Days away from giving birth after a high-risk pregnancy, Kiki Van Newtown has experienced first-hand the dire state of our maternal health services. She’s calling on the government to take urgent action.
It’s late on the maternity ward at Wellington Hospital, and I’m curled onto a couch at the end of a dark hallway, trying to figure out a way to explain why every person having a baby, and every baby born, deserves to have the very best support that society can provide. The words aren’t coming even remotely easily, and I’m realising that this feels like begging for scraps. That it doesn’t matter how poetic or visionary my writing is, that appealing to our government to pull us out of the current maternity crisis is not a new call – this crisis has been decades in the making. No amount of hopeful euphemisms or metaphors are going to save us.
I’m in here because at 32 weeks, my placenta decided to go rogue, which put my pregnancy roundly in the high-risk category. Gold standard with this kind of rogue placenta is to be seen urgently for specialist assessment, admission at 34 weeks, and a planned caesarean at 36 weeks. Of course this diagnosis was cause for alarm, but my midwives calmly went about putting a plan into action, hustling the overfull system to try to find a gap for me to be seen by a doctor.
Over the next two weeks I had countless appointments booked and rescheduled and rebooked and rescheduled, so I was left dangling with the interim measure of resting at home and calling an ambulance if I started to bleed. The whole situation felt like thinking you’re on the guest list but then getting to the club and the bouncer is like, “sorry, I don’t see your name on the list”, then you’re standing there stressed out and inadequately prepared to not be inside and desperately trying to talk your way in because you really need to pee, except with a way more I-hope-I-don’t-die vibe.
Just after 34 weeks I finally saw the maternal foetal medicine team, and was admitted a few days later. Over the week while I’ve been an inpatient I’ve seen report after report of the dire state of our maternity sector. I’ve read about how staff shortages across the country have led to situations where maternity units have reached capacity and staff simply cannot look after any more women. That people are struggling to find lead maternity carers in their communities, and women and babies could die because our government is choosing to under-resource the maternity sector. It’s grim reading, and it’s impacting real lives.
As reported by RNZ above, Capital & Coast District Health Board (CCDHB) is down a third of its midwifery workforce, with 17 vacancies for midwives, and no applications for the eight graduate positions currently available. Ongoing chronic understaffing, unpredictable work conditions and poor remuneration have resulted in low morale across the midwife profession, creating major issues with recruitment and retention. The midwives union MERAS wants to see the development of supported pathways into midwifery as a career, and changes in the next collective agreement to include a retention allowance for experienced midwives. Alongside pay equity, they are also calling for the prioritisation of women’s health, including more financial support for new families, and wrap-around services for vulnerable women and their children.
Obstetrics and maternal foetal medicine departments are also understaffed, with the Royal Australian and New Zealand College of Obstetricians and Gynaecologists’ recent briefing to incoming ministers outlining the “current workforce shortages in obstetrics and gynaecology and midwifery that put services at risk”. This is particularly true across regional areas, and in major centres where specialist care for complex pregnancies is delivered. A survey from January 2020 showed concerning understaffing at 13 of the 21 DHBs nationwide, and reports suggest the lack of experienced and specialist staff remains an ongoing issue across the country.
The 14th annual report just released by the Perinatal and Maternal Mortality Review Committee (PMMRC) shows ongoing inequitable health outcomes for Māori, Pasifika and Indian families due to systemic failures to provide adequate accessible care. The committee has laid down a wero for the government to finally implement PMMRC recommendations that have been made across the last 13 years to ensure Aotearoa is a safe place for everyone to give birth. RANZCOG is backing these calls for change, specifically highlighting the need for better maternal mental health care. Suicide is the leading cause of maternal death in Aotearoa, and particularly affects wāhine Māori, who experience heightened systemic barriers to support.
None of this is fair on parents and their children. And none of it is fair on our maternity workforce – the doctors and midwives and nurses who are working extreme hours under extreme pressure, running from bell to bell and trying their very best to ensure the wellbeing of those in their care. The kindness and expertise that I’ve experienced over the last few weeks has been extraordinary. We truly have some of the most skilled and compassionate people providing maternity care in Aotearoa, but our government is taking them for granted and forcing them to work in situations that compromise everyone’s safety and wellbeing.
There’s no doubt that whānau forms the foundation of our society. If we treat all families well and support them to thrive from the get go, our communities will flourish. So many of our social issues would be solved if our government chose to invest real money and resources into whānau wellbeing, starting with maternity care. Over the last 12 months we’ve seen the ability of our government to respond rapidly and decisively to a crisis. We’ve seen them open their purse and pour money into our economy. We know that they’re capable of making big decisions to save lives and keep our communities safe. And now we need to see them step up with that same kind of energy to address the maternity crisis we are in.
The second weekend after I still hadn’t seen an obstetrician, I spent two days crying in bed, updating my will in case I suddenly haemorrhaged to death before I reached the safety of a hospital admission. Every day I thought about writing a letter to health minister Andrew Little about this crisis we’re in, asking the Ministry of Health to please implement the recommendations of PMMRC and RANZCOG and MERAS, and to work in partnership with maternity organisations and Māori health experts to create a national framework to address the disintegrating state of our maternity services. But all I could think was, what difference will my polite letter make? What will raising my singular voice do, when all I actually want to ask Andrew Little is if he knows how much blood a pregnant woman can haemorrhage before they die?
While I’m sitting here waiting for my baby to be born, I ask myself, is it good enough that we send pregnant women home with a high-risk diagnosis and the best care we can provide is to tell them to call an ambulance if they start bleeding? Is it good enough that our midwives and doctors are burning out from being under-resourced and over-worked? Do I want to live in a society where we are failing our parents and babies before they’ve even had a chance to meet? The answer of course is no. I’m not prepared to accept that this crisis is inevitable – I wholeheartedly believe we can do better, but it is going to take us raising our voices together and demanding concrete action from the government to turn things around.
There isn’t a polite or poetic way to put this. Our kind and transformative government is under-serving parents, and failing our babies before they’re even born. Every pregnant person, parent and baby in Aotearoa deserves the very best care we can provide as a society, and right now we’re not even coming close. It’s not good enough. But together we have power. Which is why I’ve put together a petition that you can sign here. Our government works for us, and it’s our responsibility to join our voices and demand that our government solves this crisis. Not through incremental changes and stop-gap funding, but through a full rebirth of our maternity sector.