Making births safer

October 19th, 2010 at 11:00 am by David Farrar

Kate Newton in the Dom Post reports:

Serious changes to the system are needed to protect babies during birth, Parliament has been told.

Compulsory supervision of first-year midwives and a national data unit collecting information on all births are among recommendations from the health select committee, which presented a report yesterday.

The report was in response to a petition presented last year by The Good Fight – a group of women whose babies died or were left disabled because of problems during birth.

The group called for “immediate and wide-ranging change” in the maternity system.

In an unusually detailed response to a petition, the report urges changes, saying “serious work needs to be done to improve some aspects of the New Zealand maternity services”.

The changes initially introduced by Helen Clark in the 1980s which led to GPs abandoning maternity care have been arguably the biggest disaster in the health system. It is a classic case of unforeseen consequences.

One can not turn the clock back, and get GPs back into maternity care – they have basically departed for good. But the steps proposed should go some way to making things safer.

The report’s recommended changes include making it a requirement, rather than an expectation, that all new midwives complete the College of Midwives’ first year in practice programme.

The committee said it had heard anecdotal evidence that births in which the baby died or was hurt often involved newly qualified midwives “working without sufficient experience or support”.

The committee chairman, National MP Paul Hutchison, said yesterday: “We’ve made a pretty clear and strong suggestion there that midwives, for at least a year after graduation, should be subject to … mentoring and very close supervision.”

The report also urges the Government to set up an independent national unit to collect information on all births. Currently, information is collected consistently only when a baby is stillborn or dies during or shortly after birth.

The Good Fight spokeswoman Jenn Hooper, whose daughter Charley was left severely disabled when her resuscitation at birth was bungled, said a database would be able to capture information about birth-related disabilities and “near-misses”, which were now left out of reporting.

Both recommendations seem very sensible to me.

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20 Responses to “Making births safer”

  1. Pauleastbay (5,035 comments) says:

    Good news, we had a near miss with our son 14 years ago because the mid wife got caught out.

    Got a doctor for kid number two

    Alot of mid wives are great, but you are dealing with your kids here, doctors and hospital rather than lounges and spa baths

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  2. John Gibson (295 comments) says:

    “The changes initially introduced by Helen Clark in the 1980s which led to GPs abandoning maternity care have been arguably the biggest disaster in the health system. It is a classic case of unforeseen consequences.” – I believe that cost cutting was not the only motivation for this horrendously foolish decision. It was also a response to feminist pressure to take the patriarchal doctors out of a female experience.

    This was a completely moronic act. When my daughter had her first child a decade ago I supported her financially to get the level of doctors care that the state would not provide. Ironically the doctor was female.

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  3. alex Masterley (1,517 comments) says:

    Our children were born with the support of an obstetrician and LMC with a midwife as support. At some cost too, but it was worth it.
    Our family doctor did have an obstetric specaility but due to the Clark changes of the ’80’s he bailed out of the field. He considers the changes were an utter disaster for obstetrics.

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  4. projectman (224 comments) says:

    “It is a classic case of unforeseen consequences.”

    Yes, but they shouldn’t have been unforeseen. Thorough risk analysis would have identified the potential negative effects and allowed appropriate measures to be incorporated into the “roll-out” of the new regime. More likely, the politicians and officials of the day were not interested in negative side-effects, being driven by other agendas.

    Agree this has been a huge disaster in maternity care provision. It would take enormous effort (and changes) to get GPs back into maternity care – very unlikely with current attitudes held by the College of Midwives.

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  5. James (1,338 comments) says:

    State medical monopolies and the flow on negative effects…..old news…..sigh! ;-(

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  6. BlairM (2,341 comments) says:

    Midwives are the result of some hippie cultists thinking births should be “natural” and unimpeded by some medical professional – usually one with a penis – “interfering”. It’s bizarre. Thank God we had twins – it meant we actually got doctors looking after us. This is not the stone age – let’s get the hippies out of childbirth and get the doctors back.

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  7. slightlyrighty (2,475 comments) says:

    These changes were (in part) promulgated by an extreme feminist viewpoint that the medical field is patriarcal in nature. There was a backlash against the medicalization of childbirth as opposed to the idea of natural childbirth. Of course, when the pendulum swings, it can swing too far.

    There are radical notions of natural childbirth that have (if you will excuse the term) thrown out the baby with the bathwater, and situations which could have been resolved with medical intervention have ended disasterously as the midwife, or parents, resolve to not disturb the natural birth experience. Now I am not opposed to home births. I am not opposed to those who wish to have a natural birth experience, but to put yourself, or your baby at risk because of a mistrust of medical intervention should things go pear shaped, is irresponsible at best and criminal at worst.

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  8. Komata (1,191 comments) says:

    The fact that one H E Clark introduced these ‘alterations’ raises an interesting question, namely that given the ‘lady’s’ self-interested ‘I will have control of everything’-agenda, her well documented socialist hatred of ‘the family unit’, (and that ideology’s intention to destroy this base upon which Western , Judaeo-Christian society is based), in tandem that she was never a mother (and never, ever, will be), is it possible that her intent was in fact malign*- and another ‘tool’ to achieve he ‘family-destuctive’ aim?

    If it were not for the fact that it was DL who introduced this legislation, I wouldn’t be thinking this, but, given all of the above, one must wonder about agendas – especially secret ones (and we know now that she certainly had/has them) . . .

