A woman, her baby and family should be at the heart of any maternity system - yet they are exactly the people who are missing out as New Zealand’s simmering maternity crisis deepens.
This is not about the hardworking healthcare professionals who care for our women and work within an incredibly difficult, complex and constrained environment. Instead ‘maternity system’ refers to the method by which maternity care is funded, organised and delivered to our women and it is failing.
Many women in New Zealand have a good birth and postnatal care experience, but to varying degrees, there are horror stories that clearly demonstrate that our maternity system is a lottery and completely dependent on where a woman lives.
The 20 July NZ Herald article highlighted the acute issues at Middlemore – babies are dying and vulnerable mothers are being made to go home hours after giving birth, while rural women in Southland are being forced to give birth on the side of the road and in carparks because of a lack of facilities.
To some, these reports may seem extreme, yet they highlight the systemic issues that exist because of the way our maternity system is funded and are likely to become more commonplace unless serious attention is given to the way in which DHB’s fund maternity services.
Under the current system, a women’s maternity experience, including her postnatal care is very dependent on where she lives because the power to fund facilities and services lies in the hands of the DHB.
This funding structure is flawed in a number of ways, including: the maternal facilities available for women are those which the DHB chooses to fund (rather than what the woman chooses); the DHB driven approach results in an inequitable and inconsistent approach to the delivery of maternity care; there is a lack of transparency as to how the DHB allocates their maternity funding; and there is an ideology that the private sector has no place in providing improved health outcomes.
For example, Counties Manukau DHB chooses to fund maternity care in their own hospital (Middlemore) and three primary birthing facilities - none of which are in close proximity to the hospital itself. Earlier this year, the DHB identified the need for increased primary birthing capability closer to Middlemore which would not only alleviate pressure on the hospital (by freeing up beds and staff currently used by low-risk women for those who have high-risk pregnancies or have existing health conditions) but provide better outcomes for low-risk women. This facility exists, yet the DHB refuse to fund it or even visit it – instead choosing to pile more money into their own Middlemore hospital.
This injustice that our women are currently being subjected to are a major concern. The geographical inconsistencies are having a detrimental impact on the health and wellbeing of many women and their children. The bottom line is New Zealand needs policies that support a nationally consistent maternity system and holds DHB’s accountable for improving maternal health and wellbeing outcomes.
New Zealand can and must do better for women and their children, their lives and future depend on it.