Open Letter To NZCOM regarding Dec issue of Maternity News

20 December 2017

To the Committee of NZCOM

Firstly we would like to express our delight at the focus of the latest issue of Midwifery News on primary birth settings. As was expressed so well in several articles across the magazine, there are multiple advantages to mothers and babies when birthing in primary settings, and significant risks when low risk women birth in hospitals. What concerns us greatly is that within this discussion on primary settings, the option of home was almost ignored, and in the context of this focus, that is concerning.

We as a consumer organisation are disturbed by what appears to be a lack of support for one of the three key place of birth options as outlined by the Ministry of Health. The HDC Code of Rights requires all expectant mothers to be clearly informed of all three options and allowed to make the decision that suits them best. We are highly concerned that this is not being done, and that many women are not aware that they have three options, or that they are being restricted in their choice by what locations the midwife prefers. We are concerned that a number of midwives are not meeting their requirements under the Code, both to provide full and clear information, that allows informed decision-making by all women regarding place of birth but also to be able to provide sufficient care and skill to meet their client’s needs. If a midwife working as an LMC is only confident enough to support a low risk birth in a hospital setting, then that is not meeting the Code of Rights requirements. We are concerned that the number of midwives who fit this description is significantly high, and we feel that the College does as well, hence the focus on primary birth in this magazine issue. Hence we request the College be more strident in assisting in the return to the norm as it used to be – midwives who are capable of fulfilling their duty under the Code of Rights and the College of Midwives’ Consensus State, and being actually able to support birth in ALL three settings, and not just paying lip service to this.

The location of home being given scant attention in the latest Midwifery News may not have been intentionally done, but it illustrates the widespread attitude of home being considered a minor option, and this seems to be an attitude that is clearly entrenched in the minds of the midwife collective. Even what was otherwise an excellent article by the President, Deb Pittam, mentions home in a subtly derogatory way, with the expression “as far as the safety of birthing in primary units or, for that matter, at home is concerned, the evidence is strong.” Home is mentioned as an afterthought. And while it is quite possible that Deb doesn’t actually feel that home is of lower standing to a primary unit (although she may, we couldn’t rightly say), the inference by a casual phrase like that is often subconsciously reinforcing midwives’ opinion of home birth as not on an equal level with either hospital or primary units. We feel compelled to point out that tacit messages like that, as well as discussions of primary/community locations where primary units are strongly pushed, and home is barely mentioned at all, will continue to reinforce these negative ideas about home birth in the minds of most midwives. The College needs to lead the charge of upholding home and primary units as equally valid, and equally excellent places for babies to be born in safe and empowering circumstances, as Deb alluded to in the opening statements of her article. The skills and expertise of a midwife experienced in true normal, physiological birth is more than sufficient to operate in both settings. It is the clients that are missing out if their choices are being restricted by where a midwife is more comfortable working.

While we acknowledge that the article on community birth by Lesley Dixon did mention home twice, in qualifying the term primary or community locations, in actual fact the angle of the entire article was clearly to promote primary units only. We request clarification on why home could not have been given priority in part of the same article. As research studies were strongly used by Lesley in her discussions, if there isn’t sufficient quality research that focuses on or includes home birth, we respectfully enquire what NZCOM is doing to rectify that. If the next issue of Midwifery News plans to give the same amount of time and attention to home birth as the primary units received in this issue, then we await it with interest and wonder why that was not stated early in the article, making it clear that home is not nearly invisible, but a primary location, the first listed in Ministry of Health information, and strongly supported by the College. As pointed out by Jacqui Anderson in her article, private providers are behind a number of primary units, and if primary units are being promoted to the detriment of home, and home not being supported in equal measure, it does begin to ring alarm bells in the minds of some as to who is profiting by an uneven support of primary locations over home.

Another situation that surprised and dismayed us, particularly when considering the focus of this issue of the magazine, was the lack of any mention of the recent national Home Birth conference held in early October. It took place before the Joan Donnelly conference, which received a full report in this issue, but not only was similar attention not afforded the Home Birth conference, but there wasn’t even a snippet mentioned in the Bulletin paragraphs towards the final pages of the magazine. We find this quite extraordinary, particularly since not only was one of the College’s senior staff a delegate, but she also contributed to this magazine issue. The natural assumption is that as a staff member, Lesley would have been required to report back on her attendance at the conference to the College, and we wonder how the speakers and topics covered, were not deemed relevant to mention in any way in this December issue. The conference was very successful, with as many as three quarters of the delegates being midwives or student midwives, and the topics presented were not only well received but things delegates wished could have received a wider audience. Our venue had a capacity of 120 and we had reached capacity and were receiving emails from people desperate to attend two weeks out.

We thank you for your consideration of our concerns, and look forward to receiving your thoughtful response as soon as possible.

