Midwife reporting

Nearly two decades after changes in the health system that allowed midwives to supervise the birth of babies independent of doctors, and the general departure of doctors from that area of practice, controversy continues to dog the system, writes The Press in an editorial.

 At the time of the changes, many general practitioners were angered at what they saw as their ideologically engineered removal from the process. Now few, if any, are involved in it. The consequence, some claim, is a maternity system that is less safe than before, with more avoidable deaths and injury.

The latest to suggest that the quality of the care for birthing mothers has declined since midwives effectively took over the system is GP Lynda Exton, who has documented her criticisms in a recently published book, The Baby Business. Exton blames many aspects of the maternity system, which she calls a "national scandal", but believes that GPs have been pushed out of the system to the detriment of mothers and babies. According to Exton, at least a third of women need a doctor's expertise during labour or birth and she wants to see the system overhauled so women can use a range of medical professionals during pregnancy and labour, not just midwives.

Anecdotal evidence also suggests that all is not well within the system. Many stories have reached the media over the last few years of births that have gone wrong in ways that reveal such shocking shortcomings that readers have been left wondering how many other such cases there may be that have not been reported. Stories that reach the media may not, of course, present a true picture of the system. Indeed, the Ministry of Health and the New Zealand College of Midwives strenuously assert that they do not. The ministry, for instance, says so far as infant mortality is concerned, at least, the figures are at a record low, not worsening.

We may accept that that is correct, but infant mortality figures may also not be giving a good idea of what is happening within the system. A good deal can go wrong for both mother and baby during a birth that can have a disastrous consequence short of the death of one or the other. Many of the stories about midwives concern mishaps that have caused injury, sometimes serious, but not death. Unlike doctors and nurses, however, there is no obligation on independent midwives to report an incident unless the mother or baby dies. This is entirely unacceptable.

The Health and Disability Commissioner, Ron Paterson, has said that introducing a national reporting system for independent midwives should be a high priority. He is right. Increasingly rigorous oversight of doctors and nurses has been introduced in recent years. This has the aim not primarily of finding someone to blame but rather of improving skills and assuring the highest standards of professional service.

Without mandatory reporting of incidents, there can be no way of knowing, short of the crude mortality figures and complaints when things go wrong, how well or badly the system is performing. Without proper data, assurances that everything is satisfactory are meaningless. Oversight comes at a cost, of course, in increased paperwork and the like. But where the wellbeing of vulnerable mothers and babies is concerned, it would be a small price to pay.

The Press