NZ Midwives’ Mantra: “we are natural and good and medicine is bad”

Midwifery may be a bit different in NZ

Midwifery may be a bit different in NZ

A reader has brought to our attention comments made by a NZ medical student on reddit New Zealand discussion thread.

These comments arose during a discussion about an Auckland midwife that arrived late for a flight. When she was refused passage she got her own back by making a bomb threat. During her court appearance she claimed not to know the consequences of her actions. Here’s the link.

The remarks made in the thread appear to confirm many fears about the practices and attitudes of some midwives in New Zealand.

If you’re emigrating to New Zealand to work in midwifery, or are planning to have children, you may find the following of interest.

The UK or Europe (I’ve forgotten which countries in particular) the midwives are essentially specialist nurses with decisions being made primarily in tandem with the doctors, as opposed to here where a doctor cannot have input unless requested to or certain criteria are met. I see the advantages of our system in that you need far fewer doctors but the disadvantage is that there is less oversight and more maverick midwives can get away with pretty much anything until something terrible happens.

From what I understand, their training is essentially some basic anatomy and principles of obstetrics plus assisting in I think 40 births. There is no training in understanding research or interpreting studies which may be why so many are resistant to change. They do what they know and what they were taught.

I’m not sure of the American system at all so can’t compare, but the European/UK SHOs I did obstetrics with were horrified with our system. Their opinions have probably skewed mine a lot.

I definitely agree there needs to be more actual medical/nursing training in their teaching, if not for anything other than mitigating the whole “we are natural and good and medicine is bad” culture that is dangerous and present. The good ones seemed to have that (the best ones I worked with were both ex-nurses) and that’s a system I would fully support. But as it stands currently, I was quite horrified at some of the things I saw…

In my med school OnG run, the first birth I partook in the midwife told the mother not to give baby a Vit K shot. The second one actually changed the time labour started to avoid having to call the obstetrician (result was a nasty 2nd degree tear), there was also a lot of homeopathy/naturopathy, a lot of doctor/medicine bashing, and this was nothing compared to some of the experiences my colleagues had. There were some midwives who were bloody fantastic but far too many who I would have laid complaints against had I the guts to do it. One of my good friends’ kid ended up in PICU because the midwife misinformed them about the pertussis vaccine. I don’t have many good malpractice anecdotes but the ones I do are almost all from obstetrics…

(on the dynamic between doctor and midwife) I wouldn’t necessarily agree it’s a complete partnership. There is still financial incentive to delay calling an obstetrician in the hopes whatever trouble resolves spontaneously. If that trouble doesn’t revolve then the lack of timely intervention is a problem.

Apparently “there is no financial incentive for primary care doctors to get involved, as they get paid less for a delivery than a midwife. Midwives lose out on a lot of money if a doctor ends up delivering.”

For a home delivery, the midwife had to pay a doctor to attend, ie it comes out of their earnings. In the hospital, if an obstetrician delivers the baby the midwife misses out on about a thousand dollars

Now, from another poster

What’s the system like in Europe/UK? I’ve only talked to people from the states and I’m somewhat horrified with their system.

In the past, midwifery was a “post-graduate” degree that you did after nursing, I think. Now it’s a standalone course. I don’t actually know what the course entails (anyone here who’s a midwife please feel free to let me know!) but I don’t believe it covers basic human physiology, the importance of observations etc. Most of the midwives I’ve worked with have been “core” midwives (ie working full time in the hospital) so they kind of get that.

I’ve also heard some hilarious/scary stories of things that women have been told by their midwives!

I will try and do GPO – currently there’s no training for it in NZ but we’re planning on going to Aus for 6-12 months in a few years for me to do it there, and I’m 80% of the way through my O&G post-grad diploma. If I wanted to be a city GP I wouldn’t bother, but I want to do rural++ medicine and I think there needs to be someone nearer than 3 hours away that can do assisted deliveries, and knows a fair amount about obstetrics (and also I really like medical gynaecology)

Now for a reply from a student midwife (are you sitting down and ready for this?). According to her Obstetricians are not specialists in the majority of births (i.e. low risk) that happen in New Zealand. However, midwives are,  but it is their call to decide when they become high risk and a doctor needs to become involved.

