OUR HEROINES: TALES OF MIDWIFERY THROUGH EXTREME WEATHER EVENTS AND CYCLONE GABRIELLE

Auckland Anniversary Weekend marked the beginning of a treacherous time for Aotearoa, with torrential downpours and atmospheric rivers causing chaos in Northland, Auckland and the Coromandel, followed by the wrath of Cyclone Gabrielle, which devastated the Hawke’s Bay and Tairāwhiti areas. Throughout it all, midwives continued to provide an acute 24/7 maternity service with limited resources, pulling together in their communities to keep whānau safe. Amellia Kapa caught up with a few midwives from some of the affected areas.

Linley Taylor had been working in the Napier area as an LMC until the end of 2022, when she wrapped up her caseload in preparation for working with Médecins Sans Frontières (Doctors Without Borders). In the early morning hours of 14 February, Linley observed howling winds and lashing rain over the city from her home on Napier Hill. Her power had switched off, but she still had cellphone service, so she called the maternity coordinator at Hawke’s Bay Hospital in Hastings, to check if they needed help.

Acting Director of Midwifery Catherine Overfield answered. “We didn’t really know how bad it was at that point,” Linley explains, “and some of it still hadn’t happened yet. Roads were still open, the hospital still had power, so when I called and asked if they needed anything, they were ok at that point. But within about an hour and a half, all of the roads were suddenly shut and news was coming in saying the river banks were bursting, or had already burst.”

After messaging the local private LMC Whatsapp group and only getting one response, Linley, who is also the sub-regional College chairperson, knew the situation was serious. “That’s when I realised how bad things were. I did a couple of ring arounds and couldn’t get hold of anyone. I then called Catherine back to let her know people couldn’t even call their LMCs, so we had a major problem.”

“Catherine mentioned Julie Kinloch (LMC) was heading down to the Napier Health Centre to set up a temporary space for pregnant women,” Linley recalls. “That’s only a few minutes away from my house, so I went down there. A plan was made for Julie to stay at the health centre overnight and a paediatrician had agreed to stay too. There was no way in or out of Napier at that point, and no way to get hold of anybody either, so it was the best solution we could come up with.”

“By the next morning, a couple of other LMCs had trickled in,” she continues. “They would pop in to say they could help, but once they left, there was no way to get hold of them again. I realised the best use of my time was to get on my laptop and using my list of College members, find out where everybody lived, go around to all of their houses and put together a roster to take us through until Sunday.”

After visiting every Napier midwife on the list, a roster was produced. “I took a photo of the shift list, emailed it to Catherine so she knew what was happening in Napier, and then we were away. Everyone was amazing – it was like clockwork. We still had no communication lines, but everyone turned up. As the only one with cellphone service, we made the decision that I wouldn’t be on the roster, but I’d be on call 24/7 as a second midwife for births or any other situations requiring another pair of hands.”

Pooling resources from across the region was key, as Linley explains. “We pulled an old CTG machine from our Midwifery Resource Centre in Napier, we had homebirth kits from LMCs at the ready, including oxygen. We managed to get a Neopuff over from Hastings hospital as well as PPH drugs – the extra drugs homebirth midwives wouldn’t normally carry. So along with triaging, we were ready to deal with birth, neonatal resus and PPH if need be.”

“An obstetric registrar who lived in Napier turned up as well, so it was like we had a mini maternity centre. The camaraderie was actually really cool. Everyone I spoke to was more than willing to help and in the end, they didn’t need to do much – some women did get transferred out, but no one birthed in Napier over that time.”

Even though she played a significant role, Linley is clear that the reason the temporary clinic was established so quickly was due to the foresight of widely known and respected LMC Julie Kinloch. “It was Julie who went down there to the Napier Health Centre, off her own bat, without waiting to be directed. She planted herself there, set things up and made it happen. And it was the core midwives and LMCs who turned up on cue.”

Over in Hastings at the Hawke’s Bay Hospital, Catherine Overfield, Acting Director of Midwifery - Te Whatu Ora Te Mata a Maui, was managing the secondary unit under the same challenging circumstances.

“The day of the cyclone I’d come to work in Hastings from my home in Napier and within a few hours the roads had closed, so it became clear that those of us who were from Napier couldn’t get back. Hastings itself was functioning reasonably normally – there’d been some interruptions to power but people could travel, so we didn’t really know the full scale of the emergency because we had no communications coming in from those places worst hit. There was no cellphone service or power in Napier, so we had no way of knowing who was even coming in to work their shifts,” Catherine says.

The only solution was to work with what they had. “There were a few of us midwives who just camped out at the hospital and worked back-to-back shifts.

