What is going on with New Zealand’s midwives?

In the first in our series on the midwifery crisis in New Zealand, Kimberley Davis writes about what it is a midwife does, and why midwives need higher wages and safer working conditions. 

You might have noticed there’s been a bit of a public fuss lately over the working and pay conditions of Aotearoa’s midwives. But, unless you’ve got a direct reason to care – like you’re about to pop a kid out or help someone else pop their kid out – you probably haven’t given it a second thought. Why should you? It’s got nothing to do with you, right?

Ahem. Wrong.

In New Zealand, midwives have one of the most important jobs in our communities: they ensure the well-being, both physically and mentally, of newborn babies and their mums. This is a job that has far-reaching ripples. To be really basic about it, happy babies mean happy mums mean happy communities. To be a little less basic, putting money towards maternal health makes good economic sense. According to the World Health Organisation, “investing in nurses and midwives is good value for money”, as evidenced by the UN High Level Commission on Health Employment and Economic Growth, which concluded that investments in these sectors “result[s] in a triple return of improved health outcomes, global health security, and inclusive economic growth”. In other words, taking care of babies and their mums is good for all of us.

However, all over the country, midwives are being forced to walk away from their jobs. It’s not that they don’t like what they do, or that they’re not good at it; it’s that they’re being grossly underpaid for what they do, and that the demands of the job aren’t compatible with having a life outside of work – or, indeed, with doing the job itself. You only have to spend a couple of minutes reading the stories on the Dear David, Aotearoa Needs Midwives Facebook page to see how heartbreakingly dire this situation is.

From all of our urban centres and regions, midwives are telling us just how bad things are. Many report working for as little as $5 an hour, one recounts wetting her pants on the job because she didn’t have time for a toilet break, and yet another tells of working 35 hours with no sleep all while covering 300 kilometres in her car to visit her far-flung clients.

Midwives are working too many hours. They have to take on too many clients. They are not being paid enough for it. And many are not able to care for themselves or their families because they don’t have any time left over after their job is done.

The College of Midwives released a document titled “Midwives in Crisis” in December last year that outlined the state of things. The average age of practising midwives in New Zealand is 48, most student midwives are in their thirties, student-applicant places are no longer being filled, and DHBs are finding it pretty much impossible to recruit or retain midwives because of the stress of the job combined with the under-resourcing and abysmal pay. The profession is petering away and those midwives who are left practising are increasingly burdened.

It is, indeed, a crisis.

And, in the background are the ones who should really be front and centre in all of this: pregnant women and new mothers. In urban centres like Auckland, women are finding themselves forced to call over twenty midwives before being able to find one to care for them – and, as a result, they’re then forced to take the first midwife they can get, rather than getting to choose who will care for them at this extremely vulnerable time in their lives.

In more remote areas of the country, women are finding themselves without access to midwives all together. Te Anau now has no midwife. Wanaka is down to its last one. Each day we are hearing more and more about areas who do not have enough midwives to cover their community.

When you consider that a midwife’s job can be quite literally a matter life or death, it’s unfathomable that things could get so bad in a little country like ours. And yet, here we are.

The politics of why midwives are undervalued is up for debate. What isn’t is the skill, experience and qualifications required to become a midwife.

The idea of a midwife as a kind of moral-support sidekick seems to be a pretty popular one, and it’s a myth trotted out to attempt to explain the appalling pay rate of the profession. It couldn’t be more misguided. A midwife is a trained medical professional. It takes a four-year degree plus another intern year to learn how to be a midwife, and then there’s ongoing mandatory upskilling throughout their career.

Midwives work alongside other medical professionals like GPs and obstetricians, but a midwife alone provides a very particular kind of care that these professionals don’t. A midwife provides 24-hour on-call cover to every woman in her care throughout pregnancy, the birth and for six weeks beyond that.

To bring this into clearer relief, each of these three main stages carry all kinds of specialised demands. In the prenatal phase, during a woman’s pregnancy, a midwife is responsible for organising all scans and tests to check the baby’s growth. A midwife also screens any pre-existing conditions or risk factors that might affect the birth process. They then use this information to ensure that the birth will happen in the safest circumstances possible.

Then, when it comes to actually having the baby, there’s a bit more to it than back stroking. This is where the “life or death” factor comes in. It’s the midwife who has to know when other medical professionals are needed, it’s a midwife who needs to know if the woman isn’t already in a hospital, she needs to get there. In rural areas, where transfer times to hospitals can be as much as three or four hours, and can be affected by extreme seasonal weather such as snow and ice, this becomes even more critical.

Also, you may have noticed that babies have a funny habit of entering the world at the most antisocial times. Midwives get called out at all hours of the day and night to be at the side of birthing mums. And, where some labours can stretch over days, others are a matter of hours – which is to say, they happen so quickly that the midwife has to catch the baby before any move to a hospital or birthing unit is even possible.

It’s a huge responsibility. It’s certainly not a job you’d want someone doing when they haven’t had enough sleep, and you’d think it would be heartily compensated in order to ensure it’s done properly. But it looks like you’d be wrong.

And we haven’t even got to the postnatal component of what a midwife does. For six weeks after a baby is born, a midwife treats baby and mum. For many new mums, their midwife is their main lifeline at this time. The midwife is the person who turns up and supports them when their partners have gone back to work or if their families are far away or absent altogether. Many new parents will tell you it’s these early weeks of a child’s life when life is hardest. There can be serious feeding issues, parents can encounter serious postnatal depression, almost much all parents will be operating on way too little sleep, bodies are still mending, nerves utterly wrecked and relationships fraught. A midwife is the person who turns up and sees these issues and more. It’s in these early postnatal weeks that she makes sure that babies are safe and that their parents are safe.

It’s easy to see that there are many places where things can – and do – go wrong. Even assuming that a pregnancy will obediently follow the three stages outlined above is a gross underestimation of just how awry things can go. It doesn’t account for miscarriage or for stillbirth, or for any number of grave issues that can arise at any moment and for which parents will require specialised and compassionate care to navigate.

This is but the most superficial introduction to what a midwife’s job is, but it should nonetheless give you an idea of why we should be valuing them more. Pregnant people should have the right to choose who their main carer is throughout their pregnancy. They shouldn’t be forced to go with the first midwife who can fit them in. Then, when they’ve chosen their midwife, they should know that their midwife will have the time and resources to care for them and their baby. Midwives themselves should – at the very least – be paid enough (which is to say, shitloads more than they’re currently getting) and be able to get enough sleep to support themselves and their families.

The reality is – if our midwives aren’t paid more, aren’t treated like the health professionals that they are, they will continue to walk away from the job. And who can blame them?

Happily, however, it seems the government is at last paying attention. Earlier this week, Health Minister David Clark, speaking to Checkpoint with John Campbell, said “I accept that we’ve got a problem here. Too many of our midwives feel stretched beyond capacity. … We have inherited a mess.” He then confirmed that the Ministry is working on an urgent solution to the current crisis in the May budget, but warned that it would not be a quick fix. “This is not just a matter of pay,” he said. “It’s actually about the sustainability of the model.”

The idea that the system needs to be overhauled, or that the model is “broken” has been rejected by many midwives. They say the problem is simply funding and resources.

So that’s where we’re stepping in. The Spinoff Parents wants you to know what the bones of the problem are, and how the critical issues midwives and pregnant women are facing differ throughout the various parts of our country. We want you to know what the current system is so that you know what changes to ask for. We want you to know that, whether you feel this issue touches you or not, so that you have the power right now to have your say. This is just the first piece on a series on the New Zealand midwife crisis. Stay tuned.

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