Inside a birthing suite (Getty Images)

ParentsMay 5, 2020

Covid-19 has only made it harder to be a midwife

Contributing writer

Inside a birthing suite (Getty Images)

Today, on International Day of the Midwife (May 5), midwives share what it’s like working through a pandemic.

As you read this new lives will be delivered into the world. Not just new babies, but new parents too. For those women birthing, this might be the most powerful and strong, scared and overwhelmed, vulnerable and hopeful they’ve ever felt. They’ll remember these days for the rest of their lives. About 6700 babies have been born during alert levels four and three in New Zealand. No matter what the state of the world, babies are always born.

Midwives hold many lives in their hands – not just of baby, but mother too. The role has always been an enormous one, and over recent years the workload has only increased. In New Zealand in 2020, the international year of the midwife, some maternity carers say it feels untenable.

Midwives were meant to catch a long awaited break this year. The hope was that with pay equity midwives would have a sustainable funding model that finally acknowledged the crucial role they play and the huge workload they carry in caring for all communities.

And then Covid-19 happened. The challenges have been immense for many midwives.

Lakes District Hospital, Queenstown (supplied)

The pressure is particularly intense in the area covered by Southern District Health Board, midwives say. Due to safety concerns, birthing mothers in Queenstown were recently moved out of the maternity unit at Lakes District Hospital and across the road into what had been a dental clinic. The clinic had no functioning shower, so a portable one was erected by the side of the road. The shower barely worked, one midwife told Stuff. “Water just dribbles out, there is no heating, there is no privacy.”

Now, because of the showering issue at the clinic, some midwives are instead using a local hotel for birthing, at a cost to mothers of $195 a day.

“[The hotel] has no hospital facilities or doctors nearby or staff midwives overnight like the dental clinic does. Women already feel vulnerable birthing two and a half hours away from the nearest base hospital. Covid-19 just exacerbated issues that were already here,” midwife Holly* told The Spinoff.

Holly says Southern DHB made decisions about moving the unit without consulting local midwives. “And then it’s up to us to front this to our women and apologise for it.”

“The one good thing that has come out of the move is something that has been fought for, for almost a decade, and that’s a birth pool is being installed in the birth unit. However, this also delays our return to the unit. This was again decided upon without consulting midwives and I’d rather use postnatal rooms and be in the main (hospital) building with access to safe, warm showers and doctors in ED only a corridor away.

“The saddest thing is Southern DHB recently closed a beautiful and perfectly set-up birth unit half an hour away in Lumsden. Why couldn’t we use that as our interim birth unit instead of a place where women have to shower by the road?”

In a statement, Southern DHB associate general manager Debi Lawry said the temporary relocation of the birthing unit was a safety measure as part of the Covid-19 response. “Whilst not purpose-built, the building has provided a safe environment, away from the potential exposure to Covid-19 positive cases, for mothers and babies to receive good, safe clinical midwifery care.

“The temporary facility does not have a permanent shower, although some alternative, less accessible options have been provided. This has not appeared to be such an issue for the women, as they understood the constraints in this Covid-19 dominated world. They identified they wanted skilled midwifery care in a safe environment.”

Photo: Christopher Furlong / Getty Images

The Spinoff spoke to other midwives around the country about how Covid-19 has affected their jobs. Kate* a midwife working in Bay of Plenty, says her immediate response was fear and confusion. “Immediately I had women texting me asking me what this meant for them. But I had no idea what it meant. Nobody did, but somehow I was expected to know.”

In the days that followed Kate worried for her family – her father is sick and her daughter has an auto immune disease.

“I was scared for myself and I was scared for my women. I had no idea how I was meant to work and social distance and keep myself and others safe. How do I do that when I am in everyone’s bubble?“

Jumping from bubble to bubble is frightening, Kate says, and she feels a huge responsibility – not only to mothers and babies, but to also keep her own family safe. Between texts and phone calls she describes as “endless”, she has to keep calm and prioritise care.

