Midwives at breaking point

Known as the backbone of maternity health, midwives play a vital role in the protection and enhanced health of mothers and babies. Many of us have benefitted firsthand from the consistent care, knowledge and emotional support provided by our midwife through a pregnancy, birth and postnatal care of a child. Story by Abby Beswick Photos by Florence Charvin

“It’s a massive privilege to be there watching a woman become a mother, watching a couple become a family and to be there walking with them.”

In spite of the value they bring to families and society, these frontline workers are suffering from huge workloads, challenging working conditions and low pay. Put simply, our midwives are facing emotional and physical exhaustion from the demands of a job that’s pushing many to breaking point.

Supporting couples through the journey to parenthood is a huge privilege, say midwives. But the relentless demands of the job, exacerbated by Covid-19, have taken a toll on our midwifery workforce, which was already crumbling before the pandemic.

Here in Hawke’s Bay a number of midwives are choosing to leave the industry, which is putting further pressure on those who are left and making it increasingly hard for pregnant women to find care.

Overworked, unsupported and underpaid

The envy of many countries, New Zealand’s midwifery service is considered among the best in the world for the consistent, efficient and effective care they provide. Midwives look after women throughout their pregnancy until about one month after birth. These highly qualified healthcare workers are on call 24/7 for the women they care for.

Ask any midwife and they’ll tell you they didn’t choose their profession for the money or the lifestyle. The relationship between a midwife and family can be a magical experience for both sides, but it also comes with huge responsibility – during every birth the midwife is responsible for two lives.

Hastings midwife Angelika Mollman has helped more than 1,500 women birth their babies during her 30 years in the industry. She loves her job and accepts the lifestyle that comes with it, but the demands of the job are challenging, she says.

“It’s a massive privilege to be there watching a woman become a mother, watching a couple become a family and to be there walking with them.” Being on call 24/7 is difficult, especially if you have a young family of your own, she says. By default, your partner is also always on call, and you need to always have back-up options for your childcare and home and family responsibilities, says Mollman. “There is no other job with the same responsibility and with the same accessibility.”

Women presenting with medical complexities has become more common, increasing the risk factors for pregnancy and birth, says Mollman. For example, women with underlying health conditions, rising levels of obesity and pregnancy through artificial means.

For each woman they care for, community-based midwives work about 40 hours and are paid between $3000 and $4000 (before tax and GST). The fee covers everything involved in the woman’s care from pregnancy until one month after birth, including checkups, home visits, paperwork, on-call responsibilities and expenses such as car and phone. There is no sick leave, bereavement leave or annual leave. A full-time client load for a community midwife is 40 women per year.

ANGELIKA MOLLMAN

Extra responsibilities

On top of the demands of the job while juggling family life, the role of midwives has extended beyond the typical boundaries, adding further pressure, says Julie Kinloch, a community-based midwife in Napier with more than 30 years’ experience. Kinloch is also the regional chairperson for the NZ College of Midwives central region.

In Hawke’s Bay a growing number of families are struggling to make ends meet, leaving midwives to carry out social services to ensure newborns and their families are safe, says Kinloch. Midwives are often supporting families to source food, blankets, warm clothes and even housing they desperately need. “That’s been one of the burn out issues. There’s more and more poverty, there’s more and more distress and there’s nobody to attend to that,” says Kinloch. “We have deprivation here, which is massive.”

The impact of Covid

The long-time pressure on the industry has been heightened by Covid-19, says Kinloch. As part of this, a fear of hospitals at the beginning of the pandemic

prompted more women to choose to give birth at home. Hawke’s Bay has around 20 home births a month, which is higher than the national average.

Unlike many jobs that could be practised remotely, midwives were required to work with clients in person throughout the pandemic to carry out routine checks and attend births. This regularly took place when there were active cases of Covid-19 in the household.

We have 111 midwives in Hawke’s Bay, according to the 2021 Midwifery Council statistics. Due to the vaccine mandate, the region has lost eight of these, which is significant for a small workforce.

