Birth in New Zealand.
Uniquely New Zealand.
In New Zealand women can choose to have the same midwife, or doctor care for them from early pregnancy through birth and up to six weeks afterwards as part of the country’s maternity services. These practitioners are the woman’s ‘LMC’ or Lead Maternity Carer with whom she contracts to access all funded supports such as pharmacy, pathology, radiology and, or hospital services as needed, in accordance with national guidelines. Maternity care has been free for all New Zealand women since 1938. The legislative support for women’s choice of a midwife was included in 1990, following a long campaign by women and midwives led by Joan Donley.
Currently over 75% of pregnant women each year opt to have a self-employed midwife as their LMC. About 15% choose a hospital employed midwife to consult in pregnancy and following birth in that hospital. Their labour and birth care is given by staff or ‘core’ midwives working when the woman is admitted. A few women seek the LMC care of a GP or Obstetrician, 1.7% and 6.6% respectively in 2010. These latter choices mean the woman does not have the same carer attend her through-out pregnancy, labour or post-natal time. Nor can these women have the option of labour care at home or in a primary unit (birth centre). Having an obstetrician LMC may incur additional costs for a woman and her family.
New Zealand’s Dilemma.
International studies and enquiries into maternity services show women benefit from one-to-one or continuity of carer as it fosters a relationship and comfort with their carer for a more satisfying birth experience. Comfort and trust between the woman and carer can increase the likelihood of a natural birth outcome, as does a woman opting to birth at home or in a primary birthing unit. However in 2010, only 3.2% of New Zealand women birthed at home and 10.8% in a primary unit. Many LMC midwives do not offer home birth or primary unit care. Nor do most women appreciate the safety and benefits of these options as the community and media here, as elsewhere portray birth as ‘risky” and hospital as the safest choice. However, “hospital is an alienating environment for most women, in which institutionalised routines and lack of privacy can contribute to feelings of loss of control, ….and increased anxiety brought on through loss of control can interfere with the normal effective physiology of labour” .
The latest Ministry of Health (MOH) 2010 Report on Maternity says that “the majority of women (65%) gave birth by spontaneous vaginal delivery (including home births)”. But this group also includes some of the rising number of New Zealand women who had an induction (19.8%), augmentation (28.6%) and, or epidural (24.9%). There is no data collection about how many women begin labour naturally and progress biologically to a spontaneous birth of baby and placenta in New Zealand. Whereas in UK countries increasing this group is a target for quality maternity services, as is lowering the rates of intervention in childbirth. Instrumental (8.9%) and surgical (23.6%) deliveries in New Zealand hospitals were also up in 2010; “the majority of women gave birth at either a tertiary (44.7%) or a secondary (40.7%) facility (hospital)”.
Last October the MOH reported that the risk of birth interventions for healthy first time mothers depends on the hospital where they labour. Annual MOH reports state that “Common interventions during labour and birth include: induction, epidural, episiotomy and augmentation”. A recent UK study has shown that post-partum (after-birth) bleeding can be a fatal consequence of hospital birth. One hospital practice which evidence shows increases the rates of caesarean section with-out any improvement in outcomes for babies, is the use of CTG monitors in the labours of well women.
Yet the New Zealand Midwifery Council (NZMC) Competency Performance Criteria states that “the midwife:
- promotes the understanding that childbirth is a physiological process and a significant life event (1.8),
- utilises a range of supportive midwifery skills which facilitate the woman’s/wahine ability to achieve her natural potential throughout her childbirth experience (2.4),
- recognises the midwife’s role and responsibility for understanding, supporting, and facilitating
the physiological processes of pregnancy and childbirth (4.2)”
Also according to the New Zealand College of Midwives (NZCoM);
- “Continuity of midwifery care enhances and protects the normal process of childbirth. (Philosophy statement)
- Midwives have a responsibility not to interfere with the normal process of pregnancy and childbirth.
- Midwives have a responsibility to ensure that no action or omission on their part places the woman at risk. ( Code of Ethics)
- The midwife is accountable to the woman, to herself, to the midwifery profession and to the wider community for her practice.” (Standard of Practice number 7)
- Annual Updates on ‘midwifery skills to facilitate physiological birth’ as a Compulsory part of the NZMC’s re-registration requirements,
- Check that each midwife LMC ‘enhances and protects the normal process of childbirth‘ as an essential element of the NZCoM’s Midwifery Standards Review,
- Health and Disability Commission checks there is informed consent or refusal underlying place of birth and intervention decisions in their bi-annual reviews of DHB code compliance,
- creation of ‘Birthing Naturally’ video to compliment the MOH Breastfeeding Naturally video,
- Parliamentary support for the Maternity Manifesto‘s campaign for Normal Birth and increased Alternatives to Hospital Birthing,
- MOH, NZCoM, Royal Australian New Zealand College of Obstetricians & Gynaecologists and maternity consumer representatives create a NZ Campaign for Normal Birth like that in the UK,
- MOH notice or web site informing women of the intervention rates at each maternity unit, and of each LMC,
- MOH notice or website encouraging women and their midwives to use primary birthing units or home birth, like the UK’s National Health Service (NHS).