New Zealand’s midwife shortage has been in the news a lot in the past week – but the working conditions of midwives has been an issue for much, much longer. Spinoff Parents editor Emily Writes asked midwives to talk about why they do the vital work that they do.
It’s a job few would sign up for. It is round-the-clock physical and emotional work that you’ll need to do 24 hours, seven days a week, 365 days a year. On-call, you begin your shift not knowing when it will end. You must be patient and kind the whole time, and if you make a mistake – it could be life or death. There’s little support for you, and people slander you for the bedside manner of a colleague. You’re a target in the media and a political football. Don’t even ask about pay. You’re caring for people at a time in their lives when they’re incredibly vulnerable. You’ll need to train for four years and have ongoing training – but again, your pay will never reflect this. There will be magic and mountains of paperwork. Every time anyone mentions your profession they’ll include comments by people who believe you shouldn’t be doing that job you’re doing based on the actions of another midwife.
Who would want this job? I wanted to find out. I put a call-out to midwives around New Zealand and here are their responses in their own words. I talked to more than a dozen midwives and these comments are anonymous because I wanted them to be able to be frank without fear of backlash.
Some of their comments will shine a light on other stories in the media about the safety of overburdened, underfunded post-natal wards. Last week, the chief executive for the College of Midwives, Karen Gilliland, told Nine to Noon: “We are putting women into these stressful situations, that the midwives have no control over and then the midwives are constantly being held responsible for that context and she has no control over it. She can’t cope with that pressure.”
Why are midwives leaving their profession? Who would stay given the conditions they work under? In their own words – here’s what our midwives say:
Why did you become a midwife?
I became a midwife after my own experience of suffering PND as a teen mum. My midwife helped me transition into being a kick ass mum during the first six weeks after my son was born. I wanted to be able to support and build a partnership with women during their transition to motherhood. I think it’s one of the most vulnerable and empowering experiences a woman will go through in her lifetime. The care a woman receives by midwives shapes her development during the post-partum period, and I want to provide care that facilitates strong mums in our community. – midwife, Auckland
I truly believe that when we empower families as they embark on their journey, we improve outcomes for everyone in the whānau. I hated seeing my friends starting parenthood believing they didn’t know anything and couldn’t be trusted with their own babies and bodies, and I wanted to fix it all. – midwife, Hutt Valley
When I was 20 and travelling in Europe, a friend told me the story of her pregnancy, labour, and the birth of her son. She felt as if she had been on a conveyor belt in the hospital and she felt angry at the disrespect she was shown in labour. She remembered the birth of her son with heaviness rather than joy. A seed was sown in me that day, and germinated over the next five years to the conviction that I wanted to be a midwife, which means ‘with woman’. This is the biggest life change that women will ever experience, and I wanted women to feel fully respected and powerful as they journey through pregnancy to motherhood, in what is not always a straightforward experience. I investigated whether to study in Europe or New Zealand and found that we have one of the best maternity and midwifery care systems in the world, so I returned home to study. – midwife, Christchurch
I wanted to walk the journey beside women and whānau as mothers are made. I wanted to empower women, who are so often overlooked and undervalued in our society. – midwife, Wellington
I became a midwife to support women to have the best pregnancy, labour, birth and post natal experience they could have. My first birth left me feeling unsupported and a little lost as a new mother, but the midwife I had for my next two babies was amazing- and I wanted other women to have the opportunity to feel supported and respected. – midwife, Hawke’s Bay
“After experiencing birth myself being supported by a wonderful midwife, I thought this has to be the most incredible and special job there is.” – midwife, Auckland
If you have left midwifery, what made you leave?
I am still working as an LMC midwife, but feeling close to burn out and considering my options. The endless on-call hours, the demands of clients impacting my time off, the issues that come with being unable to hand over care when appropriate at the hospital due to staff shortages. Unable to afford a holiday as I can’t book clients for when I won’t be available and then still have to pay a locum. Irregular pay cycle, months where due to no fault of mine my income is reduced due to women moving away or other reasons. The irregular hours, the weeks I feel I haven’t seen my own children and then my phone rings and I have to leave again. – midwife, Hawke’s Bay
Have you considered quitting? What made you stay?