Clinics and post-natal appointments had to completely change their operations due to social distancing, she says. “I have women cry in my clinic, new mums needing a reassuring hug and I can’t. I’ve not cuddled a baby for too long now.

“It breaks our hearts. The lovely part of our job, the bit that people say ‘oh it must be so lovely doing that’, it’s gone. For now. It’s been really, really hard. And I also miss my people. I can’t wait to hug and see my dad.”

There’s a part of the job of midwife that goes beyond practical birth care. “The hard stuff”, Kate calls it.

“The hard discussions, miscarriage, domestic violence, social issues, emergencies and the long, long, long days and nights, plus all the paperwork. I easily worked 32 hours this last weekend, much of it unpaid.”

Jane*, a midwife in the Hawke’s Bay region, says constantly having to explain changes to her women, when she’s still trying to get information herself, has been hard. “We’re trying to explain how the scan, previously deemed as necessary by an obstetrician, can now suddenly wait, or the blood test that you ordered is no longer available as the lab has now been directed to do Covid swabs.”

An increase in cleaning, hand washing and sanitising, both during and between visits is as crucial as it is time-consuming. PPE hasn’t always been available, Jane says. Friends, family, and clients have stepped in to provide it.

In her region there have been 22 home births in the last month, she says.

“Parents are choosing this option rather than expand their bubble too far, ensuring they can be together for all of the labour and birth. As wonderful as it is to attend a home birth, I have to source and pay for the equipment used there – this is time-consuming and can be expensive.”

Mae, a midwife working in the South Island, says she’s found midwifery during Covid-19 an overwhelming experience. She works at a primary maternity unit, supporting parents through labour and their first days as parents.

“We are a ‘green zone’ which means that although only people with no risk factors for Covid-19 could come to the unit, we still have had to practise physical distancing,” she says.

“Midwives get in there. It’s in our DNA. It’s impossible to do hands-on breastfeeding support from a distance. And sharing the exuberance of triumphant births with women and their support person while in full PPE doesn’t come easily.”

Still, Mae describes her work as “amazing” and “soul-nourishing”.

Today, more babies will be born. Midwives will be there. This pandemic has shown exactly what most parents already knew: midwives are an essential workforce in Aotearoa. Not just today on the Day of the Midwife, but every day.

Keep going!

A bond created in lockdown. Illustration: Toby Morris.

ParentsApril 30, 2020

The reality of routine at home

Charles Anderson

Contributing writer

A bond created in lockdown. Illustration: Toby Morris.

In the second part of a new series sharing the stories of families learning from home during lockdown, Charles Anderson tries to impose some order on his household and learns that disorder is OK too.

It was somewhere between week two and three of level four lockdown when Ivie Anderson, aged 5, began to have a meltdown about not being allowed to do “fun stuff”, like go to the supermarket.

“It’s not fair,” she yelled. “You get to go in the car. You get to go buy things.”

This was our benchmark for fun now. But it wasn’t really about fun, it was about a break in routine. Our precious routine. It was something we’d really tried to institute in our family of four.

We tried to have somewhat set hours of what was “school” time and what was everything else. That would allow all of us to have a semblance of structure. The kids (Ivie and Elijah, aged 12) could do some learning, I could do some work and, a few days in, it seemed to be functioning.

When it was the school holidays, we let the kids write their own list of what they wanted to do. The list acted as a writing exercise for Ivie as she practised her letters and sounding of words. The list could include anything they wanted, but there needed to be a balance. Next to each task, there was a box to be ticked. For Elijah that might include finishing his school assignment, practising his guitar or reading to his sister before he could play Fortnite against his mates. For Ivie, that might include writing a story, drawing a picture, making muffins, patting the cat, jumping on the trampoline, or screen time, as well as having breakfast and getting dressed. Maybe we would also go for a walk or a bike ride.