It is interesting to get the story from both sides isn’t it,  compare her comments to the statements made above. Is a little knowledge a dangerous thing?

Hey, I’m a student midwife and I feel like I need to clear up several things hear.

Midwives absolutely study human physiology. We have three full years of it. And we definitely study the impact of taking observations and how important they are. Taking and recording observations is learnt in the first few weeks of the degree.

Secondly, midwives are the specialists in low-risk healthy pregnancies and births. Obstetricians are not specialists in low-risk pregnancies and births. Obstetricians are however, specialists in medium or high-risk pregnancies and births.

When the pregnancy or birth has complications, doctors start making the decisions because that is what they specialise in. Doctors are great, but they are not in a position of power over midwives. In the hospital setting when there are complications, doctors and midwives work together for the patients benefit.

The systems in the USA, Europe and the UK are very different to the system in NZ. In NZ midwives are, usually, respected for the qualified professionals that they are. People come from all around the world to study midwifery in NZ because (and I’m not exaggerating here) the midwifery training is better in NZ than any other country.

Yes, SOME midwives are incompetent, but MOST midwives are excellent at their jobs. As with any job, most people are great but a minority are not.

Ooops, there goes that blissful “NZ is better than any other country” incantation. That alone should sound alarm bells.

We’d like to hear from anyone who has experience f obstetrics or midwifery in New Zealand. Tell us your experiences of birthing in the youngest country on earth. This thread will be kept open indefinitely.

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40 thoughts on “NZ Midwives’ Mantra: “we are natural and good and medicine is bad”

  1. Just want to throw another log on the fire:
    http://www.nzherald.co.nz/nz/news/article.cfm?c_id=1&objectid=11532901
    7:44 PM Wednesday Oct 21, 2015 by Kurt Bayer
    ‘Unsupervised’ new midwives costing lives: Researchers
    University of Otago researchers are calling for an urgent review of New Zealand’s midwife training system. Photo / iStock

    A furious row has today broken out between midwives groups and researchers who have concluded that “unsupervised” new midwives are costing lives.

    University of Otago researchers are calling for an urgent review of New Zealand’s midwife training system after finding that babies have a 30 per cent greater chance of dying if being looked after by a newly qualified midwife.

    “The chance of the baby dying equalled two extra deaths per 1000 births compared to the pregnancies cared for by the more experienced midwife-only trained midwives with five to nine years’ experience,” said the study’s lead author, Associate Professor Beverley Lawton, of the Women’s Health Research Centre, University of Otago, Wellington.

    Midwifery Council chairwoman Associate Professor Dr Judith McAra Couper said the research failed to show causality between new midwives and increased perinatal mortality.

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  2. Only in NZ?

    “A former Blenheim midwife who told a teenage mother to keep her legs together and be “ladylike” after a tear that meant she could barely walk for weeks has been reprimanded by the Human Rights Review Tribunal.

    A declaration by the tribunal at the end of February found Natasha Thomson breached the Health and Disability Commission Code of Consumers’ Rights by failing to provide services of an appropriate standard to a 16-year-old mother.

    The tribunal decision said Thomson was working as a community-based registered midwife in 2011 when she started providing care to the patient.

    Thomson had been working as a midwife for about nine months at the time.”
    http://www.stuff.co.nz/marlborough-express/news/67420640/reprimand-for-midwife-over-teens-birth-care

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  3. Our condolences go out to the family of the deceased child. It is shocking to think a 3rd year trainee could be carrying out unsupervised caesarian sections because the on-call specialist was “too busy” to attend. At her previous hospital she had been approved to do caesareans unsupervised, they were probably short of specialists there too? Add to that a breakdown of communication between the on-call specialist (who lived 1.3km from the hospital but took 20-30 minutes to get there) and the registrar and it was a recipe for disaster.

    Reading this report it looks like a lot of butt covering and buck passing was going on, but the family is unlikely to receive anything more than an apology from the DHB for the loss of their child.

    Absolutely, Positively Third World.