On top of this, rolling cases of Covid19 during the pandemic continue to have an impact, placing yet more pressure on available midwives to pick up the slack. Burn out is common, says Kinloch. Recently she covered for five midwives over 10 days while they were off sick with Covid-19, on top of her usual workload. “We don’t want harm to come to women. Someone has to step in because those women are still pregnant and still need the care,” she says. “Historically, we’ve always been well numbered with midwives, but I would say that the last two years have really taken a toll.”

The lack of value placed on midwives is perhaps nowhere more evident than in their Covid-19 payments. When a midwife puts on full PPE and enters a Covid-positive house to look after a pregnant woman she’s paid $100. The amount is a one-off fee paid per family, regardless of how many visits there are. The payments are demoralising and illustrate the lack of acknowledgement for their work, say midwives. The fees are paid quarterly by the Ministry of Health via Te Whatu Ora - Health New Zealand - the new entity replacing health boards. Midwives spoken to for this article said many of their colleagues are still waiting to receive payments.

“Historically, we’ve always been well numbered with midwives, but I would say that the last two years have really taken a toll.”

JULIE KINLOCH

A privilege like no other

Poor pay, a lack of support, and 24/7 on call responsibilities have created an environment where midwives are mentally, emotionally and physically drained. It’s no wonder then, that many of them are choosing to move overseas for better treatment or are leaving the sector.

So why do this job at all? It’s magical, Kinloch tells me. “I have loved the vast majority of my 35 years. It’s a lifestyle but I wouldn’t have changed it for the world because sharing this time with women and empowering them to get on and have their babies and support them in becoming parents is an honour.” Better pay is part of it, but ultimately, it’s more support that midwives need. We need to attract more people to the industry and keep them. Graduates should be supported through their studies, like other trade programmes receiving Government funding, says Kinloch.

Midwifery students commit to four years of full-time study and are required to have a huge knowledge base. In addition to the demands of study, exams and assignments, during placements they are on call 24/7, leaving no time for additional work to supplement their student loan. Kinloch describes the job as “arts and science” as their roles range from providing medical expertise to emotional and practical support to families.

Kinloch and NZ College of Midwives midwifery advisor, Jacqui Anderson, point to a system problem when it comes to negotiating improved pay and conditions. “We’re a tiny profession of nearly 4,000 midwives and we just have no voice,” says Kinloch.

When midwives suffer, everyone suffers

Midwives are highly qualified. They provide medical support, emotional support, and in many cases, social support to women and families throughout a life changing experience.

They are always on call, yet they don’t get paid a callout fee like an electrician or plumber does. They’re overworked, under supported and poorly paid. There is no other job in New Zealand like it.

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Over the years that we have been working with families, we have seen how helpful pre-planning and arrangement can be for everyone involved. We think of preplanning as a gift of love for families because it means you are helping them fulfil your wishes at a time when they are feeling the immediacy of your passing. Our new website is now online to help you prepare information ahead of time which means they know you will

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Two countries, two very different midwife experiences

Hastings mum Melisha Bradley gave birth to her two children in different countries and her experiences of midwife care couldn’t be more contrasted. After several heartbreaking miscarriages, when Bradley became pregnant with her first child, while living in Australia, she and her husband Cameron decided to get a private obstetrician to provide additional care and peace of mind.

Under the Australian system, GPs provide initial care during the pregnancy before referring women to a hospital midwife for shared care in the later stages. Rather than having one midwife, Bradley saw whoever was on duty each time she had a check-up, so she never got to know the midwives well. However, she felt confident she had all of the right people around her to provide the care she needed.

By her third trimester, Bradley had developed pre-eclampsia, deeming her a high-risk pregnancy. The couple decided against having their obstetrician at the birth as it would cost an additional $10,000, but they were comfortable they would be well looked after by the hospital staff.

Unfortunately, Bradley’s birth wasn’t the calm, straightforward experience she’d hoped for. After being induced, she required a lot of interventions due to multiple complications – a situation that was exacerbated by having midwives who didn’t know Bradley or her birth plan. “It was just one thing after the next,” she says.

