Government ready to tighten controls on midwives

By Martin Johnston

The Government expects to tighten safety controls on private midwives after sharp criticism from an investigation into the traumatic birth of a baby who later died.

The boy died in November 2003, three days after he was born by an emergency caesarean operation at North Shore Hospital in Auckland.

He suffered brain injury from oxygen deprivation during birth.

After an investigation, Health and Disability Commissioner Ron Paterson said New Zealand's maternity service was failing patients on a crucial aspect of safety.

His report, foreshadowed in the Weekend Herald before its release yesterday, calls for maternity hospitals to be given greater control over private practitioners, mainly midwives and obstetricians.

He recommends allowing hospitals to check up on their skills and requiring them to follow hospital safety policies.

Health Minister Pete Hodgson said last night Mr Paterson's recommendations would be discussed in talks starting this week on maternity regulations and he could see no reason not to implement them.

But Mr Hodgson again rejected National health spokesman Tony Ryall's repeated calls for an independent review of maternity services.

Mr Ryall said the Government must act because "more and more frightening incidents" were being revealed and health practitioner groups were calling for change.

The parents of the dead baby told the Sunday Star-Times that staff at National Women's Hospital, to where their son, Charlie, had been transferred, told them he should never have died.

"Had we known a balls-up like this could happen in a hospital in New Zealand, we would have gone private," the father said.

The mother, now pregnant with her third baby, was 37 at the time of the birth of Charlie, her first child.

She said people should not assume health workers "know exactly what they are doing".

Mr Paterson found a lack of co-ordination of care and confusion about who was responsible - issues not confined to North Shore Hospital but "relevant to maternity services throughout New Zealand".

He said the independent midwife and the senior hospital registrar involved in the birth had a poor understanding of the fetus' deteriorating condition during the labour.

He said the drug Syntocinon was given to induce contractions in circumstances where it should not have been given for reasons including fetal distress. He also said the caesarean took too long to start.

Mr Paterson also highlighted what he considered a gap in the access agreement, which governs use of maternity hospitals by private midwives, obstetricians and GPs.

The agreement, prescribed in the Government's maternity services contract, prohibits hospitals from checking whether practitioners are clinically safe and competent.

Nor can hospitals compel them to comply with hospital policies.

"Indeed, the only 'safety' obligation imposed on the practitioner by the access agreement is to ensure the 'cultural safety' of the woman," Mr Paterson says.

"The current approach puts practitioner autonomy ahead of patient safety.

"It is artificial to think that midwives and other lead maternity carers [LMCs] who use public hospital maternity facilities to deliver babies can function (legally or practically) as 'independent' practitioners."

The access agreement's "blinkered approach" fails mothers and babies, Mr Paterson says. "Women in this country deserve better."

He notes the public-protection roles of the Health Practitioners Competency Assurance Act, the Midwifery Council and maternity regulations, but says more is needed.

Like the private-hospital system of "credentialling" surgeons and anaesthetists, district health boards should be permitted to require lead maternity carers to prove their competence.

"LMCs should be specifically credentialled to undertake particular procedures that carry greater risk."

A spokesman for the College of Obstetricians and Gynaecologists, Dr Bill Ridley, said a better definition of boundaries was needed when it came to transferring care of women in labour.

Midwives' "fear of medical intervention" led to access problems in hospitals.

- Additional reporting NZPA

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