I considered quitting. Some weeks I barely saw my own children. I have worked during acute staff shortages at our hospital, sometimes I had ten patients, worked a 12 hour shift with no break and then was accountable for the substandard care that was being provided. It was hard. Bells were ringing. Mums needed support and we were barely able to do their observations and hand out medications. It was unsafe for the patients and for the staff. – midwife, Auckland
Yes I’ve considered stopping. Sometimes I feel very guilty for how much time I am away from my family. I worry that my children and husband may think at times my women and their babies are more important than they are. I had a two year period with four horrendous tragedies, two stillbirths and two neonatal deaths, the grief and anguish I felt walking alongside those families left me stripped bare. – midwife, Auckland
Yes I have considered leaving many times. I have worked as an Lead Maternity Carer (LMC) and core midwife. Both hold challenges that are difficult to articulate. LMC work is practically impossible if you have young children. It is entirely unpredictable with no safeguards set in place about how many hours you can work in a row or how much time you have off between call outs. All expenses have to be covered by what you are paid, which has hardly increased in years. As for being a core midwife, the staff shortages are soul destroying. It is so frustrating to know that you are unable to give the level of care that you want to as your workload is just too high. Often this means the small moments get missed, this is so hard as I believe empowerment of women happens in these small moments. I have stayed for several reasons. When you peel back the shit the crux of why I became a midwife is still there. – midwife, Wellington
I’m always considering quitting. But I don’t want to do anything else. I am passionate about supporting women in this time of their lives. – midwife, Hawke’s Bay
For all the long hours, lack of sleep, my on-call phone never leaving my side, the missed dinners and family events, the all too often hostile hospital environment – there is something so incredible about being present at the moment of birth. Seeing a couple become parents. Meeting a brand new baby. In those moments what I do doesn’t feel like work at all. I can’t believe I’m lucky enough to do it! – midwife, Auckland
I consider quitting more and more frequently. My husband tells me to leave and go work anywhere else as I will be less stressed and earn more. The idea of working in a supermarket and less stress is appealing – plus I will get weekends off and get to sleep at night in my bed. – midwife, Auckland
I have considered leaving midwifery but not in a serious way. The responsibility is huge, but this is not the issue. Rather, it is the sense that if a poor outcome occurs in spite of the very best care from all involved, the necessary process of investigation of the outcome can feel like a hunt to apportion blame. Childbirth is safer than it has ever been, but this gives a false sense of certainty that we can guarantee a perfect outcome. We can’t. Midwives are more vulnerable and less protected by the system and by society than the medical profession, yet we all have the same level of responsibility for our actions and we are trained with many of the same skills when it comes to managing emergency situations. – midwife, Christchurch
What do you think we need to do to fix the issues facing maternity care in New Zealand?
It all comes down to funding. We need more midwives and equal pay. We are currently funded on an archaic structure that doesn’t reflect the acuity of patients in our birthing population. We care for an ever increasing complex case load with a rising caesarean section rate and diabetic woman at incredibly high rates. These are just two obstetric complications but they impact heavily on the time required to provide care in the pregnancy and post natal period. – midwife, Auckland
There’s not enough money – for midwives and maternity units, but in a general sense, LMC midwives are picking up the pieces of health and social service cuts all over the show. Mental health services are insufficient, which means I’ve done daily visits three weeks running for a woman with postpartum mental health issues. Postal services cut? That means I have to drive further to get time critical test cards in the mail to National Screening Unit. Lack of hospital midwives? I wait in recovery for three hours with a woman post C-section because no staff midwife can take the handover. The Government is relying on the good will of overworked self-employed midwives who fear media judgment, to make up for all the cuts that affect our scope of practice, however indirectly. So we need more money to allow us smaller caseloads, and make us feel valued, but we also need the Government to value other health services, and stop relying on the good will of individuals to make up for shortfalls. – midwife, Hutt Valley
The delivery suites need more midwives: post natal wards should be staffed by midwives, not nurses from a casual pool. Babies on the post natal ward should also count towards patient numbers when workload is being allocated. DHBs should fund the education required by the Ministry of Health and the College of Midwives rather than charging LMC midwives for it – they are already running the courses for their staff, it is not going to cost them significantly more to allow LMCs to attend for free. – midwife, Hawke’s Bay
The level of responsibility and the on-call requirements of midwifery need to be recognised by the Ministry of Health through remuneration that matches that of GPs (who are broadly not on-call), in order to make the profession sustainable and equitable. The Ministry of Health and government policy and media releases need to be fully supportive of midwifery, and actively promote the benefits of our amazing continuity of care system.
Social policy needs to value motherhood with high levels of social (financial) support. – midwife, Christchurch
There is currently campaigning for workplace safety by the government – it seems to cover everyone except midwives. We are often expected to work all night after working all day and then drive home. The hospital has no place for us to sleep. We often get no breaks or meals and then have to drive home. I have driven off the road twice on the way home due to tiredness. I feel it is only a matter of time before a LMC midwife is killed driving home. – midwife, Auckland
What are the biggest challenges you’re facing?
