26/08/2021
Ugh. With the news confirmed this morning that Te Awakairangi is closing on the 23rd September, we are left feeling fully deflated. This decision has been another kick in the guts for us midwives at the coal face taking care of mums and babies. But itâs the final kick. This is the one that has caused major haemorrhaging. And everyone has run out of syntocinon.
Over our careers we have been able to be fulfilled by working with women, babies and their whanau and seeing the amazing life changing experience that they go through. However that doesnât and cantâ sustain us. Years of perpetual sleep deprivation, stress, poor pay, being ignored by DHBâs and Governments, working within a very understaffed, under resourced maternity unit, watching our core midwife sisters fight to do their job each day, EVERYONE other than midwives telling you they know more about your job than you and now the taking away of a very much needed and loved primary birthing unit.
The rhetoric we hear a lot is âWell you knew what you were in for before you started this jobâ. Really? Really?? No, it was not this bad when we started. It wasnât great but it has gained momentum as the years have gone on. Just because we choose to this very much needed job, does that mean we should do it in unsafe conditions and for less than minimum wage? And if we donât do it, who will? It wonât be the GPâs â who by the way, we DID NOT push out of practice. I know us midwives are quite magical but not that powerful. GPâs stopped doing obstetrics because the funding model changed and it was no longer viable while they had their busy GP practices to run. Yes, when midwives gained autonomy in NZ and were able to work autonomously as LMC (Lead Maternity Carers), the government changed the funding and it dropped. That why GPâs left. Women had also spoken with their voices and their feet and demanded a women led continuity of care service. WE WERE WANTED.
On that note of funding â we find it incredibly hard to believe that people still without logic, think that if we involve a doctor in the care of our women that we lose money. And so we are less likely to ask for assistance and would deny caesarean sections for some financial benefit to us . With a bit of critical analysis, Iâm sure a lot of people would know that this doesnât sound right. But you only need to look at the comments section on NZ Herald and Stuff to see this said time and time again. We are saying it for the last time â WE DO NOT LOSE MONEY FOR INVOLVING A DOCTOR IN OUR CLIENTâS CARE. To understand the funding model, midwives are paid via section 88 for primary care and obstetricians, paediatricians etc receive funding for secondary care. Two separate pathways.
The need we feel to protect our profession is huge. While we are talking about social media comments, we can say that it is disheartening to say the least and the comments reflect this. There is a massive lack of understanding about midwives and what we do. For a very old profession, we understand that the LMC model of care is relatively new in NZ (30 years) but has been proven time and time again with research not only from NZ but around the world that we have a gold standard midwifery education programme and a midwifery led maternity service that is envied around the world. Research shows that women and their babies have better outcomes under midwifery led care. Health outcomes have improved in the time that midwives became lead maternity carers. Our 4 year degree specialises in midwifery. There is no need to be a nurse first and learn about nursing across many many different areas that have nothing to do with Midwifery. The basic nursing principles are taught in the first year of the midwifery degree before it goes on to specialise.
One of the major differences between nurses and midwives, is philosophy. Nursing follows a medical model because they are primarily dealing with sick and injured patients, while midwives are dealing with normally well and healthy pregnant people. In saying that, pregnant women and their babies will have complications sometimes but the midwifery degree prepares and trains you to deal with those specific maternity related conditions. Nursing is a 3 year degree and midwifery is 4 years to account for the speciality. Midwives work autonomously, diagnose, treat and prescribe. Features that nurses do not have. This is not an US and THEM with our nurses, because we all work closely together for better outcomes for the public and we could not do without them in our caesarean section theatres and SCBU/NICU wards. It is prudent to point out the differences between our professions to those that say we are under educated just because we werenât nurses first. Itâs kind of like saying electricians and plumbers should have done each others training first to fully understand and be educated enough in their trade. Ludicrous right?
Legislation â all pregnant women in Aotearoa New Zealand should have access to home birth, primary birth facilities and secondary care facilities within our DHB. The Hutt Valley DHB receives funding for primary care but does not pass that on to the womanâs choice of birth space, nor do they provide a space away from the busy secondary unit. Maternity care is not ring fenced so we do not know how maternity money is used by the DHB. Te Awakairangi was purpose built to meet the needs of the Hutt Valley by a charitable trust â The Wright Family Foundation. It is a multi million dollar facility that the DHB has not had to fund even though they should have. Over 600 women have birthed here in 3 years and many hundreds more have started their labour journey here or spent some time postnatally. The DHB has received money for all of these women even though they may have never stepped foot in the DHB, essentially saving the DHB money. Where did that money go?
Te Awakairangi was built by one of the directors of The Wright Family Foundation as she had a passion for women to be able to access primary services and solid postnatal care. It is a charity, not a private business. They are simply providing what the DHB isnât. What they have asked for, is to have the primary funding follow the women to her birth space to pay for their care and keep the facility free for the public. It is not and cannot be private due to legislation in NZ requiring maternity services to be free. The money would only be enough to keep the facility open and to âbreak evenâ not make money out of it. If the woman doesnât go to the hospital and use their services then it hasnât cost the DHB anything. Why canât that money be passed on?
The DHB has stated that they are spending $9 million dollars upgrading the maternity unit at Hutt Hospital. This includes the secondary service â obstetrics and the special care baby unit, and that that should be enough for the women of the Hutt Valley. What they are willfully ignoring is the overwhelming voice of women saying that they do not want to birth within the hospital. Women who are primary who do not need to be in there. Where is their safe space? Te Awakairangi would only cost $1.5 Million a year to run â thatâs ridiculously cheap compared to how much it costs per woman in hospital.
On the hospital â the upgrades are not going to be finished until the end of 2023. What provisions has the DHB put in place for primary women come 23rd September when Te Awakairangi closes? We refer to our previous Facebook post refuting CEO Fionnagh Douganâs statements around womenâs choice to birth in the hospital. We call BU****IT. Her hospitalâs maternity unit is not in a good way and we will fight for our employed core midwife sisters to get the facility, equipment, environment and pay that they deserve. We worry about the women, their babies and whanau left in this unsafe system. It is not the doctors nor the midwives who are unsafe, but the system.
But for us, LMC midwives, this has all made our job unsustainable. Fighting bureaucrats, politicians, social media, bean counters, government and moreâŠthe list goes on.
If we could do our job safely, with good facilities and fair pay then the rest of it is just noise. However the noise is too loud. We are too tired. And our families need us now.
