Editorial: Midwife focus reopens debate

In recent months, botched births resulting in baby deaths have been all too common in the headlines.

The latest case making news is that of Linda Barlow in Hamilton, whose baby died in 2009. She ended up on life support after suffering a stroke and cardiac arrest.

Coroner Gordon Matenga has recently made explosive criticism of the midwifery profession's philosophy and training.

Matenga said there was a tolerance within midwifery for working outside the "safe harbour" of the referral guidelines - a document designed to manage safe transfer from community to hospital care - if the mother and baby are thought to be coping. He is seeking to stamp out this tolerance and has also expressed misgivings over midwifery education.

Midwives took over from doctors delivering babies in New Zealand following the Nurses Amendment Act 1990, introduced by the then Minister of Health Helen Clark. This allowed a registered midwife to look after the care of women throughout pregnancy and childbirth, without being supervised by a doctor.

The joint care system eventually stopped by the mid-1990s, following a ballooning maternity budget and the development of the Lead Maternity Care system.

Even if we think we have the best system, we still need to ask: are too many babies dying?

Latest figures from 2010 show 704 babies and foetuses died that year between 20 weeks' gestation and 27 days following birth as a result of "perinatal-related deaths".

We also don't compare well with Australia. Our perinatal-related mortality rate in 2009 was 11.3 deaths for every 1000 births, compared with Australia's 9.8 average. There's no doubt there are hundreds of brilliant midwives but you only have to ask around to find unhappy "customers".

It is now timely to reignite the debate over maternity care in New Zealand. After all, there is nothing more precious than life.