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  4. Kiwi doctors and midwife’s failure caused a baby’s death.

    “A newborn Wellington baby died after a communication botch-up left an inexperienced junior doctor in charge of its delivery.

    In a report released today, Health and Disability Commissioner Anthony Hill found the Capital & Coast District Health Board, and two doctors had failed the first-time mother. They had provided her with “sub-optimal care” which was a “severe” departure from the acceptable standard of care, Hill said.

    “Failures by multiple staff to adhere to policies and procedures suggest an environment and culture that do not support and assist staff sufficiently to do what is required of them.”

    Hill also said the woman’s midwife had failed her, because she had not told the hospital that the mother was coming in for induced labour.”

    The report doesn’t name the hospital but it sounds like it could be Wellington.

    http://www.stuff.co.nz/national/health/67140892/wellington-baby-died-after-junior-doctor-was-left-in-charge

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  5. I do know that the crime stats are tailored. There was an effort to make people “feel” safe by presenting good crime numbers. So, what happened was the metric under which crime numbers were presented was changed. The redefinition was “reported crime”. This redefinition redefined what crime was.
    The other part is what information was made readily available. Police, for years, have provided “police blotter” info to newspapers. The latest way to make people “feel” safer is to just make that info more difficult to obtain. Ignorance is bliss mentality. Ignorant is uninformed is more like it.
    This is only in one area that I know of, I figure it to be comparable in others.

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    • Clearly this is a new concept for you. Yes, you learned something all right, but probably not what you think.

      When you say cartel, you mean the mainstream “health system” right?

      To be clear: I’m no “take this daisy and all will be well in the world” all-natural-herbs-can-cure-everything person.

      However, as a parent of a few children all of whom were born with the assistance of a competent midwife, having first-hand experience of the F***ups of births in the “health system”, knowing midwifes, doctors and surgeons personally and professionally, I can tell you that doing one’s own homework on a midwife combined AND becoming familiar with pregnancy, birth and childcare, is FAR preferable than the lottery of the “health system”.

      So YES, a good midwife performs their role better in my opinion than doctors and surgeons. That doesn’t mean that there aren’t good doctors and surgeons out there – of course there are. However, very few if any have the training and experience of midwives, and invariably take a highly medicalised approach.

      That, combined with the tendency of obstetricians and the like to organise birth timing around their golf holidays and ski-trips to Whistler, leave me concluding that if you can avoid hospital and instead find a good midwife – preferably part of a collective – it’s well worth it.

      Thanks for reading.

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      • When you say cartel, you mean the mainstream “health system” right?

        To be clear: I’m no “take this daisy and all will be well in the world” all-natural-herbs-can-cure-everything person.

        However, as a parent of a few children all of whom were born with the assistance of a competent midwife, having first-hand experience of the F***ups of births in the “health system”, knowing midwifes, doctors and surgeons personally and professionally, I can tell you that doing one’s own homework on a midwife combined AND becoming familiar with pregnancy, birth and childcare, is FAR preferable than the lottery of the “health system”.

        lottery of the “health system”, I can understand.
        Especially when you have Professor Ranginui Walker saying
        “It only takes an IQ of 100 to succeed in medicine. It’s not rocket science.”
        and
        “As far as the university was concerned the problem was fixed. But then came the influx of new immigrants. In Walker’s words, “the Asians started to squeeze out Pakeha students”.

        So the university broadened the criteria for selection. They were no longer strictly academic. It counted if students did kapa haka, went to the marae, played sports or practised music.

        Walker explained that gave Pakeha students “a bit of an edge over Asian students who are totally, single-mindedly focused on academic excellence and had nothing else to offer the profession”.”
        http://www.nzherald.co.nz/nz/news/article.cfm?c_id=1&objectid=10813483

        I don’t know any obstetricians who play golf.
        Probably because they’re Asian. Try engaging with that community sometime. 🙂

        Remember, a mind is like a parachute, it only works when open
        BUT
        don’t make the mind so open the brains fall out.

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        • If the mind is too closed, it has no connection with the outside world.

