Capital and Coast District Health Board has, thank goodness, backed down on its silly plan to bribe new mothers to leave hospital quickly. There is a critical shortage of beds in the maternity unit in Wellington Hospital, so in order to keep enough beds available, the hospital was going to give mothers a $100 voucher if they left within six hours of giving birth. The target group was second time mothers, people who already know a little bit about how to look after new born babies.
A moment’s reflection tells you why this was a silly plan. The risk is that people who still need trained care and assistance would choose to leave the maternity ward, even if they were not well. A very poor health outcome, for mothers, and for new born babies.
The bribe is gone now, but not the pressure for women to leave hospital early. If you read the article, you will see that lead maternity carers get an extra payment if women leave hospital early, and that hospital staff are still under pressure to keep women moving out.
This is anti-women, and anti-family. I have written before about the difficulties of sending new mothers home within hours of birth, in connection with establishing breastfeeding.
Rooming in looks very nice, but there’s a big problem with it. Although it is phrased as “allow”, in practice, it becomes, “mothers and babies must be kept together”. So a woman who has been through an exhausting delivery will nevertheless not be given any chance to sleep, because the nursing staff won’t help her to settle her baby, and won’t consider taking the baby into a nursery even just for a while, to allow the mother to sleep. The baby can always be brought back to the mother when it wakes, so there’s no lack of breastfeeding. However, it does take staff time to manage a nursery. So babies must stay with mothers, even at the cost of the mother’s exhaustion. This is a worse problem if the mother is heading home to other children. Unless she has a partner who has time off work, or family nearby, she will be required to look after those children too. So her brief time in hospital really is the last chance she will have to get a decent rest for weeks, if not months. And surely, that must have a bad effect on babies.
And I just don’t see how any hospital which encourages new mothers to leave after just two or three days could possibly be described as a “baby friendly” hospital. Breastfeeding is a learned skill. Some women and babies find it very, very easy, but others don’t, at all. They need help and support, especially in those early few days, when they are tired from the processes of giving birth and being born. By about day three, a new mother’s milk will be coming in, so she and her baby will be getting used to an entirely new process, but that’s almost exactly when hospitals kick mothers out the door. New mothers need to be able to stay in hospital, where they can rest, and where they can get help, for more than just a few days. To my mind, to deserve the title, “Baby Friendly”, a hospital needs to encourage women to stay for five or six or even more days after birth, if that’s what they need. And in order for that to happen, hospitals need to be properly funded.
The solution to funding pressures is not to refuse to treat patients. Let’s see if we can think of other ways that funding pressure could be reduced by not treating people. Maybe kids with broken bones could be sent home to see if they really need hospital treatment. Middle aged men with chest pains could be told to wait a few days, just to see if it really is a heart attack. Perhaps people could be discharged straight out of operating theatres, if they feel that they really have come through surgery quite well.
One of the difficult aspects of this whole episode is that any woman who is due to give birth at Wellington Hospital in the next few months must now be feeling quite nervous. This will affect my family – my brother and sister-in-law have a baby on the way, and they are due to give birth there sometime in January, all going well.
Please, if you have a partner, a friend, a sister, a daughter, a daughter-in-law, who is due to have her baby at Wellington Hospital sometime in the next few months, be there for her. Be there to fetch, run and carry, to sit by her bedside and look after her, to make sure that hospital staff don’t put pressure on her to leave too early.
Of course, that’s the sort of thing that families and friends do in third world hospital systems. We have always liked to think we are a bit better than that, but perhaps we are not. And that’s perhaps the most disturbing aspect of this whole story, that we simply can’t rely on our health system to provide a decent standard of care.