I have already writtenabout the Capital and Coast District Health Board (CCDHB) plan to give women who have just given birth $100 of grocery vouchers if they leave hospital early, within six hours of giving birth. The ludicrous plan was quickly abandoned, but as I said in my post, the pressure for women to leave hospital early would remain.
That pressure turns out to be real. The CCDHB Clinical Director of Women’s Health Services, John Tait, said on Morning Report this morning that over the next two months, women would be encouraged to leave the delivery suites and maternity ward as soon as possible after giving birth, because there is a shortage of midwives. My understanding is that the shortage of midwives has led to some beds in the maternity ward being closed. There is literally no room at the hospital for women who have given birth.
The whole issue of women being sent home early has been highlighted by a very sad story in the news this morning, of a woman who gave birth to her first baby at Wellington Hospital, and was sent home just five hours after the birth. Her baby died within a few hours of their return home. It’s not clear that the baby died because the mother and child were sent home early – sometimes post-natal deaths just happen. However, as more details have emerged, it seems very, very odd that this new mother was sent home in the first place.
She was in labour for 20 hours, and had been awake for 10 hours before labour started, so she had not slept for 30 hours. She had an epidural. She had an episiotomy. Although she had a vaginal delivery, the delivery was not “normal”, according to John Tait (in the Morning Report interview).
I had a long, difficult labour with my first child. At about 24 hours in, there was a serious discussion about whether or not I should have a Caesarian. My husband and my mother stood beside me, and supported me through that discussion. Eventually, I didn’t have the C-section, and our baby was delivered using forceps, about 8 hours later. It wasn’t much fun.
Even at the 20 hour mark, I was in no state to make sensible decisions, despite all the careful thinking and planning surrounding the birth. By the time our baby was delivered, I was completely and utterly exhausted. I was quite surprised when, in accordance with my birth plan, the midwife suggested I tried feeding the baby. But I dutifully did what I was told to do, by my medical professionals. I am an intelligent, articulate, independent woman. I don’t usually get pushed around. But the overwhelming physical process of giving birth meant that I simply could not assess information and make decisions. I was totally reliant on the medical professionals. My husband and my mother were there for me, and supported me, but like me, they are not medical professionals. They gave me the emotional support I needed, but like, me, they were dependent on the medical professionals too.
The new parents whose baby died seem to have left the hospital at their independent midwife’s suggestion. They were not aware that they could stay in the maternity ward, and it seems that the option of staying in the maternity ward was not even presented to them. In addition, it seems that the hospital staff were not consulted, although given that there had been some low level interventions in the labour, the hospital staff must have at least been aware that there were some issues, even if they had not been formally invited to assume care for the mother and baby. So someone, somewhere, made some very bad decisions.
And these decisions would have been bad whether or not the baby died. It is just plain wrong to shoo new mothers out of hospital as though they were a nuisance within hours of a baby’s birth. A first time mother has so much to learn about caring for a baby, and even more to learn about breastfeeding. She needs to be able to access expertise and assistance. A second or third time mother just needs a rest before she goes home to deal with her other children, as well as her new born baby. It’s called labour for a reason – it’s hard, tiring work. And that’s with a normal, straightforward delivery. For all that midwives like to buy into the cant that birth is a natural process, and therefore a good process, many births are not good births. And in those cases, the default position needs to be that the woman stays in hospital, where she can access the care and assistance she needs. Of course, if a woman wants to go home, then that’s fine. But, no matter what, she should be entitled to stay, and that entitlement should be upfront.
My understanding is that lead maternity carers get an extra payment if a new mother leaves hospital early. I think that extra payment is starting to work as a perverse incentive.
I am also deeply worried for the women who are due to give birth at Wellington Hospital in the next couple of months. They will be under pressure to leave, simply because the hospital does not have the resources to care for them. Will we see more infant deaths, and maybe even maternal deaths, as a result of this pressure?
I am also concerned that part of what is going here is an on-going battle between midwives and doctors for control of birth. The midwife was seemingly reluctant to consult doctors before directing the woman to go home. That just seems to be plain stupid to me. When will midwives and doctors get over their power struggle, and have the decency to focus on the people at the heart of childbirth, that is, the woman giving birth and the baby, and along with them, the mother’s partner?
I have a suggestion for CCDHB. It seems that resources are very short, so perhaps they should be directed to where they are most needed. People who are having babies over the next couple of months made the decision to have a baby about six or seven months ago. They are in no position to rescind that decision; no matter what, they are committed to having a baby.
However, people who play sport make a decision about whether or not to do it every time they walk onto a playing field. They are entirely able to avoid playing sport. I suggest that CCDHB asks people to avoid playing sport, of any sort, over the next couple of months. This should eliminate sports injuries altogether, and so reduce the load on Wellington hospital. The free resources could be devoted to childbirth and maternity care instead.
This post is somewhat incoherent, I’m sorry. I am very angry about this whole situation. It seems to me that when the going gets tough, it’s women who get shortchanged, shunted aside, and treated as second class citizens, or in this case, not treated at all.