Where to, maternity?

For further information, contact Melissa Maimann at Essential Birth Consulting. Link

A tiny kick reminds Anna Edlington that her life is about to change. Forever. Soon the 27-year-old West Aucklander will not only be a daughter, a wife or a teacher. She is becoming a mother ... Foxcroft investigates the midwife crisis, and the state of the baby business across Auckland.

... The ability to choose who delivers a baby sets New Zealanders apart internationally. Our maternity system is discussed, held up and analysed by other nations. This year, the hard-fought-for system is set for a shake-up with a new Ministry of Health Maternity Action Plan.

... It is given that Auckland has very real problems in the baby business. The Aucklander reported more than two years ago that there are not nearly enough lead maternity carers (LMCs) for the population.

... The College of Midwives recommends midwives care for four women a month, or 50 a year. Some midwives cannot say no to the voice on the phone, pleading: they are taking eight or more clients in a month because the women have no one else to turn to.

... "My husband and I were lucky. We were able to find a midwife late - I was eight weeks pregnant. I know it's not the same for others."

Mrs Edlington also counts her lucky stars her midwife takes only a limited number of clients - four a month.

"For her, it's never been an issue that she is at one birth when someone else goes into labour. It just doesn't happen," she says.

"In terms of personal care, it makes a huge difference. It's harder the more clients your midwife has."

... the shortage of midwives is the biggest problem.

... Another problem is the lack of primary birthing centres ... We would like more women giving birth in primary units or at home."

... We have to remember that New Zealand is often referred to as the gold standard."

BEFORE 1990 a doctor had to supervise all births, which is still the case in other countries. The Nurses Amendment Act 1990 allowed midwife-led care for well women; in 1996 the Government enshrined choice for women by developing the Lead Maternity Care model. This meant women could choose who would look after them during pregnancy, birth and post-natal care.

It was a brave and socially challenging decision ...

... there is no standard model for health boards to collect electronic data. The methods differ from area to area ...

Post-natal care is another issue. "Having primary care centres where mums and dads can get used to being parents would help ...

Fray, an independent midwife based on the North Shore, sees areas ''screaming out for improvement.

''Hospital shiftwork midwives earn minimal incomes, especially considering the enormous responsibilities of managing the care of a labouring woman and unborn foetus,'' she says. ''Self-employed midwives can earn a reasonable income but only with the cost to lifestyle by being on call 24-7. Let's face it, that deserves an excellent income.''

... ''The other horrid area ... is the hideous way the media revels in attacking midwifery. Childbirth has never been so safe, yet midwives have never been so slammed with criticism. It's incredibly denigrating and disparaging to all of us who work with phenomenal dedication.''

For Denise Hynd, another independent midwife, the main concern is the high level of medical intervention, stemming in part from where most of the country's babies are born.

''Even with midwives it's still a very medicalised system,'' she says. ''All the evidence suggests that normal healthy women have best outcomes if they give birth at home or at birthing centres.''

But she praises our approach against other countries where she's worked - Australia and Britain.

... Dr Mark Peterson, the Medical Association's maternity spokesman, helped write the draft action plan but believes it needs refinement.

''Maternity care requires a team,'' he says. ''The potential problem of our system is we have lost the team philosophy. Care is concentrated on one person.

''Disasters tend to happen because of system errors, not because of people. But when you only have one person the system is not so robust. When you have a team you have more eyes.'' ...

... An overwhelming 75 per cent of women chose a midwife as their lead maternity carer 6 per cent chose an obstetrician 6 per cent went to their local GP The other 13 per cent? Believe it or not, most don't use ante-natal services - they ''rock on up'' to hospital when the time comes ...

We asked a range of people what works in Auckland's maternity services and where the challenges are ...

Anna Edlington (mother-to-be) loves the choice for women but believes the present system needs more resources.

... Denise Hynd (independent midwife) ''The system is too 'medicalised' but it's OK. We need more birthing centres.''

Kathy Fray (independent midwife) ''The dedication of lead maternity carers makes our system so successful. But the people who work in the field need to be recognised for their work.''

Karen Gulliland (NZ College of Midwives) ''The system is sound but we need more lead maternity carers, a standardised system across district health boards and more birthing centres.''

Dr Mark Peterson (NZ Medical Association) ''We need more teamwork and integration between GPs, specialists and midwives.''

In Australia, we can only dream of such a maternity system!

Melissa Maimann, Essential Birth Consulting 0400 418 448