Is Taranaki’s midwife crisis almost over?
For much of the last two years, Taranaki has had the highest vacancy rate among hospital midwives in NZ. But the numbers are showing signs of improvement. Nick Walker looks into how things are changing and what the shortage means for new parents and babies.
There’s a shortage of midwives all over New Zealand, and in recent times Taranaki has been held up as the most understaffed region in the country.
In September, Te Whatu Ora Taranaki (formerly Taranaki DHB) District Director Gill Campbell said they’d had a vacancy rate of more than 50% since the start of the Covid pandemic more than two and a half years ago. That means they’ve had more vacancies than they’ve had midwives for that whole time.
But last month, Taranaki manager for child and maternal health Lydia Rae said they’d have the vacancy rate down to around 40% by Christmas, and 30% if you included trained Registered Nurses that have been seconded into midwifery positions.
They’ve appointed a new Clinical Midwife Manager and four full time midwives, together with “a number” of additional casual midwives. Rae said there were more to follow, including graduates joining the workforce.
It’s an improvement, but it still leaves around a third of roles vacant. To say that’s a good thing shows how bad things were, and not for an insignificant period of time either.
But it’s not just in maternity wards that there’s been a shortage.
Lead maternity carers (LMCs) are thin on the ground too. They’re like private midwives – the ones expectant mothers connect with when they first find out they’re pregnant. They have regular check ups, monitor babies and mothers before and after birth, and assist in a range of ways beyond just the birth itself.
Ange Hill is one such LMC. She limits the number of mums she works with to four or five a month, so she doesn’t get overwhelmed and can properly care for the ones that do get through. Every day, she has to tell multiple people that she’s too busy to take them.
She knows many won’t end up being able to find one.
“If they can’t find an LMC, they’re cared for by the hospital midwives and whoever’s on shift when they go into labour. The hospital team is great and the care is still great, but it just means you can’t have that relationship throughout the whole pregnancy, which is really important.”
Hill’s careful to add that just because the standard of care is high, that doesn’t mean there isn’t a problem.
“If you really wanted a particular type of birth, such as a home birth, you may not be able to get it, and that could result in some trauma. Research also shows the outcomes are better if you have a known midwife for the whole journey.”
“We’re also hearing around the country that women are giving birth themselves at home with no midwife. I haven’t heard of that happening in Taranaki, but there’s certainly potential for it, and that’s a concern.”
Te Whatu Ora uses a range of strategies to ensure babies and mums are well cared for. Gill Campbell says managing clinical risk is the top priority.
“We can cover vacancies with experienced maternity Registered Nurses, as well as a number of experienced casual midwives and LMCs who support our service by working shifts alongside our permanent staff.”
It also launched a 24/7 0800 number and email in April, that people can call if they go into labour, have concerns or queries, or if they’re looking for a midwife. Child and maternal health manager Lydia Rae believes 0800 1MY BABY (0800 169 22 29) is the only one of its kind in New Zealand, and says it’s averaged more than 80 calls and 35 emails a month.
There’s no quick fix to getting more midwives, though Te Whatu Ora Taranaki hopes open borders and a new maternity unit at Taranaki Base Hospital – due to be completed in late 2024 – will help to attract more midwives to the region.
While there have been positive signs, there’s still some way to go.
LMC numbers took another hit this month with the closure of the Partners In Pregnancy Midwifery Centre. The centre had five midwives; two will be retained as community LMCs and the other three are planning on helping out at the hospital maternity unit at least part time. That means it’ll become harder still for expecting mothers to get a midwife.
Ange Hill says they need the ministry to step up to support them better, so they can support families better. That includes better pay and conditions, both in training more midwives to bolster the workforce, and for fully qualified midwives.
It’s a delicate balance talking about the issues without putting off potential midwives from what is still a very rewarding career. However, Hill says the reality is that it’s hard.
“Midwives are burnt out and they’re leaving, but they’re torn because they don’t want to leave other midwives in the shit. Taking time off for holidays or illness is hard because there is no-one to cover or do the work.
“I absolutely don’t want to put fear into people. I want them to know about the shortage and how it could affect them, but I don’t want them to be fearful.
“We just need families talking, amongst themselves and to the ministry, to show that this is what families want for their care, and this is how they want their care to look.”
I cried when our midwife had to leave before my wife could have our baby.
It was 7am on a Thursday, and she’d worked 23 of the last 24 hours. She had to go home to get herself sorted for the day ahead – which feels like a ridiculous thing to say, because she’d just been awake all through the night helping us.
I’ve said this to a few people since my wife had our daughter last October, but I’ve never recommended anything or anyone as highly as I recommend our midwife. She was such an incredible support to my wife through a complicated overnight labour, and, just as importantly, in the emotional days that followed.
I don’t want to name her because I don’t want her to be beholden to the phenomenal standard of care she gave us. I expect it’s par for the course for her, but all the same, let’s call her Emma.
The night before, Emma went home for dinner after a full day’s work expecting she’d probably be back with us for a birth at some point in the night. The hospital called her an hour later, because things progressed faster than they thought. It seemed like a baby was coming pretty soon.
But when she got there, things slowed down. The next 12 hours are a bit of a blur, but Emma was a constant, calming presence throughout a night of contractions, consultations, and finally, the hasty arrangements when it was decided my wife needed an emergency c-section.
Emma was an absolute rock, and it felt like we owed her a baby at the end of all that. She deserved to bring that baby into the world.
The hospital staff were awesome, and this is no slight on them, but they weren’t Emma.
She was amazing before the birth, and she was even better after it. Recovery from a c-section is intense, painful and slow, and Emma went far beyond the call of duty to advocate for my wife and make sure she was looked after.
I saw the effect she had on my wife whenever she walked in the room – it was such a relief that Emma was here, and she would take care of whatever was going on at the time. It happened in the middle of a tough moment one day, and she just took over the room with ease and authority and made it all manageable.
Emma wasn’t the only one who was stretched either. We were told that nurses had been seconded from other departments to the maternity ward, because there weren’t enough specialist hospital midwives. Not enough by half.
That we had exceptional care from them too belies the intense work demands they were faced with.
This was all during level 3 last year, when hospital visitors were heavily restricted. However, after a bit of a scare with our daughter, Emma arranged for my wife’s mum to be able to come and see her, which was so needed.
I found out later that ours was something like the fourth baby Emma had helped to deliver in five days. And yes, she wasn’t there for the actual birth, but she was just as critical to it as the people who were in that operating theatre.
She did it all with a student midwife by her side, who was also great. I can’t help but feel like that student couldn’t have wished for a better role model.
The hours they both worked were ridiculous, and that’s before you think of the intensity and emotion that’s involved. Emma was absolutely committed and a total expert – you don’t really know what to expect when it’s your first baby, but we could not have been in better hands.
This is just my experience of seeing the value that midwives provide, and a brief glimpse into their reality. I’m aware that my wife’s take carries more weight than mine, but this is mine nonetheless.
Midwives are worth their weight in gold. The conditions they work in are emotional and relentless. Anyone in another profession would want time off, but they keep turning up time and time again.