Keeping Mum
Dita De Boni looks at the trials and tribulations of being a parent.

Making maternity better


If a practising Kiwi GP is saying the maternity system is in crisis, it would be nice to think our warring politicians would take note.

I doubt they will, however, obsessed as they are with economies, tax breaks, and televised leaders debates.

But it is something that definitely needs further exploration.

Like many of the people criticising Christchurch GP Lynda Exton's book, I haven't yet read it. But I do know The Baby Business makes quite bold claims about New Zealand's maternity care, saying essentially it's become less safe since the 1990 maternity reforms that allowed midwives to practise independently of doctors.

Midwives are quite accustomed to being in the firing line from GPs and obstetricians, so unsurprisingly they have reacted angrily to the book's premise.

And in a way their anger has some justification, because the statistics that Exton has used to talk about birth outcomes are like most statistics - able to interpreted in many different ways.

For example, a study from the University of Canterbury in May this year compared GPs and midwives as Lead Maternity Carers and found that having a GP as your LMC reduced the neonatal death rate by 10 per cent.

The study also had to note, however, that midwives see less affluent women, more Maori and Polynesian women, younger women, and those who have had more babies.

But even if GPs are unequivocally better, it's not really an issue for most Kiwi women. GPs make up under 4 per cent of the country's LMCs (and midwives almost 92 per cent) because the current model, according to doctors, does not pay them enough to take on maternity work. Which is a shame, because many women would love their GPs, who have a complete back knowledge of their medical history, to also guide their pregnancies.

Regardless, many women are very happy with midwives (when they could find them, which is another point raised by Exton) and it seems to me that where a birth is largely uncomplicated, they are possibly better off.

My obstetrician care was technically very good during my two pregnancies, including my first pregnancy which was heinously complicated (and perhaps I would not have a live baby today had I not had him).

Still, I have sighed with some envy when I saw a pregnant friend tended to by a midwife, with her focus on the mother's comfort and emotional state that I never quite experienced.

I think her midwife even gave her a massage!

There are other points drawn out of Exton's book however that can not be in dispute and should be rectified - one in particular: The number of women who have trouble establishing breastfeeding is huge, and being turfed out of hospital after just a few days (or hours in some cases) is absolutely the reason for this.

Everyone who has been through it knows that if you manage to establish breastfeeding easily, you are amongst the lucky few.

It would be fabulous if lactation consultants were available freely in the days after birth, and you were allowed the space and time to receive their advice free of the demands of other children, partners and other friends and family.

Exton says all women but particularly first time mothers should be allowed to stay in hospital for four days after the birth. She absolutely right on this - why can't they?

If the Ministry of Health and its minions are seriously committed to breastfeeding, there should be every chance for women to be able to do so and, amongst other things, Lynda Exton is right to be pointing it out in The Baby Business.

If only our next Minister of Health would read it!

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