The Maternity Services Consumer Council has backed the communication from Auckland Hospital's women's health service as “a long-overdue initiative". Photo / 123RF
The Maternity Services Consumer Council has backed the communication from Auckland Hospital's women's health service as “a long-overdue initiative". Photo / 123RF
Auckland Hospital’s invitation for women to consider giving birth at home or at a primary care facility has divided opinion, with one expert labelling the initiative inappropriate and “disturbing”.
Those who are concerned about the communication include Peter Stone, an emeritus professor in obstetrics and gynaecology at the University of Auckland’s School of Medicine.
“It’s really trying to persuade people to reconsider a plan of care that they may have already decided upon, after consideration. I don’t think it’s the place of an authority to do that,” he said.
“It is actually saying, ‘You need to consider giving birth somewhere else’. I think it is really inappropriate … I find the letter disturbing because I think it undermines confidence in the maternity system that we have.”
However the Maternity Services Consumer Council has backed the advice as “a long-overdue initiative to inform women that home birth and birth in a primary unit are safe options for well mothers”.
“Your lead maternity carer (LMC) - either your midwife, obstetrician or GP - has booked you into birth at Auckland City Hospital,” states the letter, from the women’s health team.
“However, if you are well and have a healthy pregnancy, we support your choice to give birth at a primary care facility such as Birthcare or at home. Please discuss this with your LMC.
“If your pregnancy is not straightforward or there are complications which may require medical intervention or specialist obstetric or paediatric care, then Auckland City Hospital is the best place for you to give birth.
“If you have your baby at Auckland City Hospital then you will either be discharged home or transferred to Birthcare three to four hours later, or when you and your baby are well.”
Auckland Hospital is located near the private Birthcare facility. Photo / Sylvie Whinray
Jenny McDougall, acting director of women’s health at Te Toka Tumai Auckland (formerly Auckland DHB), said the letter’s advice wasn’t related to resourcing, and discharge timeframes had been standard practice for many years and weren’t absolute.
“We last updated this information in our communications to whānau in 2020 to help ensure they are fully informed ahead of time ... discharge times reflect the best care options for our māmā and pēpi, and have the ability to flex should they need to stay with us longer.
“It’s important to note that our relationship with our wāhine builds over the pregnancy, and communication is key. The LMC and whānau also have a relationship and a birthing plan, so all parties are clear on what to expect throughout the journey and in different circumstances.”
The Herald reported on the case of a first-time mother who was surprised to be sent on to Birthcare from Auckland Hospital, at 4.30am and less than three hours after giving birth to her daughter in August last year. She had an epidural and was taken in a wheelchair to the carpark. Her partner drove her and their newborn to the facility, on the other side of the Auckland Domain.
Stone, who retired from clinical work in 2014 having previously helped establish a maternal fetal medicine service which became the model for nationwide care, said the quick discharge policy was long-standing. But that did not make it right, especially when it happened at night or early in the morning.
In his view, it wasn’t satisfactory for the public system to use Birthcare, which is privately-owned, as a de-facto post-natal facility. A fundamental rethink of maternity services was needed, he said.
In an email to the Herald, Brenda Hinton, a liaison co-ordinator with the Maternity Services Consumer Council (MSCC), said it was “less than optimal” for mothers and babies to be changing facilities in the first hours after birth.
However, she said “we completely support [the hospital service] informing well women of the possibility of avoiding this situation by considering the option to give birth at either Birthcare or at home”.
“MSCC is not at all concerned about National Women’s Health/Auckland City Hospital promoting the evidence-supported benefits of planned primary birthing options for well women and their babies,” Hinton said.
“What we are concerned about is that women who give birth by [caesarean section] and those whose babies need special care are being discharged from hospital at 48 hours because of lack of staff and beds.”
Such women should have the option of four to five days of inpatient post-natal care, which was standard until recently, Hinton said, and women whose babies need special care should have the option of a hospital bed so they aren’t separated.
“Reducing the numbers of well women who give birth in our hospitals would free up space and personnel to provide care for the mothers and babies who do need medical care,” Hinton said.
The group hoped the letter would increase the number of Auckland women choosing a primary birthing option, “and reduce the numbers of women who have to get up, pack up and travel (albeit a tiny distance) within hours of birth in order to access inpatient post-natal care”.
