Tuesday, April 22, 2008

Politician slams midwives

You can tell it is election year in New Zealand. The politicians are getting into stride and of course, the health service is always a target for their pontificating.

Midwives are the cause of all evils
Stephen Franks (National party) believes that midwives are responsible for obstetricians and GPs leaving the health service as well as a rise in mortality rates, staff shortages and decrease in breastfeeding rates. I'm surprised he didn't suggest we were also responsible for global warming.

Women's choice
Grant Robertson (Labour) had a far more balanced post on his blog written by a guest, who is the mother of two babies. She pointed out that the current maternity set up came about because women lobbied for more choice and control over their birthing experiences which they believed they would get from midwives. However, the post ends with the complaint that midwives put too much pressure on women to labour without pharmacological pain relief.

The facts
The reality is that GPs and obstetricians were leaving the maternity service before midwives gained parity of autonomy. And the situation in New Zealand is following a global trend, as with the shortages of all health staff. Mortality rates have stayed stable for years and midwifery outcomes are better when there is continuity of care, which is why countries like Australia are looking at midwifery-led care schemes like that in New Zealand. The drop in breastfeeding rates must also be seen in a global context. Women in New Zealand probably get the best post natal care in the world. They are supported by midwives up to six weeks after they have had their babies. In many other developed countries, women get little or no post natal care at all.

No pain, no gain?
As for pressuring women to go without pharmacological pain relief, I feel sure that the majority of midwives encourage choice and informed consent. What worries me about the liberal use of measures such as epidurals is that women are not supported to explore other non-medical alternatives first. Pharmacological pain relief such as pethidine and epidural have side-effects and potential for harm. They can also start a slide into a cascade of intervention that cannot be reversed.

My stance would be that women should have access to all means of preventing pain, including water pools and the opportunity to labour at home with the support of a midwife for as long as they wish before they go to hospital. It is the trend for making epidurals a routine part of care in labour which midwives have grave concerns about.

How much notice do you take of politicians in election year?

Image: 'The beehive' - Parliament, New Zealand


Anonymous said...

Apologies... I'm about to over take the comments section.
This came to my inbox today. Would LOVE to go alas, no car and childcare.


MOVED BY: Mrs. Driedger


WHEREAS the NDP Government has broken its 2007 provincial election promise to enhance midwifery training in Manitoba even though midwives throughout history have been community experts in providing knowledge, skill, guidance and support to women through pregnancy, labour and birth; and

WHEREAS the World Health Organization recognizes midwives internationally as specialists in normal childbirth; and

WHEREAS the Progressive Conservative Government passed The Midwifery Act in 1997 thereby enshrining the right to practice midwifery in Manitoba in law and establishing midwifery as a regulated profession through the creation of the Manitoba College of Midwives; and

WHEREAS the demand for midwives in Manitoba far outstrips the services which the current supply of midwives is able to provide; and

WHEREAS according to the Manitoba Midwifery Action Group in the regional health authorities that offer midwifery care more than 50% of the women are turned away due to the shortage of midwives; and

WHEREAS there are less than three dozen practicing midwives in Manitoba and only six of Manitoba’s eleven regional health authorities offer midwifery services; and

WHEREAS the only institutional based midwifery training program available in Manitoba is the Aboriginal Midwifery Education Program through the University College of the North; and

WHEREAS our province needs a university or college based midwifery training program in southern Manitoba; and

WHEREAS this NDP Government cancelled a midwifery program developed for the University of Manitoba in 1999; and

WHEREAS this NDP Government has done little to increase the supply of midwives in Manitoba even though the Society of Gynecologists and Obstetricians foresees 34% of its members retiring within the next five years.

THEREFORE BE IT RESOLVED that the Legislative Assembly of Manitoba urge the Provincial Government to consider creating a university or college based midwifery program in Winnipeg; and

THEREFORE BE IT FURTHER RESOLVED that the Legislative Assembly of Manitoba urge the Provincial Government to consider acknowledging the need to do more to meet the growing demand for midwifery and to consider providing women with greater choice in the type of care they would like throughout their pregnancy, labour and birth.

Yeah... politicians are sharpening their teeth here too!
This means almost nothing politically, bugger.

aida said...

Hi Sarah

Re; comment about midwives wanting women to labour without pharmacological pain relief. I agree with you saying that we need to promote the use of non-pharmacological pain relief as a the first course of action. It has been proves like hypnotherapy, water therapy and reflexology really do work in helping women work with their labour pain.
As midwives, we ought to promote to see the use of pharmacological pain relief as the last resort - after all, by introducing drugs into labour, we are risking the impairment of women's ability to breastfeed, which has proven long term health repercussions for both babies and women - so in fact, significant impacts on the health of the nation in the long run.

I do wonder, and this is me drawing from my experience from being UK trained, if we are doing away with real midwifery skills and replacing them with obstetric skills like putting up drips, assisting at instrumental births, scrubbing for theatre etc. Not that I am saying that those skills are not useful, but I fear that they might be at the expense of real midwifery skills. It is hard not to think that way when you look at how midwives progress up the Band system in UK hospitals - the skills that they have to be competent with are such like cannulating skills, suturing skills. Why is there no recognition of skills such as being able to facilitate physiological third stage, or facilitating physiological labour and birth? It seems our worth as midwives are measured by how much we can do, and NOT how well we can sit on our hands and be passively vigilant and allow for a natural process to progress at its own rate?

Sarah Stewart said...

Hello hbacmamma

Thank you for the glimpse into midwifery issues in Canada. I think life is going to get more and more difficult as the global shortage of health workers increases. If we do not address ways of getting people like midwives into the workforce now, we're going to find life gets very tough on health consumers like pregnant women.

Hello Aida, thank you for your comments. I would absolutely agree. But have we gone too much down the medical road now? Will we be able to reverse the high epidural, induction and cesarean rates & do we want to?

Indigo said...

Sarah, you said;
"Will we be able to reverse the high epidural, induction and cesarean rates & do we want to?"

That is the chilling thing, isn't it? Do women really want normality anymore? Is it too high an aspiration which doesn't occur regularly enough that women are unaware of its benefits? If so, where does that leave us as midwives? Aren't we supposed to be the guardians of normal childbirth? If that is becoming extinct, then does that make us obstetric nurses?

Sarah Stewart said...

I also wonder, Indigo, how committed midwives are to normal birth?