    *MALIGN: Adjective: Evil in nature or effect: malevolent: “a malign influence”.

    re or effect: malevolent: “a malign influence”.
    Verb: Speak about (someone) in a spitefully critical manner

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  9. wreck1080 (3,923 comments) says:

    Everything Helen touched turned into a disaster.

    The economy tanked, house prices dived, unemployment jumped, government books went into the red, and many more people became beneficiaries, introduced unpopular socialist policies (antismacking).

    I still don’t get why people say she was a great prime minister.

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  10. Komata (1,191 comments) says:

    I suppose W1080, that, in the best socialist tradition, if you tell people something loudly enough and for long enough, it will become ‘fact’. The socialists are very well practiced at it, and have been doing this sort of carry-on for decades. The labour party’s’ ‘sheeples actually believe it too . .

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  11. PaulL (5,987 comments) says:

    It is a classic case of unforeseen consequences.

    Too busy today to do some research. But I’d bet cash money that if someone went back and looked at media at the time, they were absolutely not unforseen. I’d go so far as to say that someone like the Medical Association would have predicted exactly this result, and perhaps even gone so far as to suggest that this was a gender-based decision that would all end badly.

    I can have some sympathy for unforeseen consequences, as long as they are reasonably unforseeable. If the consequences are unforseen because you’ve closed your mind to any dissenting viewpoint, then I have a lot less sympathy.

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  12. scrubone (3,099 comments) says:

    PaulL – absolutely. Actually I heard a rumor of one case where changes were actually made that drove a specialist out of business- deliberately.

    Whether or not it was malicious, that business, and those that ran it are both gone. And the poor are the ones who miss out.

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  13. GPT1 (2,122 comments) says:

    I can not understand anyone who thinks hippy home births are a good idea. Birthing is a massive trauma with so many things that can go wrong. Doctors, specialists and machines nearby are a must. I know too many people who have had complications – often able to be dealt with relatively safely and promptly IN A HOSPITAL – that could have had serioius consequences (like death) to think child birth is something that can be done simply.

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  14. Chris2 (766 comments) says:

    There is a shortage of midwives in hospitals because so many go into lucrative private practice – many midwives earn considerably more than your local GP. Counties Manukau (ie: us the taxpayer) had to pay one midwife $700 to have her cover one shift on a casual basis.

    If a midwife is the Lead Maternity Carer (LMC) she is paid something around $7,000 per pregnancy. The College of Midwives recommends a Midwife take on no more than 60 patients a year but some in private practice take on more than 100 a year – do the maths.

    Midwives are reluctant to call in doctors for help when thing begin to go wrong because then they have to share the fee. That’s the real reason more and more complaints are upheld against midwives – failure to get specialist help soon enough.

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  15. voice of reason (490 comments) says:

    Given the 50% increase in elective cesarean sections in the last 10 yrs – this problem will eventually sort itself out.

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  16. voice of reason (490 comments) says:

    “The committee said it had heard anecdotal evidence that births in which the baby died or was hurt often involved newly qualified midwives “working without sufficient experience or support”.

    I would have thought that in a birth where the baby died, there would be more than just “anecdotal” evidence !

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  17. annie (539 comments) says:

    Newly qualified doctors have to work in hospitals as DHB employees for a minimum of two years after gaining full qualifications – any reason why midwives shouldn’t do the same? It means that trainees gain experience in an environment where, if it all goes belly up, there is backup. At least in theory.

    Having new midwives working alone in the community is made even more dangerous by the fact that fewer GPs than previously have knowledge of and experience in obstetrics, now that medical students and junior doctors have very little access to training. The majority of midwives won’t allow them to be present at deliveries and as a consequence they’re not adequately trained in obstetrics.

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  18. Barnsley Bill (983 comments) says:

    The changes that the beast made to birthing were based upon social and political doctrine.
    She will forever be known as the baby killer in my family.
    David, we have discussed this here and privately so believe me when I tell you again that your repeated spruiking for a republic while the baby killer is still alive will result in me placing my size 13 boot in your generously proportioned arse if that fucking woman returns to terrorise us as president.
    All of my progeny who managed to survive her idea of modern birthing suffered unecesarily as did mum because the “wimmin” think they know best.
    Curse her.

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  19. sarahstewart (1 comment) says:

    Hello everyone

    Please can I point a couple of errors in people’s comments here. Firstly, midwives do not earn up to $7000 per case. Chris2 (294) says do the maths – I have…and at $700,000 per year…do you seriously think there would be a shortage of midwives in New Zealand? The reality is that LMC midwives earn up to $3,000 per case depending on what services she provides and whether the mother is a first time mum or not. As with any self-employed person, you have to take out tax, ACC, insurance, professional fees, car, phone etc etc. It works out you get about $1000 cash in hand per case.

    The second error is: if a midwife has to hand over care to an obstetrician and secondary hospital services, they do NOT lose money…they do NOT share the birthing fee. Secondary consultant and hospital services get paid out of another fund. There is NO financial incentive to prevent midwives referring women to secondary services.

    If you are interested in knowing how the maternity services and LMC midwives in New Zealand are funded, please refer to the document that has all the information: Section 88 Maternity Notice: http://www.moh.govt.nz/moh.nsf/indexmh/section88-maternity-notice-2007-feb07

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  20. katieh123 (2 comments) says:

    Sarah Stewart- Thank god someone with some sense posted on this blog. BLAIRM you are an absolute ignorant and uneducated p***k with no idea about the role of midwives. We are not some hippie breed infact if you did some research you would find there are more cases of infant death when under the care of a specialist. Suck on that.

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