Wednesday, 20 May 2009

Quick hit: More Money for Maternity Care

The Herald is reporting that the Government is putting an extar $100 million into maternity care over the new four years.

The money will go on:

* Longer stays for new mothers in birthing facilities

* An optional meeting each trimester for at risk mothers, attended by the pregnant woman, their GP, and their lead maternity carer (usually a midwife)

* Obstetric training or refreshers for GPs wishing to return to maternity care

* Meeting the costs from the increase in the number of births each year

* Fully funding the Plunketline 24 hour telephone advice service (although this was previously announced)

In general more money on maternity is good and that longer stays might be good for some new mothers.

When I lived in Korea many mothers were in post-maternity for a month and had the mother-in-law move in to help with the baby (though some women may have seen this more as curse than a blessing). They were absolutely horrified that New Zealand hospitals were discharging woman after just a few hours in some cases.

I do wonder if merely training GPs will give the more incentive to provide LMC care given that the major issue is that the time involved in being an LMC just isn't worth the money for most GPs.


Sarah said...

Being classified as 'at risk' myself any help there is welcome.

A little off the thread but having that classification clarified across the country would be good as I would be given help at the miscarriage clinic if I lived in Wellington but don't quite fit the classification in Auckland. Not really fair as left to fend on my own (with great GP) or pay for private help just as I happen to live close to Auckland. We'll pay for it, but I wonder about Mothers to be who can't afford the help.

Anna said...

When I had my kids (7 and 3 years ago respectively), I was 'at risk' both times - and I actually felt safer as a result, because I wasn't put under pressure to leave so quickly. I also got my own room, which was a relief! Being in hospital when your milk comes in can be a very good thing - that's the critical period when you learn breastfeeding, and it's great to have support on hand, although the quality of that support can vary depending on the staff you get.

Anonymous said...

I am a little surprised that this hasn't been given as much attention as some of the other posts here. It is a very good policy.

Alison said...

I don't believe this is a good policy actually. I have some serious concerns with it; the first is simply that it's empty words - maternity wards have lost beds and wards over the past decade. In my own area, that's been so they could be replaced with theatres. Longer stays mean more beds, and this money is not enough to provide that, without making them shared rooms. I know that if there's one way to ensure women leave hospital faster, it's making them share rooms in the postnatal ward.

Secondly, I'm distressed by the lack of knowledge displayed about the maternity system by both Tony Ryall and the media. All the rhetoric has been around women being kicked out and left "without support for breastfeeding", which completely ignores the role of midwives in our maternity system. Independent midwives are required to provide support and visits to women up to six weeks, and in the first week post-birth they visit women at home pretty much daily. Most of the reporting has totally ignored that.

I'm never against more money being given to maternity (I am, after all, a student midwife) but I don't understand why the money seems targeted towards a different type of maternity care than we actually have (i.e. predominantly doctor-led).

Anna said...

If women genuinely feel under less pressure to leave hospital before they're ready, that has to be a good thing.

But as Alison says, it's mistaken to think of hospital stays as a sort of cure-all in maternity. If you've got good staff on hand and you're in comfortable surroundings, great - particularly if you're struggling to breastfeed. If those things are absent, it can be crappy.

I've been reflecting on this (after a very interesting talk with Alison!) and I'm a bit concerned that there's a slightly anti-midwife tone to the way this policy has been presented - a suggestion that women will now get 'proper' care in hospital rather than have to resort to midwives. The two kinds of care should really be seen as complementary, and offering choice to mums, I think.

Alison said...

I'm a bit concerned that there's a slightly anti-midwife tone to the way this policy has been presented - a suggestion that women will now get 'proper' care in hospital rather than have to resort to midwives.I think that's really my concern too Anna - I'm really worried that it's a precursor to a major overhaul - there was mention of that pre-election. That overhaul would be a) not based in evidence (our maternity outcomes have improved since we moved towards predominantly midwife led care) and b) not led by women as midwife autonomy was.

It's interesting - I think most women of an age to have children now just have no memory of what the maternity system was like before midwife autonomy in 1990 (I don't either, but have spent months studying it) so a lot aren't really aware of what a different system might look like.

I thought I'd post a link to the NZ College of Midwives statement, but I can't seem to access Scoop just now; I'll admit that my heart sank when I saw the headline ("NZCOM welcome maternity funding" or similar), but actually I think NZCOM have inserted a lot of subtle barbs pointing to concerns similar to mine.

PS) Anna, great to meet you last night! I'm sure I talked your ear off - it's just always nice to meet people who aren't midwives themselves who want to talk about the politics of what I do :)

Anna said...

I enjoyed talking to you too, Alison - I wish I'd had more time, but grumpy toddlers can be difficult to work around! Hopefully we'll get another chance to chat!

I remember my mum having babies in the pre-midwife days. Baby-having was an incredibly institutionalised and prescriptive business then - things like having to labour in one room, then give birth in another, even though moving when you're going into transition is bloody uncomfortable - that was just how it was done.

I think some people identify that routinsation of care as being synonymous with safety and medical professionalism, and find it quite reassuring - a bit of a generational thing?