          My main point is that the mainstream health system has its own PR/comms people, as do the professional medical bodies, etc. and the politicians of course. All in all, it is more about economics and less about health.

          Oh, and midwives are a threat to the “system” so when they make mistakes, the news travels far and wide. Doctor/hospital mistakes rarely make it to the outside world.

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          • The problem is, all your connections to the outside world are a consequence of your perception.
            Faulty perception = faulty connections.

            Also, I find it hard to believe that the truth can be so easily hushed up now in a connected age.
            Even as far back as 2005 there was Youtube. People can get named and shamed there.

            I figure the real reason behind it is,
            as a small country,
            Kiwis are “scared to complain”
            because they can then be “on the outside, with the migrants and others that have to pay a toll to be accepted by the in-crowd”.

            So it’s not that the “complaints are hushed up”,
            it’s really more that they’re “chicken”.

            So much for “harden up” and “be staunch” 🙂

            That’s how I see it.

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          • Relative perception is not a problem – it’s what keeps us from forming a morass of grey, bland nothingness!

            But yes, people are scared to complain. Not just in NZ, but everywhere.

            Try complaining in NZ about the health system. Your experience will vary.

            Same in Australia, and you get nowhere. Multiple times worse than NZ.

            “Staunch” is a strange phenomenon, though. It has a destructive side to it that is anti-intellectual, anti-education, etc.

            Better, in my opinion, to be assertive in a structured, logical way. Unfortunately, the more emotional a complainant is, the less likely they are taken seriously.

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          • r,

            “Same in Australia, and you get nowhere. Multiple times worse than NZ.”

            Yeah, sure, it’s always worse in Australia. Take a look at the OECD data on international health systems, particularly the percentage of GDP spent on health, and the outcomes.

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          • There’s theory, and reality. Trick is to find the significance of anecdotal material vs. sanitised and massaged figures

            I speak from personal experience of five different health systems: NZ, AU, 2x european and one Asian.

            Make your own call, but I suggest it would be be beneficial for you to reference actual experiences of the different systems.

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          • You’re asking people to believe hearsay rather than facts? Rather a tall order, “R” Sorry, we don’t serve Kool-Aid here so you’ll have to do better than that.

            If the official figures were in New Zealand’s favour would you be so eager to dismiss them?

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          • No I’m not asking people to believe heresay over facts.

            However, I am pointing out that to get a balanced view one is well-served by speaking to people who have has actual experiences and dig deeply into the figures. Business people worth their salt do this all the time i.e. either pretend to be customers or get somebody trustworthy to report back to them what their experiences are. If you ask businesses, govts, orgs to do their own reporting you will find the figures are filtered, massaged, selected and otherwise tampered with to give the impression you are after.

            To answer your question: I have enough experience with statistics and figures to know that it is one of the easiest way to confuse people and make them believe pretty much whatever you wish.

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          • Perhaps you can give specificexamples of how businesses, govts and orgs in New Zealand filter, massage and otherwise tamper with their figures?

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          • Sometimes it isn’t the actual numbers, but the definitions used to arrive at the numbers.

            For example, unemployment.

            Another is life expectancy.

            Health systems around the world regularly present selective views of disease outbreaks to support a specific view of reality.

            Governments routinely use figures to support their spin, then contain any fallout if/when it happens. Viz statistics concerning gang members in 2014.

            Humans are not good at assessing statistics or risk. Those who understand them run rings around those who don’t.

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          • Sorry, but you’ll have to be more specific than that. Can you give specific examples of how businesses, govts and orgs in New Zealand filter, massage and otherwise tamper with their figures?

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          • (1) @ Admin,

            Yes, indeed, “r” seems to have the ability to audit and assess health systems on the basis of personal experience only, amazing! All those economists, accountants and statisticians are wasting their time.

            (2) @ “r”,

            “Perhaps you can give specificexamples of how businesses, govts and orgs in New Zealand filter, massage and otherwise tamper with their figures?”

            Excellent question from Admin,”r”, are you suggesting that NZ businesses are not audited?
            I’m a retired accountant so, naturally I’m intrigued.

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          • @RussellW: Silly question. I’m sure HSBC was audited as well.

