Childbirth system 'not delivering'

16:00, Feb 23 2013

Sara Gutzewitz, who suffered a tear requiring 140 stitches during birth, does not want to launch a witch hunt against the midwife who delivered her baby - she wants the system fixed.

Charges of alleged professional misconduct relating to Otago midwife Jan Scherp's care for Gutzewitz in 2010 were dismissed at a Health Practitioners Disciplinary Tribunal hearing last week. An appeal against the decision has not been ruled out but more important to Gutzewitz is the midwifery system itself. She says midwives are wedded to a healthcare philosophy that has them at odds with obstetricians.

"There is too much discretion on an independent midwife," Gutzewitz said.

"They go through the same amount of training as a nurse. The difference with a nurse is she is practising around her peers every day. Midwives are independent, on their own, and their ideals can come into it far too much."

Women needed more balanced information on the risks of birth, including more input from obstetricians, she said.

"Obstetricians and midwives haven't just parted ways. They've drifted further and further apart."


However, NZ College of Midwives chief executive Karen Guilliland said New Zealand has one of the safest maternity systems in the world because it is led by midwives.

Scherp was "investigated, heard and exonerated" based on evidence, she said. "This is the same natural justice available to all people accused of negligence regardless of their discipline," she said.

"It is difficult to see why this is not seen as accountability when it is the same process and system for all health professionals."

Tanya Crosswell, who almost died as the result of a blood clot that was missed by a midwife in 2003, complained about her midwife, who was found not at fault. She felt the midwife wasn't properly investigated. "I don't think they're disciplined at all. I think the Tribunal is there to back them [midwives] up. I have lost my faith in the medical system."

Jenn Hooper, who founded Action to Improve Maternity (AIM), disputed the college's comments. The latest allegations expose more flaws in the system, including a lack of transparency, she said.

"What the hell does someone actually have to do to be held accountable? The whole thing is rotten to the core. I completely believe there is more wrong with our system than right."

AIM is lobbying for an independent inquiry into the maternity sector and wants a database that lists infant mortality cases, so expectant mothers know a midwife's history.

Obstetricians last week also signalled support for change, saying The Lead Maternity Carer model was "unworkable", according to an article published in the Australian and New Zealand Journal of Obstetrics and Gynaecology.

Researcher Dr Dawn Miller, a senior health lecturer at Otago University, interviewed 23 obstetricians, including 13 who had left the field.

"If you give midwives a job that is inhumane, like a 24-hour call, seven days a week, most of them tend to burn out or get sick," one participating doctor said.

The research recommended a shared model of care where doctors and midwives work together to make clinical decisions, especially in emergencies. But the College of Midwives said the findings did not accurately represent GPs or the midwifery profession. Guilliland said there was no evidence burnout was an issue.

A Ministry of Health maternity spokeswoman said she was confident in the midwife-led system, but accepted GPs were leaving maternity care.

Infant mortality rates were at an all-time low in 2012. A total of 256 deaths in under one-year-olds were registered, down from 290 in 2011, Statistics NZ figures show.

Sunday Star Times