Dialogue: Big improvement in store for mothers and babies

The new National Women's Hospital will, contrary to criticism, provide facilities that better meet the needs of women, says ROB BUIST.

National Women's Hospital is not closing. Its services, along with those of the other Auckland District Health Board hospitals, are being reconfigured to provide an efficient, effective service.

Like a number of other hospital buildings in the area, National Women's was facing an extremely costly upgrade to ensure its earthquake readiness. The staff fully participated in the 1997 decision to shift our inpatient services (including women giving birth) to Grafton.

The name National Women's will survive the shifting of services, and the principles under which we work - including maximising the safety, privacy, dignity and choice of women - will remain.

Consultation with both the staff of National Women's, its access-holders and the community has occurred throughout planning. In particular, we sought the views of patients. This feedback has strongly indicated that women value safety in childbirth, and the physical facilities in which they are cared for.

Kiri Munro, our adviser on issues affecting Maori, is critical of the Women's Health Action Trust, which claims that services will be fragmented. The trust does not speak on behalf of Maori or other cultures who use National Women's. The new hospital will better meet the needs of women of all cultures, she says.

The planning is finely tuned to meet the needs of mana whenua. Each unit in the new facility will have its own whanau (family) room, which is unique.

The Government endorsed the health services delivery plan for Auckland, including the plans for National Women's, in 1999. The issue of whether National Women's should remain a discrete, stand-alone hospital is, and will remain, contentious.

Our geographic isolation from the Auckland Hospital campus (or even, at times, Green Lane Hospital) provides considerable challenges in providing care to many women and, more frequently, their babies. While for many of the staff a discrete women's hospital on the Grafton site would have been desirable, it is prohibited by space constraints at Grafton and cost issues.

Margaret Dotchin, the manager of women's health services, says most staff are convinced that the plan represents a significant improvement over the existing layout. The women's assessment unit, ultrasound service, delivery unit, newborn unit, and some wards and theatres will be on the same floor and much closer together than they are now (on eight floors).

The closeness of our clinical units will help staff communication and this will have benefits in improved care coordination.

National Women's clinic and short-stay (including most of our fertility, breast and minimally invasive surgery services) will be provided in the new National Women's Health Centre on the Greenlane site. As with other Auckland District Health services, this means that most of our contacts with patients will not require women to go into Grafton.

The inpatient, delivery and postnatal parts of National Women's will be housed in the top floor of the new acute services building at Grafton. Some clinical units and postnatal beds will be in the refurbished Auckland Hospital Tower building, although the buildings will be directly connected by a walkway that is shorter than an existing National Women's ward. Access to the building and the National Women's unit will be straightforward.

Midwifery director Ann Yates says the changes to birthing units and rooms reflect the consultation with midwives and women and the trends in birthing practices globally.

At least half of the delivery rooms will have pools for relief of pain in labour, each room will have its own en suite, and most postnatal rooms will be single.

The new National Women's will be dedicated to women's health. However, both women and their babies will have immediate access to all the diagnostic and therapeutic services available at Auckland, Green Lane and the Starship hospitals. For the first time breast services will be provided as part of an integrated women's service.

In the first three months of this year, National Women's had to transfer 50 newborns to the sister hospitals, some of those in intensive care. There are times when mothers are unable to accompany their babies, for various reasons. This will still be the case on the new Grafton site, but those transfers will be on-site, not across town.

Neonatal specialist Dr Carl Kuschel says that by being closer to the Starship and paediatric cardiology service the close relationship the clinicians have will dramatically improve for the benefit of babies and families.

Similarly, our gynaecological staff will be ready to help colleagues in the other hospitals on-site, for instance in cases of women admitted with severe abdominal pain, or with care of teenage girls at Starship.

Many clinicians who provide care at National Women's already work at a number of other sites in Auckland, including other Auckland public hospitals, the Medical School, their own consulting rooms and other private facilities. Staffing two major women's health facilities should, therefore, not be a problem.

* Dr Rob Buist, a consultant obstetrician and gynaecologist, is the clinical leader of National Women's Hospital.