National’s Maternity Policy

National released their policy for maternity care (PDF) yesterday. I have looked at it in detail below. I note in passing that, as we get closer to the election, National seem to be producing more and more detailed policy which is well costed. This is in contrast to Labour which seems to have little (recent) policy, none of it costed or, at least, realistically costed. Please do better, Labour. I would very much like to do a head to head comparison of health policies. I would like to do this before the election.

Readers who are unfamiliar with the history of maternity care may wish to read this post before continuing.

National’s Maternity Policy

“Establish a voluntary bonding scheme that writes off student loan debt for graduate midwives who agree to work in hard-to-staff areas for three to five years. ”

 Similar to the policy on doctors. Like the doctor’s voluntary bonding scheme, it does not really address the problem of why midwives do not wish to work in rural areas. These include financial disincentives (long travel times and hours for the same money), working in isolation and poor backup in an emergency (a helicopter sounds very exciting until you realise it can take up to two hours to arrive, assuming the weather does not ground it).

Also, the last person you want working in a remote area is a new graduate midwife who may not have the experience to judge the dangers of a birthing situation accurately. So whereas the doctor’s bonding policy might be useful, unfortunately, this one will not. To make rural midwifery attractive, I would suggest:

• Allowing GPs and Midwives to form full teams (not just an occasional meeting). This will require funding both the midwife and GP (don’t even think of shared funding – you have a long way before midwives and GPs trust each other that much).
• High-level broadband connections to rural birthing suites including video.
• An advanced midwifery qualification for rural practice. This should be focussed on practical emergency skills such as intravenous cannulation and intubation.
• SIgnificantly more money to compensate for isolation and travel.

“Fund an optional meeting each trimester for at-risk mothers so they can discuss their care plan with their LMC and their GP together. ”

At-risk mothers deserve better than an occasional meeting between a GP and a midwife. Nothing less than a full team effort is acceptable. The provisos mentioned above are relevant here too. There are difficulties identifying at-risk mothers. Many of the recent midwifery disasters have occurred because midwives have not identified a mother at risk. A case could be made for team care up to the end of the second trimester for most pregnancies.

“Subsidise retraining and refresher courses for GPs who have a postgraduate Diploma of Obstetrics and Medical Gynaecology (or equivalent), and who want to resume providing maternity care. ”

This is an excellent idea. However, there is currently no incentive for GPs to return the maternity care. Shared team care would go a long way to encouraging the return of GP obstetricians.

“Encourage clinical networks across regions to assist in the planning, delivery, and improvement of maternity care. ”

Pointlessly vague. Networks of who? Will there be funding for it or are National hoping that networks will be formed spontaneously?

“Work with DHBs to provide greater choice in birthing facilities. ”

More choice would be nice. But a substantial proportion of women are constrained to a single choice by lack of transport and remote location. Home births should only be available if there is emergency backup rapidly available (within 15 minutes maximum)

“Ensure mothers have the choice to stay in birthing facilities longer so they can establish breastfeeding and the confidence to return home.   ”

“Boost funding for postnatal care by $11 million a year so that new mothers can stay longer in birthing facilities and have better access to breastfeeding support. ”

Fair enough. The actual cost is quite low and a longer stay would be very popular. The current average is 2.9 days. Most mums I have spoken to seem to think 5 days would be better. I don’t support a minimum length of stay, however. Mums with really good whanau support at home are probably better off there, rather than in hospital

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