11 minute read
A TESTING TIME FOR MIDWIVES AND WHĀNAU
Aotearoa’s stringent Covid-19 response has impacted significantly on our lives since early 2020; however, in comparison to the majority of the world, we have been able to enjoy relative freedom. Horror stories of prolonged lockdowns or periods of significant restrictions, strained health care systems and high death rates around the world - although shocking - seemed like a remote and somewhat abstract reality. However, with the arrival of the delta variant in August this year, Aotearoa entered a new phase in its Covid-19 response, with a number of significant changes, including the move from an elimination approach to a suppression strategy, and the announcement of vaccine mandates.
Tāmaki Makau-rau has continued to bear the burden of Covid-19 since August, with a prolonged lockdown, and Auckland midwives have once again carried out their essential work in a highly professional way, in often very difficult circumstances. As we sit on the cusp of a wave of community transmission throughout the remainder of the country, we will all soon be experiencing what the rest of the world has been living with for almost two years, and our lives will be changed forever.
Fortunately, the impacts of the ‘new normal’ will be considerably softened, as we will have achieved extremely high vaccination rates by international standards before widespread community transmission occurs. As a result, hopefully we will not have to live through the ghastly experiences that other countries have, to quite the same extent. The past few months have been a testing time for midwives and whānau having babies, as we have had to come to terms with the reality that living with Covid-19 will soon become our permanent state of being.
ALISON EDDY CHIEF EXECUTIVE
Reconciling the government’s mandate with our unique professional perspective was always going to require deep introspection and enquiry; weighing up our personal right to choose with the rights of those we care for to have their risk of exposure minimised by their health provider.
Some weeks before the vaccine mandate for healthcare workers was announced, Ministry of Health officials approached the College to seek our feedback on what we considered the likely consequences of such a mandate. Our advice to them was that we did not support mandating vaccination and that an educative, supportive approach was preferable, considering:
• The vast majority of midwives were already vaccinated.
• The workforce was already stretched, therefore we didn’t want to lose any midwives.
• Contradicting the informed consent principle sits uncomfortably for our profession and could result in the opposite of the desired effect.
We advised that soon-to-be implemented strategies - like vaccine certificates - were more likely to shift vaccine-hesitant individuals towards acceptance, as the reality of reduced personal freedoms sunk in. Why not let these initiatives have an impact, before considering a mandate?
However, like all things Covid-19, the government’s decision needed to be made swiftly, and although the initial proposed timeframe was unfeasibly tight, the decision itself was not unexpected. The decision aligns with the government’s overall response to the pandemic thus far, which has always aimed to preserve the life and health of New Zealanders, protect our economy, minimise inequities and mitigate any deleterious effects on our health system. Although our culture is one which highly values personal freedom, there is strong public and cross-party political support for the mandate. There is also international policy alignment, as vaccine mandates are becoming increasingly common overseas.
As a profession whose history and underpinning tenets are intrinsically linked to advocacy for women’s rights to informed choice, the government’s decision to mandate vaccination for health workers was always going to pose some philosophical questions for us. We have a proud history of standing up for women’s rights to decline medical interventions. Many of these interventions were applied universally during childbirth, without supporting evidence, often for spurious reasons or clinician convenience, as opposed to serving the best interests of the women involved. We are the profession caring for women in all birth settings and we adapt this care in order to respect women’s self-knowledge and expertise. We know that healthcare choices are deeply linked to personal beliefs, and that the right to choose is an essential element of being autonomous over our bodies, enabling us to feel as though we have agency over our lives and sense of wellbeing.
So, reconciling the government’s mandate with our unique professional perspective was always going to require deep introspection and enquiry; weighing up our personal right to choose with the rights of those we care for.
The College has heard from many members as the reality of what this mandate means has become clearer. Overwhelmingly, the majority of members recognise that vaccination is a strongly evidence-based intervention, which reduces the likelihood of transmitting the virus to others, as well as the severity of its impacts on the individual. For many of us, Covid-19 has changed the way we view the world and reset our priorities and values, including how we perceive our individual rights in contrast to our responsibilities as health professionals, or even as New Zealand citizens. Importantly, Auckland midwives have been highly supportive of the mandate, which demonstrates that lived experience of risk of exposure to Covid-19 infection is perhaps a reality check that those of us throughout the rest of the country have not yet experienced. Strong support has also come from those whose families are based in highly-affected countries overseas.
