Hodgson rejects midwifery review

Health Minister Pete Hodgson has rejected the Wellington coroner's call for a full review of the midwifery service after the death of two babies.

Instead he has taken the advice of the perinatal and maternity review committee which explicitly said a full review was not needed.

"Not to be disrespectful to the coroner, but the coroner has a law degree," Mr Hodgson said.

The Wellington coroner, Garry Evans, called for a review after two babies died at home under the care of midwives.

He said midwives were increasingly becoming sole maternity providers, looking after more high-risk women who could have emergencies for which the midwives might not be prepared.

The Royal Australian and New Zealand College of Obstetricians and Gynaecologists supported him at the time, saying it was important that maternity services be assessed and improved. Chairman Bill Ridley said midwives provided excellent service but it was "time for a mature and thorough examination of the systems".

Mr Hodgson said the expert committee had identified some information gaps about some midwifery services, including not enough data being collected about home births.

He still has to receive Ministry of Health comment on the committee's preliminary review report, which he got a few days before Christmas. The report, with ministry comment, should be available in three or four weeks, Mr Hodgson said.

Asked if he expected some backlash from not launching the full review recommended by the coroner, Mr Hodgson said that was possible.

But he would rather take the advice of an expert health committee "likely to have a more informed view of the appropriate way forward".

The coroner's November call for a full review sparked an outpouring of comment, with some medical professionals claiming babies were being badly affected by some midwifery deliveries and the system was falling down.

Problems could be prevented by midwives having to work more closely with family doctors, they said.

Problems happened when midwives did not recognise when they needed to seek help. Some midwives did not get enough hospital or obstetrics experience before working independently in the community, the medical professionals said.

Family doctors also said most of them were forced out of maternity care by changes to the funding system.

Mr Hodgson said the Wellington coroner's recommendation had sparked the reopening of "the battleground of 15 or 16 years ago".

That was when midwives had been given a scope of practice, as they had in most other countries. Mothers had wanted more options, including home births, and more care before the birth.

Mr Hodgson said he was not surprised by the committee deciding against a review of the resultant maternity service.

The ministry was already negotiating with midwives - in national contract negotiations - about forming stronger links with primary health, including family doctors and Plunket. The ministry was hoping there would be "further improvements".

Aims included boosting the number of young mothers visiting family doctors before birth, because a significant proportion did not.

It was also important for mothers to re-establish links with doctors after the birth and Plunket care.

- OTAGO DAILY TIMES