Midwives battle to transfer sick mums to hospital to give birth
Lisa Johnstone's water broke in Wanaka at 1:30pm on Tuesday August 2. It took her more than four hours to get to hospital for her emergency caesarean-section.
Johnstone already knew her baby was in a breech position, and had booked in for an elective C-section, but she went into labour 10 days early. Her midwife, Deb Harvey, called Dunedin Hospital and asked for a helicopter transfer.
"They wanted us to take an ambulance," said Johnstone.
Ambulances have important medical equipment, but are a slow option for a transfer. The ambulance arrived from Cromwell, around an hour after Johnstone's water broke. The plan at this stage was to change ambulance twice en-route. "That's why my midwife was really campaigning to get a helicopter. She could see things were happening quite quickly."
Midwives around the country are fighting for recognition of the pressures they are under. After the mdwives filed High Court action, on Wednesday the government backed down and agreed to go into mediation to discuss equal pay and conditions.
The mediation begins on Monday – and if the Ministry of Health agrees to improved pay and conditions for midwives, that will take effect in three months' time.
Johnstone's case was one of two recent near-misses involving transfers of expectant mothers in Central Otago. In the other case, a midwife tried to arrange for a mother to make a two-and-a-half hour ambulance transfer from Queenstown to Invercargill, but was told Invercargill couldn't take her. Instead the ambulance was directed to Dunedin – a four-hour journey.
By the Johnstone and Harvey arrived at St John in Cromwell to change ambulance, Johnstone said her labour was "progressing fast". Her contractions were three to four minutes apart.
She waited in Cromwell for about half an hour while Harvey and St John staff petitioned Dunedin Hospital to agree to a helicopter transfer.
Eventually St John organised a helicopter to come from Queenstown. Johnstone arrived at Dunedin Hospital about 6pm, by which time she was experiencing near-constant contractions. "At the point where you have to start pushing, basically."
If Harvey had driven Johnstone to Dunedin in a car, she would have arrived about 5pm.
Johnstone was rushed into a theatre for the C-section and her daughter was delivered safely, but Harvey said birth is inherently unpredictable, and the outcomes may not always be as happy. Whether it's a bleed, ruptured membranes, a breech birth or hypertensive issues, "things can suddenly go from nothing to critical".
"If you break a leg on Cardrona attempting something you can't do, a chopper will come and take you to Dunedin. But if it's a mother and baby, the priority isn't there."
The New Zealand College of Midwives has also written to the DHB about the bungled transfers, and received only a terse acknowledgement.
In a statement the College's midwifery adviser Alison Eddy said the situation was intolerable. "There is an urgent need to at least look at what is going on and we are very concerned that the DHB does not see the seriousness of what is happening in their region," she said.
Harvey said while the hospital seemed to expect her to manage a dangerous birth, it was telling that the moment Johnstone finally arrived at Dunedin she was rushed to theatre for an emergency caesarean.
Without the helicopter rescue, the mother had faced three hours in the back of an ambulance on the treacherous, winding roads between Wanaka and Dunedin, which includes extended stretches where there is no cellphone coverage.
Harvey said although there are protocols for a lead maternity carer like her request a helicopter transfer to Dunedin, they seldom seem to work in practice.
She said as the primary care provider, her clinical judgment should have been trusted.
"Being declined was very frustrating."
Harvey said as the region's population explodes, Central Otago needs a hospital of its own, perhaps in Cromwell. But in the shorter term, she would like to see better provision of chopper transfer services in the region, including 24/7 availability of a retrieval crew.
"Midwives are available 24/7, so the DHB should be too."
Leanne Samuel, executive director of nursing and midwifery at Southern DHB said she was unable to discuss individual patient's care.
"Patient safety is our priority. We are aware of the challenge in meeting the maternity needs for this rural region, and are continuing to explore ways of enhancing emergency and transport options."
- Sunday Star Times