. She eventually gave in when the pediatrician told her they wouldn't discharge the baby before 24 hours because they needed to make sure there was nothing wrong with its heart. It was a bit of a depressing episode (and one wonders how the woman felt that all this argument was going on in earshot of nosy people like me...)

I suppose my view is that one should have the option of a longer stay, but I was uncomfortable at the way my ward neighbour was bullied into staying.

Sarah Stewart said...

Thanks for finding the time to pop by, Dot. I guess that new baby of yours will be keeping you busy.

Again, you have illustrated the point really well that women should have choice and be able to do what suits them best. On a number of occasions I have recommended a longer hospital stay to women to help them sort out their home situations. I also vividly remember a committed home birth woman who also home schooled her children. She insisted on a hospital birth much to my surprise, so she could stay in afterwards and have a rest away from the other children.

But as you say, there is no evidence to support longer hospital stays as beneficial for women if they have good support at home. The other thing that can be quite upsetting for women is that their partners cannot stay the night with them in the hospital.

Dawne Sharplin said...

Hi Sarah
It was interesting to read all the viewpoints against the "bribe" offered by Wellington Hospital. All viewpoints made some very valid points and all were convincing. However I can't help thinking that it was all wrong. Wellington birthing unit is still understaffed even after all that rhetoric. No -one has made suggestions about how to correct that and the problem still remains. I think it was a shame they removed the money as some women could have used the $100 over xmas. If the unit is understaffed they were not going to get good care anyway. Lets change the debate to - how to keep midwives in New Zealand, both in the hospitals and the community. Just out of interest in Rotorua we have lost 5 midwives to Australia in the past year. This is what the debate should be about.

Sarah Stewart said...

I agree 100%, Dawne. This is beginning to become a theme in this blog. And of course, midwives go to Australia because there is a better standard of living. As to how they get on in their jobs, well, that is another matter.

Anonymous said...

Hi Sarah?
I am a Registered Nurse who is keen to bridge over to midwifery. What concerns me though, is despite the shortage of qualified midwife's, almost all the midwifery schools throughout the country don't offer a shortened midwifery course to registered nurses any longer (except Otago Polytechnic). And if I understand correctly, Otago Polytechnic plans to abolish that option in 2009, meaning that anyone interested in midwifery from 2009 has to start the three-year course from scratch. I can't speak for other RN's but doing three years extra on top of the three years it takes to become qualified as a RN to become a midwife is not attractive prospect. It wouldn't entice me.

Sarah Stewart said...

Hello anonymous

I cannot comment on the plans of Otago Polytechnic but I would suggest that it would be up to each nurse to get in touch and have a chat with the head of school to see how much of her knowledge and experience could be credited toward the course.

The following comment is my own opinion and not necessarily that of Otago Polytechnic. I do take your point. I am a nurse and midwife and I am not sure I would want to spend 6 years getting to the point I am now. I absolutely see where you are coming from especially if you want to do midwifery as an 'extra string to my bow' for doing things like working in developing countries but don't want to be a midwife per se. But I think you have to remember that midwifery is a separate profession to nursing. You have to look at it in terms of, say, deciding to be a teacher and having to go off and do a teaching degree. Having worked with a number of nurses in the midwifery setting, I have observed that it is a great pressure to catch up so I think it will be 'easier' to space things over 3 years. Plus, Midwifery Council has increased the number of clinical hours and expectations (eg increased number of births from 30 to 40) that a student has to achieve so it would be extremely difficult to do all this clinical as well as theory in 2 years.

I can only reiterate the importance of having talks and negotiations with the midwifery schools to find out exactly is involved.

Anonymous said...

hi Sarah, i am a midwife from the UK in process of moving to NZ with my husband and 2 children. I received free education to retrain to be a midwife which enabled me to follow my dream of doing this. I don't think i could have done it otherwise, so i think this is a very important aspect of recruiting people into the profession. Retention is another matter alltogether- I have to be honest and say that in my heart i long to be a midwife, and come from a long line of midwives (3 plus generations), but i started my training before having my children and the stress of shifts, on-calls, and the lack of support in the job that i've faced over the last few years of training and as a midwife leave a feeling of dread most days i have walked onto delivery floor. The lack of value, particularly the salary for the level of responsibility and skills required to do a great job, is really demoralising, and i do find myself wondering if all the stress, coupled with poor pay is worth the juggling of my children- or should i just get a steady "job" so i can focus my energies on my kids more. I think that better pay, on-site children's facilities, supportive staff meetings and mentoring support for newly qualifieds would go a long way in helping me develop as a midwife. Of course the short-staffing levels compound the stress, as having to look after up to 3 labouring women at once, as i have to often do here, does not make me want to stay in the job for long! And to be honest, aside from my own stress, the real sadness lies in not being able to give women the care they deserve. Women and children need to be valued more by society. where do we start? I will stop my rant, but i will say thanks for your blog.
Kind Regards, Paula Sunshine

Sarah Stewart said...

Hi Paula, great to hear from you - good luck with your move to New Zealand.

I think you have summed up a lot of the angst that midwives feel about their jobs and I love the strategies that you have suggested would help. I would add that mentoring support should be given to everyone, not just new grads. Having said that, none of these ideas are new so I am not sure why they haven't been put in place by managers, or if they have, why they don't work, or do they?

I believe we must claim our own work places and try to be a lot supportive of each other on a day to day basis.