Kind regards,

Sandy McGivern-Butler, Chairperson

Lynne Carne, Committee Member

Donna Fowles, Committee Member

Holly Neilson, Committee Member

Philip Carne, Committee Member

Rose Fisher, Committee Member

Fiona Saunders, Committee Member

Bridgette Jones, Committee Member

Alix Whittaker, Committee Member

 

on behalf of Auckland HomeBirth Community
www.ahbc.space | contact@ahbc.space

 

Cc: Sue Claridge, Auckland Women’s Health Council

Holly Neilson, Maternity Services Consumer Council

Brenda Hinton and Linda McKay, MAMA Maternity Ltd

Auckland Region Committee, NZCOM

Steering Committee 15 March 2017 Meeting Minutes

Huckleberrys Food
  • Present: Bridgette, Natasha, Rose, Marie, Sandy.
  • Cake was awesome.
  • We need more meetings about meetings (regular?). With cake.
  • Central meetings need evening facilitator and morning meeting still needs a second.
  • After the poll about ads in the main group, conclusion was there should only be our events and no ads.
    • Reasons for this are: future proof – avoids the problems of eventually having too many ads from too many different people (even with the 1 per month restriction) and people’s posts getting swamped by ads and getting lost
    • Instead there will be a resource file where people can add their relevant group or business. People can still suggest or recommend others or their own organisation or business on post, as a comment, so long as it’s relevant to the OP (original post).
  • As above, a resource file needs to be formalised.
  • The files need cleaning up.
    • Should they be AHBC files only? So as to prevent important information such as the Resource file being lost amongst other files and difficult to find.
    • Can birth stories that are in the files that people want to be private be put on the website instead in a private place only accessible by members?
  • Extension on posts that are outside of homebirth (such as parenting posts) being allowed.
    • In recognition of the fact that the group may be the only place people have or the only place they feel comfortable asking in.
    • Posts like these monitored so they don’t overwhelm homebirth posts, get too long, etc. Comments can be turned off in these instances.
    • OP always referred to any relevant groups
  • Meetings need to be more structured with a set time aside for the telling of birth stories.
    • Iterated we need a years worth of topics laid out with dates so list can be put up on the website and Files.
    • Easier to promote and facilitate.
    • Iterated and agreed topics to be rotated amongst groups.
  • Better nibbles at meetings to be more appealing. Facilitator reimbursed for cost of nibbles?
  • Practical meetings
    • e.g. How to Set Up and Birth Pool; Make a Cord Tie For Your Baby; etc.
    • Get ideas from main group about what practical things they would like help with/learn about
    • Guest speakers
    • AHBC cover costs to be more appealing
    • Koha or fee something like $5 or when Inc. Society, yearly membership covers these?
  • Re: Meetings and practical meetings – more consistency amongst local meetings or is flexibility and independence amongst meetings better?
  • Steering group (aka Admin group) members need clarifying on who and how people in this FB group contribute.
    • Anyone can still join for transparency. Those that don’t wish to contribute are normal FB member. Those who are active Steering Group members will be differentiated by being set to a FB admin.
    • This is just to make it easy to see who is a steering group member and who is here to observe.
    • Ask in current FB admin group people who wants to be steering group member, who wants to observe only and who wants to leave.

Hear the Roar Aotearoa

Hear the Roar Aotearoa logo
MC Fiona Herman opens the day
MC Fiona Herman opens the day. Photo by Sheena Byrom

A one day conference on why kindness, compassion and respect matter in maternity care.

Several Auckland HomeBirth Community volunteers attended the Hear the Roar Aotearoa conference at WINTEC in Hamilton on Tuesday. We had the wonderful privilege to listen to speakers Ross Lawrensen (Professor of Population Health at Waikato University), Soo Downe (OBE, Professor of Midwifery Studies at the University of Central Lancashire and Author/Editor of The Roar Behind the Silence), Sheena Byrom (OBE, Midwifery Consultant and Author/Editor of The Roar Behind the Silence), Robin Youngson (Cofounder of Hearts in Healthcare, Anesthetist), Tanya Maloney (Commissioner, Women’s Health Transformation, Waikato District Health Board), Aidan O’Donnell (Consultant Anaesthetist, Lead Obstetric Anaesthetist, Waikato Hospital and Author) and Alison Barrett (OB/GYN).

The day started with a beautiful and poignant welcome from Tame Pokaia (kaumātua for WINTEC, Trust Waikato and Hamilton City Council). While it’s difficult to pinpoint any one great thing about the day, the overall feel was that of validating what many of us in the home birth arena already know – that compassion, kindness and respect are essential to maternity care. We also appreciated hearing varied methods about getting our message across, growing as a movement and being a force for change.

Truly, the atmosphere of around 200 people passionate about improving maternity services was electric with many heartfelt tears during the powerful and often emotional day. We are again reminded of the power and strength of coming together, united in a common cause and enlivened with passion, love and courage in our hearts.

Why Do Bad Maternity Systems Happen to Good People by Alison Barrett

Healing Relationships in Maternity Care by Robin Youngson

 

Further Reading:

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Response to the NZ Herald article

Today the NZ Herald published a front page article entitled “Baby health concerns” (along with similar articles on other media outlets) based upon the Comparison of Maternity Care Models study by the University of Otago.