We slept in the unit, got up, and went back to work again,” she explains.

The personal sacrifice for midwives and their maternity colleagues – particularly on the first day of the cyclone – was huge, as Catherine describes. “The biggest issue for staff on shift that day was having absolutely no idea whether their families at home were safe, knowing that their areas were being evacuated and having no way of communicating with them. Yet they continued to provide care and a sense of normality for women and whānau walking through the doors, even when they couldn’t contact their own families.”

And while the issue of Napier and Hastings being cut off from one another was problematic, she was also aware that the more remote areas were potentially in even deeper trouble. “Wairoa have a continuity model, and they were in a situation where the midwives who worked there not only didn’t live there, but couldn’t travel there either. So Wairoa was completely cut off. It took a day or so before we even knew whether the hospital there was still standing, or whether our colleagues were safe and well.”

Like Linley, Catherine also observed midwives supporting one another seamlessly throughout the Hawke’s Bay region, prioritising whānau care above all else. “Those of us from Napier who got home but then couldn’t get back to Hastings pitched in at the Napier Health Centre, and in turn, the LMCs in Hastings supported the hospital staff by picking up shifts. Everyone just pulled together and supported one another across primary and acute emergency services.”

Once the cyclone was over, much needed support was gratefully received from outside of the region, as Catherine recalls. “Those midwives who came to us through the locum service brought an energy that was so well received by midwives here. For those who were directly affected, we could tell them to just stay home and do what they needed to do.”

Catherine points out that the after-effects of the events lingered on well after the flood waters had receded, and may do for some time yet. “It’s been an emotional rollercoaster. Once the adrenaline wore off, we were all coming back down from that and starting to hear the stories trickling through. The drive to and from work was quite confronting for a while.”

As highlighted by Catherine, some midwives were more directly affected than others throughout the weather events.

Jacquelyn (Jax) Paki, an LMC based in West Auckland, is one such midwife, whose rental property in Glen Eden – which houses herself, her four children and her mother –was damaged by flood waters.

On the evening of 27 January, after a full day of postnatal visits, Jax found herself desperately sweeping water out of her house as it poured through the downstairs level “like a river”. On the phone to her landlords, explaining she couldn’t do anything more after being at it non-stop for hours, Jax had to give up trying to stop the water and change tack, rescuing as much furniture as she could from three downstairs bedrooms.

“We’re on a slope, so the water was coming straight through the gaps in the house and then just running straight off the tarp in the basement. None of it was being absorbed into the earth at all, which was the main issue in Auckland.”

“We’ve got a double garage, so we moved the three bedrooms in there,” she explains. “It all just got dumped. The lounge became our wardrobe and bedrooms – initially my older girl slept in there, while myself and the little ones slept on the floor in my clinic space and my mum took the master bedroom. I had to cancel clinic because I was too whakamā to have people over.”

The emotional and psychological toll was significant for Jax, who was juggling the needs of her own whānau with her caseload, including caring for her 10-month old pēpi and still adjusting to a new lifestyle after her older son was diagnosed with Type 1 diabetes just before Christmas in 2022.

“It took me 3-4 days to reach out to māmā because I wasn’t in the headspace and didn’t have the capacity to check on them in amongst everything else that was going on. Obviously they were being cared for by my locum, but I just wasn’t able to work for a few days. Then we had more warnings about the cyclone – so I contacted all of them to ask what their plans were, to make sure they were ready and had strategies in place if their houses were at risk of flooding.”

“Eventually we shuffled everything around so I could still do clinic and felt better about whānau coming into our space,” she explains. “But for quite a few weeks I just did home antenatal visits so that I could sort out my own whare while still giving whānau the care they needed.”

The reality of potentially being cut off from services meant Jax’s conversations with whānau evolved accordingly. “Especially for māmā who were nearly term, I went over what to do if baby birthed and I wasn’t there and they needed assistance. Going over the possibility of neonatal resus with their tāne or whānau became a necessary kōrero.”

Like others, Jax says it was community support that got her through. “I wouldn’t have been able to do it without the persistence of midwife friends like Mel Nicholson and Brigid Beehan. They were so supportive. Mel dropped off a giant tray of sandwiches and helped out financially so I could go and spend a day at the laundromat.

The reality of being cut off from services meant conversations with whānau evolved accordingly. “Especially for māmā who were nearly term, I went over what to do if baby birthed and I wasn’t there and they needed assistance. Going over the possibility of neonatal resus with their tāne or whānau became a necessary kōrero.” and the heavy downpours were happening, I was cut off from going in to work my night shift. I’d tried to go down the road, but the water was too high to get through, so I had to call in about four hours before my shift to say I couldn’t make it. I had to ring on my landline because power and internet were both cut off.”