            @All: If you believe that the system operates as it says on the box, good luck. I am not here to educate you, and if you got that impression, I’m sorry but it’s time to ditch it.

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          • Looks like you won that one RussellW 😉 It’s not hard to spot the trolls is it? they’re rarely able to present a coherent argument. When it comes to put up or shut up they usually take the easy way out.

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          • Admin,

            Yes, it’s very difficult to discuss any subject with conspiracy theorists, they could, of course, be correct, however the onus of proof is on them. I’ll still put my trust in science, not anecdotes.

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  6. This piece is misguided and uninformed, as are the comments above.

    There are poor midwifes, as there are poor doctors and obstetricians.

    The media love to focus on the negative midwife cases. They take maximum advantage of the huge suffering caused by the loss of a child.

    However, doctors and obstetricians, despite their training and massive focus on reducing risk (their risk, first and foremost), make just as many if not more mistakes, but the public rarely hear about them and when they do, there is much PR and media management involved.

    For example, obstetricians miss glaringly obvious issues on frequent scans. Doctors forget to make arrangements. Nurses make errors. In their quest to de-risk a birth, obstetricians will often push for caesarian births, or schedule stupidly early inductions around their holidays. Inductions result in complications, but this is not for the obstetrician to suffer, so they don’t care.

    If there are expected or existing complications, of course a more medical approach should be taken with a birth. However, if the mother is healthy, and properly monitored, there is little to be gained (and, potentially, complications introduced) by medicalising a birth.

    Good planning, experience and knowledge all contribute to healthy, successful births, and many such births occur under management by midwifes. To suggest that a competent midwife would not obtain medical support as appropriate because of money indicates a lack of appreciation of what motivates midwifes.

    It is a complicated topic, and the over-medicalisation/intervention-drived approach of modern health systems distorts perceptions significantly. Add a self-interested, distorting media to the equation and you have a recipe for widespread, significant misunderstanding and hyperbole.

    Disclosure: I am not a midwife, nor related or connected with midwifes in any way. I am however a parent of three kids delivered by competent midwives. These births involved a high level of care/attention to needs, etc., that doctors/obstetricians simply could not provide. All the births were planned carefully, with the needs/interests of mother and child placed before anyone else. We were fortunate to not require any intervention whatsoever, but if medical assistance was required, the midwives ensured that it was able to be obtained quickly and efficiently.

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  7. The current situation is that one can learn for midwife straight after high school. One doesn’t have be a nurse or anything medical first, to become a midwife. I know this out of first hand.

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  8. I’m not sure of the current situation, however when my wife trained as a nurse in Australia in the 70s, midwifery was an additional qualification ie trainees had to be registered nurses, (SRNs) before they could become midwives and they were still under the direction of doctors. It seems from the student midwife’s comments that in NZ they operate independently.
    I doubt that she would have approved of ‘independent’ midwives outside of the hospital system, childbirth is rather dangerous.
    According to the World Bank, NZ already has a relatively high infant mortality rate compared with Australia and other OECD countries, so does the U.S. However statistical methods vary from country to country, and, to use an accounting expression, we might not be comparing apples with apples.

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  9. Just an afterthought. The woman reminds me of the bogan who claimed she was shaving the hair of the rabbits for their own good. These sort of cretins from Retardicon 6 belong as far away as possible from children, animals, and pregnant woman.

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  10. Thanks for sharing this very disturbing information. The midwife sounds like a typical Kiwi bogan based on her shoddy writing and utter inability to reason. Her claim that obstetricians do not specialise in low risk births made me laugh.

    I am glad that we no longer live in Retardicon 6 and that our children will be born in proper hospitals in Switzerland. The Kiwis who claim to be practical cannot build proper houses that stay warm and that do not become breeding grounds for mice or mould. I certainly would not want sticking a hand up a woman’s vagina and grabbing a new-born by the head.

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  11. Midwifery was almost unheard of in the States. Most kids were born in a hospital. Things have changed a bit [I most be showing my age], but I know that emergency c-sections happen all the time, and I think that I’d want a doctor in attendance.

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