Auckland Homebirth Community would like to iterate midwife-led continuity of care as safe, expert, healthy and satisfying.

A recent Cochrane Review using 15 studies involving 17,674 mothers and babies found the following:

The main benefits were that women who received midwife-led continuity of care were less likely to have an epidural. In addition, fewer women had episiotomies or instrumental births. Women’s chances of a spontaneous vaginal birth were also increased and there was no difference in the number of caesarean births. Women were less likely to experience preterm birth, and they were also at a lower risk of losing their babies. In addition, women were more likely to be cared for in labour by midwives they already knew. The review identified no adverse effects compared with other models. [[Sandall J, Soltani H, Gates S, Shennan A, Devane D. Midwife-led continuity models versus other models of care for childbearing women. Cochrane Database of Systematic Reviews 2016, Issue 4. Art. No.: CD004667. DOI: 10.1002/14651858.CD004667.pub5]] [Emphasis ours.]

Further, Karen Guilliland, chief executive of the New Zealand College of Midwives states:

Firstly the research is reassuring in that the incidence of adverse outcomes is very low and comparable with all similar countries so this is not a new finding as New Zealand is noted for its excellent maternity service.

 

The study is methodologically limited to only the data it could access and therefore its analysis is weakened considerably because the researchers couldn’t measure all the contexts/circumstances that women and babies are in. They couldn’t tell individual women’s education or income levels, whether they lived rurally or remote rurally, if they lived in violent circumstances, in appropriate housing or if they had existing medical conditions other than diabetes and high blood pressure.

 

In addition, this study mainly looks at the women under the care of midwives and these women are more likely to be rural, remote rural, Māori, Pasifika, younger, book with an LMC later, smoke, be obese and sicker. These are all well known risk factors that cause the adverse outcomes described. Unfortunately the study could only identify the care giver at registration in early pregnancy. There was no way they could identify whether women had referrals in pregnancy or labour so the results don’t tell us who was managing care and what assessments etc were undertaken by other practitioners. Therefore there has been an assumption that there were not any others involved in care decisions. [Emphasis ours]

 

The study is not comparing two models of care as there is really only one…obstetricians always have midwives providing care on their behalf and midwives also call on obstetricians when needed. [[Response from Karen Guilliland, chief executive, New Zealand College of Midwives to questions from New Zealand Herald about Comparison of Maternity Care Models study. https://www.midwife.org.nz/latest-news/study-highlights-under-resourcing-/response-to-nz-herald/]]

We would again like to emphasise our support for midwives and for the midwifery-led care system in New Zealand.

Further Reading

Supporting Midwives - 2016 Cochrane Review

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Why Not Home? Auckland Film Screening

Why Not Home Film

Dr. Michelle Minikel thought home birth was crazy–until she got pregnant. Turns out she’s not alone. Why Not Home? exposes a secret from within the medical community. A small but growing number of doctors, midwives, and nurses who attend birth in the hospital are choosing to have their own children at home.

Through the compelling stories of women who choose to go outside the hospitals where they practice to give birth, viewers experience the beauty and challenges facing families both at home and in the hospital in a way that hasn’t been seen before.

Beyond the personal stories, Why Not Home? is a critical and thoroughly researched look at how we are providing maternity care in the US and the choices we are giving women and families about that care. Maternal mortality rates are rising in the US at at time when they are falling in every other industrialized country. Why Not Home? challenges viewers to move beyond the polarization and judgement that has plagued this issue for decades and instead embrace a more integrated and collaborative model for the future.

Day: Friday 9th September 2016 📆
Time: 7:00pm

Day: Saturday 10th September 2016 📆
Time: 3:00pm

Place:
MAMA Maternity
13 Coyle St, Sandringham, Auckland 1025

Tickets:
$10 and may be purchased through Eventfinda: https://www.eventfinda.co.nz/2016/why-not-home/auckland/western-springs

Visit www.whynothome.com for more information.

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We Love Our Home Birth Midwives! Evening

AHBC Supporting Midwives

As part of Home Birth Awareness Week (Labour Day 26th October – 1st November), the home birth community is giving back to our midwives!

Midwives are an invaluable part of our community. They work long hours, at all times of the day and night and are on call to drop everything to help mothers, parents and whanau/family bring precious new life into the world.

Are you a midwife that supports homebirth? This is an evening for you! Put your feet up, relax and enjoy while we give back to you.

An evening of pampering with foot spas, facials, tasty nibbles, goodies and much more!

WHEN: Thursday 29th October @ 7:30pm
WHERE: MAMA Maternity, 13 Coyle Street, Sandringham.

Places are strictly limited! Please RSVP ASAP!
Email events@ahbc.space with your name and contact phone number. Alternately txt or phone 022 474 7673.

Facebook event: https://www.facebook.com/events/907022836051392/

This is completely free to homebirth supporting midwives as our way of saying thanks for all you do!

 

Kindly supported by: