KEY POINTS:
Health officials have supported paying for a partial re-entry of general practitioners into maternity care to help out with the midwife shortage - after more than a decade of largely excluding GPs.
A Ministry of Health paper released yesterday under the Official Information Act said there was a national shortage of 85 community-based midwives.
The paper, dated last September, follows another from weeks earlier by the district health boards' association that put the national shortage of hospital and community (lead maternity carer or LMC) midwives at around 200.
National MP Katrina Shanks, whose party obtained the paper, said that based on College of Midwives advice that each community-based midwife tended to have a caseload of 40-50, a shortage of 85 meant that around 4000 pregnant women "are in limbo".
"Things are likely to get a lot worse for expectant mums as lead maternity carers become more and more scarce."
She said the Government had failed to show leadership on the midwife shortage.
Associate Health Minister Steve Chadwick said Ms Shanks was being alarmist. No board had reported being unable to meet the demand for maternity care and solutions such as increasing annual midwife funding by $11.4 million last year were being implemented.
The ministry paper said that while the birth rate was predicted to fall and the number of midwives had been relatively stable in the preceding three years, "there are insufficient NZ-trained students to replace the midwives leaving the profession".
"We have become dependent on overseas-trained midwives, the supply of which may not continue. It is therefore wise to increase both the number of New Zealand-trained graduates and retention rates."
The paper lists ideas and changes under way to try to increase the number of midwives and to cover the shortages, including greater use of GPs.
GPs with obstetric training can be LMCs, but, the paper notes, maternity care is overwhelmingly provided by midwives. Non-obstetric GPs can be paid for providing ante-natal care only in the first three months of pregnancy, unless it is an emergency.
GPs and GP-obstetricians have long complained they have been excluded from maternity care by funding rules that favour midwives.
The paper says that where midwives are scarce, "GPs often provide the first trimester ante-natal care. This is not ideal ... [because] GPs no longer receive specific training in ante-natal care; due to the LMC model, [they] have had limited recent experience in providing ante-natal services; and [they] are more likely to make unnecessary referrals to secondary services."
After this first period with a GP, women can then shift to the care of hospital midwives for the rest of their pregnancy, birth and post-natal care.
In contrast, the Counties Manukau health board has begun paying GPs to provide ante-natal care until the start of labour, when hospital midwives take over.
The paper says this is better than a woman transferring to hospital care earlier in her pregnancy, for reasons including that women are more likely to attend their local GP clinic than to travel to a hospital, and it improves continuity of care.
"As this is the dominant model of care in the area, women expect it and may be less likely to perceive themselves as falling between the cracks. It also accesses an additional workforce and could contribute to breaking down professional silos."
GP Dr William Ferguson, who gave up obstetrics two years ago in frustration over Government policy, was last night surprised and pleased that the ministry supported a greater role for GPs, but said it was too late.
"After all that, to think common sense has prevailed. But why has it taken all those years? All that expertise and all the enthusiasm and commitment has been lost."