As one of the worst hit areas, Gisborne’s hospital resources were majorly affected, as Nerissa explains. “We have a hospital generator, but for a period of time it only covered essential power. A water pipe had also burst, so the whole hospital was on restricted water, which is never ideal in maternity, and it meant the labs weren’t fully functioning either."

“The first night wasn’t too bad,” she continues, “because the hospital still had power, but as the rain got heavier, the biggest concern was that our communications were cut off and we had around 20 women due to birth in the area, with no way of them being able to call their LMCs or us at the hospital.” ok and ask whether they were available to come in for birthing and how we could contact them.”

“The LMCs were great,” Nerissa says. “They came to the party and covered the LMCs living on the other side of the river. I stayed on-site the second night, so that my husband and I could be the runners. If someone came in to birth, we would go and get an LMC who lived on this side of the river. I was there to support our night staff to birth whoever turned up, and we also had our obstetrician, paediatrician and anaesthetist stay close to our unit.”

Brigid dropped off spaghetti bolognaise. Not having to worry about what to cook was such a huge help.”

In Gisborne, Nerissa Walters, Director of Midwifery - Te Whatu Ora Tairāwhiti was also juggling priorities as Cyclone Gabrielle hit her region and home. “On the first night when the cyclone was starting

Once the rain had slowed and the water levels had receded enough for Nerissa to get out of her road, she and her whānau evacuated and went into town. Many other midwives were still stuck, however. “The majority of LMCs lived across the bridge, but that was closed at night for safety, so we couldn’t get to them and vice versa. I went around and knocked on the doors of some of the LMCs who lived on this side of the bridge, to check they were

“The next day, the LMCs made a plan to do 8-hour shifts and created a roster. The LMC on that shift would be responsible for triaging, providing birth care, or any primary antenatal assessments. That happened for the remainder of the week and it was actually nice for our employed staff to have an extra midwife around too, especially at night.”

As one of the worst hit areas, Gisborne’s hospital resources were majorly affected, as Nerissa explains. “We have a hospital generator, but for a period of time it only covered essential power. A water pipe had also burst, so the whole hospital was on restricted water, which is never ideal in maternity, and it meant the labs weren’t fully functioning either. We couldn’t order any tests online, so all requests had to be handwritten, and they would do batch processing, so if we needed PET labs done for example, they could only be collected and processed at certain times.”

“We’ve been on Badgernet here for years,” Nerissa continues, “which is what everyone’s used to, but then power and internet went out, so we had nobody’s records. Nothing. Our LMCs couldn’t access their records either, so it was an interesting time. Our staff were so amazing though – they just carried on.”

Finding solutions as issues arose became part of the daily routine and, in some cases, the answer was found through connections, or whakawhānaungatanga, as Nerissa explains.

“There was a woman in Ruatoria region who we knew we needed to keep an eye on, but of course without Google maps, we couldn’t figure out how to locate this woman’s whare. Then we realised another whānau staying with us at the time were from the same area, so we asked them if they knew the whānau, and of course they did! With their help, we were able to create a map and instructions for the retrieval team so they could go up and collect this woman and her whānau.”

Along with the other midwives featured in this article and many others throughout the motu whose stories haven’t been shared here, Nerissa found herself going above and beyond the call of duty. “With support from our amazing social worker, I went out and found women who were on our vulnerable list. My husband and I went to their homes to find out what they needed and mostly it was food, because eftpos was down everywhere, ATMs weren’t operational, and no one had cash.”

“I went to the supermarket and at that time we were only allowed one trolley, and to shop for one whānau, but I explained to staff who I was and what I was doing, and that the three households I was shopping for didn’t have any kai. At the end, once they had scanned the items through, they asked me to wait because people standing in line had heard what I’d said and donated. I ended up leaving with three trolleys full of kai and basic supplies for those whānau in need.”

Nerissa’s pride in the way her team and midwives of the region conducted themselves throughout the cyclone is evident. “We had women who birthed over that time and the feedback was exactly the same as usual; they didn’t want to go home. Even though everything else in our lives and region was displaced, the women felt safe here, and that’s what midwifery is about.” square

Along with the other midwives featured in this article and many others throughout the motu whose stories haven’t been shared here, Nerissa found herself going above and beyond the call of duty. “With support from our amazing social worker, I went out and found women who were on our vulnerable list."

MACDONALD MIDWIFERY ADVISOR