David Knight and Ann Yates: Centralised maternity care best for mothers and staff

COMMENT

Dr Margaret Shanks gave a negative spin to the new Auckland City Hospital and the maternity services in her article yesterday.

The new facilities offer women vastly improved physical facilities for their pregnancy and childbirth. And the care from staff remains the same or improves.

The new hospital, which will be open for public viewing on Sunday, September 28, will offer great improvements in facilities for maternity care.

There are single or double rooms with en-suites for all, better birthing suites, operating theatres if a caesarean section is necessary next to the birthing suite, purpose-built clinics and many other improvements.

We agree that the facilities at National Women's Hospital are run down, but not through lack of maintenance because of the move. They are so because of their age and design.

Dr Shanks is incorrect about the reason for closing the hospital: it does not meet earthquake regulations for a hospital. The regulations are different for offices, and the building may remain for a time to be used for administration.

A few years ago we were faced with a choice of spending $32 million to rebuild National Women's to meet the regulations - trying to create a silk purse from a sow's ear - or building a brilliant new facility which has many other advantages.

The hospital is purpose-designed, women with cancer have access to cancer services, breast services become part of a women's service, sick mothers have access to intensive care, sick babies have access to Starship services. The list goes on and on. It was not a difficult choice.

Dr Shanks laments a supposed loss of continuity. Continuity is provided by the lead maternity carer. Dr Shanks provided the continuity for the mothers she looks after.

Most pregnant mothers are cared for by independent midwives, who provide excellent continuity. Such mothers will never go to a National Women's clinic. These clinics will continue, and be at Grafton, Greenlane, in the community and in GPs' surgeries. Continuity of care is about people, not buildings.

Dr Shanks criticises the arrangements with Birthcare in Parnell, whereby many women birthing at National Women's transfer to Birthcare for free postnatal care.

Previously, this popular option had limited availability for those who could not pay extra. Now it is freely available.

Birthcare provides excellent care in excellent facilities. It was New Zealand's first World Health Organisation baby-friendly hospital (a measure of excellence in breastfeeding support).

Again, there is no lack of continuity: the lead maternity carers (such as Dr Shanks) provide the friendly, familiar face for the postnatal supervision.

Dr Shanks uses Wellington, Christchurch and Wellington as examples of cities with their own women's hospitals. Christchurch is closing its women's hospital and rebuilding at the general Christchurch Hospital; Wellington and Hamilton have women's hospitals physically connected to their general hospitals.

The advantages that their women have illustrate the reasons National Women's is becoming part of the Auckland City Hospital.

Dr Shanks complains of difficulties she faces in providing care on different sites. This is true. But providing maternity services centres around the woman and family.

We have all had to change our work habits over recent years because we are now not the centre of the system - our clients are.

The issues over parking are being addressed so the women and their partners will have access to the birthing suite as easily as they do now, through specially designated parking and priority lifts to the maternity floor.

Women choosing to give birth at the new National Women's will get excellent care in an outstanding facility. They will get continuity from their lead maternity carer. They will have all the back-up needed for complications that a large hospital can provide.

The staff also get purpose-build modern facilities which they will be proud to work in. It really is a win-win situation.

* Dr David Knight is the clinical leader and Ann Yates the midwifery leader at National Women's Hospital. They are responding to Dr Margaret Shanks' view that the shift to Grafton means pregnant women have to play a game of musical hospitals.