Then at 12.20pm, we would all sit around the TV and watch RNZ’s Aotearoa History Show on Home Learning TV. We would watch as the minutes tick by and it became apparent that schedules, even for TVNZ, were malleable these days. We would learn about New Zealand dinosaurs and the New Zealand Wars and then we would have lunch. After that, well knock yourselves out. Play, have fun, live! Then at 3pm each day, my wife and I would try and do some exercise, swearing at a laptop screen as a trainer encouraged us to feel the burn. Trying to do anything productive after that hour was wishful thinking. There was dinner to be made, cleaning to be done, guilt from not spending enough time with your children to be assuaged.

It seemed to be functioning. That routine seemed to allow everyone to carve out a bit of time for productivity, learning and themselves. We plodded through the days that seemed to melt into one another, doing our drawings, our writing, our stories, our activities.

Then it came to that one day a week where I would jump in the car, loaded up with sanitiser and Dettol wipes, and head to the supermarket. The day that Ivie had a meltdown. Our routine would not save anyone from those feelings of isolation, those feelings of longing for anything normal, even if it might be walking down an aisle of pasta sauce. It would not save Elijah from feeling sad at not being able to hang out with his friends or his dad who was stranded in a different city for the level four lockdown. It would not stop me from totally prioritising my work time over that of my wife’s. Her work, in my mind, was as absent from the routine as it has been in this piece of writing. And that was a problem.

That would all come to a head when just last night, after we’d all just watched the latest Pixar movie, I had my own minor meltdown which saw me walking around the block with a glass of wine in hand, sobbing into my elbow. I missed my dad too, it turned out.

The reality is what you’re reading is way past deadline. Elijah’s school assignment is way past deadline. We’re both sitting in different rooms on laptops on a Sunday morning, while Ivie watches the original Peter Pan (and then Return to Neverland) eating toast spread with brown sugar and cinnamon. That was a vision never imagined by the routine.

I let a 21-day meditation challenge, set by a friend, lapse after day three or something. I didn’t factor inner peace into the routine. For a few days in a row, I didn’t do any exercise. For a couple of weeks, I was drinking quite a lot.

The deadline for the delivery of this piece was set with the best of intentions and the best information available at the time. It was a goal that was created after consulting our daily household routine. Yes, we had structure (sort of). There was a formula (-ish). But, come Friday afternoon, I watched those best of intentions sail past. I waved as they went by.

That’s felt like the best way to approach these past few weeks. To embrace a routine as rigid as pizza dough. The routine for learning is just a broken routine that’s created moments you couldn’t write on a list. I’ve watched Ivie and Elijah have more time together than they ever have and seen them lean on each other for support. I’ve watched as he has read her book after book, her cuddled up to him, hanging on his every word. I’ve watched as he’s come up with fantastical characters for her to colour in, name, cut out, and then stick on her wall. They’ve made stories together out of dice covered in pictures of Star Wars characters (“Dart Fader dug up a magic wand and found a robot …”). There’s been learning in the serendipitous, the unplanned.

There have been times when Ivie wanted a family ninja pillow fight on the trampoline. Sometimes it went on the list, sometimes it was organic. So we bounced around belting each other senseless for 20 minutes until we all collapsed. There have been times when we all just started dancing after dinner, while the dishes sat in the sink, swinging each other around listening to 1990s pop hits never heard by a boy who was fresh off hearing Travis Scott’s latest tunes drop on Fortnite. These times are important. My wife and I have also talked through the importance of her work routine and making that a priority too.

Really, a routine in these times is something that isn’t going to stress you out. Because who cares if Elijah’s Fortnite time stretches over the limit agreed on because the game he’s playing isn’t finished, or if Ivie watches “just one more” episode of Lion Guard? What if I spend some of the free time I carved out for myself not actually working but suggesting to Elijah’s teacher a really interesting reading comprehension about the rise of llama’s in children’s toy culture, complete with a potential line of questions?

We’re all just muddling through and sometimes the best stuff doesn’t have a box to be ticked.