In pain, Bradley requested an epidural, but it took several hours for the midwife to accept she needed one, says Bradley, as it wasn’t on her birth plan. “The midwife didn’t know me from a bar of soap … I was in so much pain, my body was shutting down.” Their daughter Aria was born healthy, but the experience of her birth has had a lasting impact. “I couldn’t sleep for the next two-three days because every time I closed my eyes I had flashbacks … It was actually quite traumatic.” The experience was so difficult for the couple, Cameron wasn’t sure he wanted to have any more children.

Determined to extend their family, when they moved home to New Zealand, they decided to try again, and the experience the second time around couldn’t have been more different.

Throughout her second pregnancy, with son Lincoln, Bradley received care from two midwives who got to know her, her medical history, preferences and birth plan. It was a huge relief, she says.

At 41 weeks, Bradley went into natural labour, and was supported by her midwives throughout. “I felt really comfortable and relaxed because I had the same midwives. They were informative, empathetic, caring and they had all the time in the world.” After a 14-hour labour, Bradley gave birth to her son on July 1.

The couple credit their midwife care as a huge part of their different birth experience with Lincoln – so much so that they’re now considering baby number three. “It was positive, it was calm and I felt like my husband and I had choices.”

The quality and consistency of midwife care in New Zealand is worldclass and should be valued more highly, says Bradley. “That’s one thing New Zealand does well is midwives. My midwives were absolutely amazing, I just wish they were paid more.”

“It was positive, it was calm and I felt like my husband and I had choices.”

MELISHA BRADLEY

Midwives play a vital role in a couple’s experience of pregnancy and birth. They build trust with the women and families they look after, get to know their birth preferences, their medical history and their personality – that’s the true value of a midwife, says Mollman. “You need to know that that person looking after you has got your back.”

The continuity of care a midwife provides has been shown to make a huge difference to women’s experiences and outcomes. “The way you’re treated, the respect you’re given, your involvement in the decision-making is important and if you’re not getting that, that affects your whole life including your parenting of that child,” says Kinloch.

From next year, Hawke’s Bay women will be struggling to find a midwife, due to the number leaving the industry, says Kinloch, whether the reason is burn out, better pay and conditions overseas, or simply ‘normal’ retirement age. She’s already had calls from women, crying on the phone because they can’t find a midwife.

All midwives are asking for is the support they need to do their job well and to be paid fairly for it, so they can continue to give women the best care possible, says Kinloch. “It takes a community to support a family and it takes a community to support a midwife.”

Midwifery is an “amazing profession” she says, and New Zealand is so lucky to have these incredible, passionate midwives.

A day in the life of a midwife

Angelika Mollman’s role as a midwife is to provide medical care and support to her clients and their family. But there’s so much more to the job than that. No two days are the same and the nature of her work means she can get called to a woman in labour at any time. Here’s one day in her role as a midwife. 7.30am get up and go for a 2.5km run with the dogs. Shower, dress, eat breakfast. 9am Start seeing clients at the clinic (Maya Midwives). Meet with six women who are at various stages of pregnancy for antenatal checks.

Midday - Get called to the hospital to assist with a colleague’s client who has gone into labour with twins. As multiple births are high risk, two midwives are present during the birth. They carry out checks of the babies, which can be challenging as it’s sometimes difficult to differentiate between the babies’ heartbeats. They need to ensure they’re hearing two different heartbeats rather than the heartbeat from one twin twice.

The mother, who is 36 weeks pregnant, is labouring well and chooses not to have an epidural. At 2.30pm the first baby comes out – a girl. Her brother follows 15 minutes later. Angelika’s colleague catches both babies, who are both healthy. 4pm Back to the clinic to see two more clients for antenatal checks. 5pm Go home. Write up notes and complete paperwork from the clinic. Check test results that have come back to see if any need to be actioned or followed up. Take phone calls from clients who have questions. Finish work, while remaining on call for the rest of the night.

Royston Hospital is pleased to sponsor robust examination of health issues in Hawke’s Bay. This reporting is prepared by BayBuzz. Any editorial views expressed are those of the BayBuzz team.

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