Midwives could be removed from emergency caesarean section delivery theatres at Waikato Hospital after a review of women's health in the district.
A review of Women's Health at Waikato District Health Board has seen 26 recommendations for change made, including to "cease using midwives within theatre" and increase the number of midwives per shift.
The review panel, made up of three independent obstetric and midwifery experts, was asked to identify service improvements and help develop a five-year-plan.
Their recommendations have been welcomed by nurses and midwives who have voiced concerns over the way things have been run at Waikato Women's Hospital.
New Zealand Nurses Organisation professional nursing adviser Kate Weston said the DHB needed to roster an extra midwife per shift urgently to manage risk to mothers and babies and to provide support to staff who are under significant pressure.
"NZNO will work alongside the DHB to ensure the recommendations for a safe workplace for mothers, babies and staff are implemented in a timely way."
NZ College of Midwives chief executive Karen Guilliland also welcomed the recommendations after reporting her concerns about the staffing situation at the women's hospital.
"The pressures on the entire midwifery workforce in the Waikato region has been longstanding and has disadvantaged both women and midwives," she said on reading the panel's recommendations.
"The college has not understood the DHB structure which sees the mixing of non-maternity surgical and medical patients with pregnant and postpartum women, and agrees with the reviewers that this must be rectified."
Chief operating officer Jan Adams said she was certain Waikato DHB was still a safe place to go and give birth.
"The Waikato fares very well [compared to other DHBS]. We have a high number of women having natural births and a low caesarean rate.
"So overall the service is actually functioning well within its constraints."
However, the review panel did recommend they completely reconfigure their antenatal gynaecology beds, review midwifery leadership and recruit more staff.
"We knew there was a need to strengthen clinical leadership, we've had challenges relating to our workforce."
Mrs Adams said they'd accepted four of the seven "immediate recommendations" while the other three were under further consideration - one of those was removing midwives from theatre.
Mrs Adams said at the moment when an emergency caesarean section was performed in the obstetrics theatre in the women's block, midwives had to leave the delivery suite to assist the doctor in the operation.
However, the review panel said a better practice was to have a registered nurse do that so the midwife could be released to care for the baby.
Of the other 19 recommendations, Mrs Adams accepted 15 with the other four under further consideration.
Women's Health group manager Di Peers said the reviewers identified several challenges, which would require a commitment to patient safety and quality improvement.
"We must put Waikato women's health first," she said.
"What the reviewers found when they interviewed staff, patients and interested parties was willingness, and in some cases an overwhelming desire, to deliver the highest standard of patient care with respect and dignity.
"I have complete confidence that Women's Health will deliver that while addressing the identified challenges."
MUM FIGHTS FOR AN APOLOGY
A mum who underwent a traumatic delivery of her stillborn son is taking her fight for an apology to the Health and Disability Commissioner.
"People need to know about the maternity care at Waikato Hospital - there needs to be urgent referrals and they need to be acted upon as soon as possible," Melanie Jones said.
She has laid a complaint with the commissioner and is hoping it'll stop other mothers from going through what she did.
Ms Jones, 38, lost her baby Louis in May 2011 when his heart stopped beating at 22 weeks, but she still had to give birth to him.
But during the birth his head became detached and Waikato Hospital staff spent several hours trying to retrieve it from her.
When she got him back there was cottonwool around his neck.
"They brought him down like nothing had happened and told me not to pick him up - not to be too rough because his head might fall off. He was completely decapitated. It was just horrific."
But Ms Jones' trauma didn't stop there with her almost bleeding to death some months later after doctors failed to detect a massive placental tumour growing in her uterus until it was almost too late.
For months after the birth she remained in pain, with heavy bleeding. But she says both her GPs and those at the emergency department failed to realise what was causing the pain.
Finally in November an MRI was done and a large tumour detected. An appointment was made with the gynaecology department for December despite the continual heavy bleeding.
But she never made it, haemorrhaging as she was driving to the hospital for that appointment.
She is estimated to have lost about 2 litres of blood and arrived with a very low pulse.
An emergency hysterectomy was performed.
In her ACC treatment injury report, independent physician Dr Billbrough said it was odd that Ms Jones wasn't seen by senior medical staff until it was "an extreme emergency".
"There seems to be no one person taking responsibility for her care and I do feel that this has ended in a sub-optimal delivery or care and possibly a delay on informing Mrs Jones as to the extreme risk she was in.
"I feel more effort should have been put into contacting Ms Jones once the MRI result was known - even going to the extreme of sending the police out to find and bring Ms Jones to the hospital if other methods to contact her had failed."
But Waikato DHB is refusing to accept that what happened to Ms Jones was a "serious or sentinel even", saying it doesn't fit the criteria.
Hamilton-based Action to Improve Maternity spokeswoman Jenn Hooper said Ms Jones "was definitely let down, by every person, every step of the way".
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