Short staff, poor pay rate and trial by media – it’s like a witch hunt. It gets us down. Midwives are tired. But we love our jobs and we keep doing it because we value what we do and the impact we make. – midwife, Auckland
We always used to joke that we were charity workers. I mean seriously -$35 an hour when you have people’s lives in your hands. People pay more for a massage or a cleaner or to get their haircut. And pretty much non-stop awfulness and negative stories about how we kill babies and force people to breast feed. We mostly felt that we had no respect from most of our medical colleagues, and not much respect from the general public or the women we looked after. – midwife, Wellington
Money! Midwifery is a women’s workforce so we are funded accordingly. LMCs take on a huge burden of responsibility and their pay does not reflect this. Core midwives are being pushed to work harder as the maternity units are not funded well enough to deal with the unpredictability and often complexity of pregnancy, labour and birth and the immediate postnatal period. – midwife, Wellington
Discrimination by government for work that is predominantly by women, for women (and thus for all of society). LMC midwives are self-employed, with none of the benefits of self-employment (the ability to increase fees). We are contracted to the government with no flexibility. We have none of the benefits of employment (no sick leave, no holiday pay, no bereavement leave). We have to cover all of our costs which have increased, and we are the only health profession that has had no regular wage increases. In real terms, incomes for this work have decreased while the requirements and responsibilities have increased in the last 15 years. Midwives are therefore leaving the profession. There is only so much that people will put up with even in such a rewarding profession, before they leave. – midwife, Christchurch
It seems the press are hell bent on sending us this way. The only explanation I have for this is that the government want to keep degrading us so they don’t have to pay us properly. – midwife, Christchurch
Very experienced midwives are leaving midwifery as they are frustrated with nothing being done. New midwives are leaving because they can’t deal with the expectations, hours and working conditions. We are tired of fighting for better pay and conditions. We do everything that is asked of us and more. The Ministry of Health keeps adding more and more responsibility on us. We are terrified of doing something wrong and ending up on the front page of the paper. – midwife, Auckland
What do you wish parents knew about midwives?
I wish they knew that when they press their bell and I can’t come for 20 minutes that my heart aches. I know they are struggling with breastfeeding and they need my help. We love our jobs, we love looking after mamas and their babies – we need support to do this safely. – midwife, Auckland
My friends who still work at Wellington have exactly the same complaints and concerns about safety as we did 10 years ago when I left the hospital. – midwife, Wellington
Don’t take this system for granted, it serves you and your whānau so well but it is under threat. I do my voluntary unpaid work out of love for you and yours but there will come a point when I will have to stop. Just like all of my colleagues we can only give and put up with so much. If you don’t support us you will lose us. – midwife, Christchurch
I wish they knew how much work we do behind the scenes. We run our own businesses, but there’s so much background paperwork, consultation, training for recertification that is invisible. Also I wish they knew how much our family and private lives are impacted. – midwife, Hutt Valley
We are here because we want to be. We come up against media storms frequently, often no better than modern day witch hunts. And yet we keep turning up, to ensure yours and your baby’s safety – both physical and emotional. – midwife, Wellington
We are only human. We are doing the absolute best we can for you and your family every day. The pay sucks. – midwife, Hawke’s Bay
I’d like to see women and their families use their voices. Tell the world how wonderful your midwife was, support us and value us. Fight back with us when negative articles are printed. If you are a recipient of hospital midwifery services give consumer feedback, make complaints if they are warranted. – midwife, Auckland
International evidence (Cochrane Systematic Review) shows that midwifery care from a known midwife results in better outcomes for well women and babies than other models of care – midwife, Christchurch
I wish they knew how hard we work and how much we care. I think women also lose sight of the fact that they are just one of say 50 women under our care that we constantly give to. I wish they knew how little we were paid and how little we are respected and that we put up with the pressures of every day life as a midwife because we care. I also wish people appreciated how well trained we are and the quality of the care we provide as opposed to a lot of private obstetricians. – midwife, Auckland
We are often expected to work all night with women in labour with no breaks, no sleep, and then we have to do a day’s work afterwards. Midwives are human beings, we do make mistakes and are not perfect but we are doing our best working in a very difficult system. We work hard for our clients to the detriment of our own health, wellbeing and relationships. – midwife, Auckland
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The system, and what needs to be done to fix it, is definitely complex. There undoubtedly are issues – because midwives and mothers are telling us so. Listening to the women who have the interests of pregnant and new mothers at heart, our nation’s midwives – is surely the best way to start the process of addressing issues like staff shortages. At The Spinoff Parents we will continue to share the words of midwives. Thank you to all of the midwives who shared with us for this piece. Most of all, thank you for your mahi. Your work is appreciated by so many families across New Zealand. You’re not just bringing babies into the world, you’re creating new families. We are a team, together. And all voices need to be heard.
Emily Writes is editor of The Spinoff Parents. Her book Rants in the Dark is out now. Follow her on Facebook here.
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