The experience of Auckland hospitals demonstrates that managing unvaccinated workers following exposure events to Covid-19 positive patients is problematic. These workers pose a greater potential risk to health service users than vaccinated workers, and they are also unprotected from Covid-19 infection or its most severe effects (in the case of a breakthrough infection), and therefore need to be managed differently in the workplace.
The College board met to discuss its response to the mandate and their views have already been communicated to members via email. The board recognised that pregnant women are highly vulnerable to the consequences of the delta variant compared to the non-pregnant population, and are also a more vaccine-hesitant population, due to intergenerational and widely communicated concerns about medications during pregnancy. It reiterated that being a midwife comes with a set of professional responsibilities, and personal choice regarding vaccination has consequences beyond a midwife’s own individual situation. Being vaccinated protects ourselves and those we care for, and this is the overriding professional imperative at this point in time.
The minority of members who are opposed to being vaccinated against Covid-19 cite concerns about informed consent and their rights to refuse health care treatments. The important distinction is that anyone’s rights to refuse vaccination are enshrined in law, and nobody can be forced to receive the vaccine, however if midwives want to remain in the workforce, being vaccinated is now a legal requirement of this privileged position of responsibility. Our role in advocacy for women’s choices and rights in childbirth remains fundamental to our profession and is not diminished by accepting vaccination as a necessary requirement of midwifery practice at this exceptional time.
I have spoken with and heard from members who state an intention to leave, as they do not wish to be vaccinated. Although I have great sympathy for the argument about informed choice, it is obvious from many of these discussions that concerns about vaccination are heavily influenced by misinformation, which is increasingly well organised, privately funded and sophisticated. The various rationale frequently cite misinterpreted data from scientific papers, unsubstantiated theoretical concerns from discredited ‘experts’, or ‘experts’ with a qualification unrelated to the area they are commenting on. The arguments often demonstrate a lack of understanding about how vaccine development and safety
monitoring is undertaken, from clinical trials, to observational and epidemiological data, to the reporting and separate analysis of vaccine adverse event surveillance data.
This statement is not intended to denigrate the intelligence of anyone who is vaccine-hesitant. Confirmation bias is present in all of us, and social media algorithms send us down rabbit-holes which feed us the information we are seeking, to confirm our point of view as correct. Indeed, the science of vaccine development, testing, monitoring and surveillance is highly complex and its analysis relies on multiple academic studies, which thousands of scientists are working on pieces of globally. It cannot be readily described or understood in brief interactions, but the nature of a chaotic and worrisome event like a pandemic leads us to search for simplicity and certainty.
We must also acknowledge the impact of colonisation, racism and medicalisation on the level of trust or mistrust in public institutions and ‘mainstream’ medicine. Those who have experienced negative interactions and associated impacts have sound reasons for being wary of recommendations from a system that has caused them harm. Perversely, these groups may suffer further harm through higher infection rates, due to being unvaccinated.
As a midwife, I am proud of my profession’s knowledge and expertise, which is underpinned by the art and science of midwifery. My midwifery knowledge and education, and my Master’s degree in public health have given me the ability to read and critique scientific literature about the Covid-19 vaccine and interpret it in the context of my practice. It has also helped me to understand public health principles and consider midwifery’s role in responses like the one we currently face.
But I am not an immunologist, nor a public health expert. And just as I expect those specialists to respect midwifery knowledge and expertise, I respect theirs. I believe that these professionals approach their work with the same integrity as midwives. When they approve vaccines, or make decisions about which population groups can safely receive them, I trust that they have the same primary motive as midwives - to do no harm. I do not believe that immunologists, public health experts, independent agencies like Medsafe, or the New Zealand government, would recommend or approve the Covid-19 vaccine unless they were confident that the evidence supported this decision.
I have detected high levels of emotion from midwives across the spectrum, with many upset that public statements made by midwives against vaccination have diminished the credibility of the profession, whilst others are angry that a core principle of their professional worldview is under threat. The common theme is that midwives hold high ideals and strong views of their professional roles and responsibilities, as natural advocates. It is deeply distressing to lose any midwives from practice; for them personally, and the profession as a whole. We must ensure that the door is left open for them to return to the profession if, over time, they feel ready to return. For this moment, because of our unique position in the world of being comparatively far less harmed by Covid-19 infection, vaccination is the pathway to the best protection available, for ourselves and our wider communities, including every new whānau in Aotearoa. square
TAUTOKO ŪKAIPŌ MAI I TŌ TĀTOU AO
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